Will your ED comply with safety goals? Don't wait until it's too late

Failure to comply with goals will mean serious consequences for your ED

It’s the one thing surveyors will be looking for in every corner of your ED during your next survey with the Joint Commission on the Accreditation of Healthcare Organizations: Proof that patients in your ED receive safe care. The Joint Commission’s new National Patient Safety Goals for 2005 include new requirements that will affect the ED dramatically. Your ED must be in complete compliance as of Jan. 1, 2005.

"Compliance is critical because if an organization is found to be out of compliance, they are cited not only with a special recommendation, but may also be cited with a recommendation at a standard," says Ann Kobs, president of Wheaton, IL-based Ann Kobs & Associates, a consulting firm specializing in Joint Commission compliance.

It’s a "double whammy," she adds. "Failure to resolve a requirement for improvement ultimately can lead to loss of accreditation," Kobs says.

In addition, as of July 15, compliance with the patient safety goals has become public knowledge as this information now is posted on the Joint Commission’s Quality Reports web site (www.jcaho.org/quality+check/index.htm). "A negative remark could be construed poorly by the community and possibly result in the public losing confidence in the organization," she warns.

Insurers are jumping on the bandwagon, too, Kobs says. "They are beginning to base reimbursement on outcomes," she says. "The hospitals that have the highest volume and the best outcomes will get the reimbursement."

You’ll need to show evidence of compliance with every goal for many surveys to come, adds Kobs. "This will be a forever thing, because the public is demanding it," she says.

Here are key changes in the 2005 goals that impact the ED, with strategies for each:

  • Use two patient identifiers when taking specimens for clinical testing or providing any other treatments or procedures.

Because up to 70% of admissions come through the ED, it is the original point of contact where the needs of the patient are assessed, an initial diagnosis is made, and a patient is assigned to an appropriate service, Kobs says.

"In order to accomplish that mission, the patient must be appropriately identified," says Kobs. You must reliably identify the individual as the person for whom the service or treatment is intended, and also match the service or treatment to that individual, she explains. Therefore, the two patient-specific identifiers must be directly associated with the individual, and the same two identifiers must be directly associated with the medication, blood products, or specimen tube, such as on an attached label.

When clinical testing is needed, you must ensure that you have the correct patient, that the correct specimen has been drawn, in the correct receptacle, and that it is appropriately transported in the right amount of time, says Kobs. "It is amazing, the number of steps where mistakes can be made," she adds.

In addition, the patient safety goals require that two identifiers are used to ensure that the correct procedures and treatments are done for the correct patient, says Kobs.

  • Measure, assess, and take action as needed to improve the timeliness of reporting of critical test results.

First, define what constitutes a "critical test result" for your ED, says Kobs. This may include "stat" tests, "panic value" reports, and other diagnostic tests including imaging studies, electrocardiograms, laboratory results that require urgent response, and test results reported verbally or by telephone.

If you don’t define "critical test results" for your ED, surveyors will consider all verbal or telephone reports of diagnostic tests to be "critical," warns Kobs. "For the ED, this probably would be almost all of the test results, including care of patients who seem to use the ED as their local family provider and manage to drop by for the malady of the week," she says.

For this reason, your ED should put together a list of your "critical" tests now, since January 2005 isn’t far off, says Kobs.

In addition, you must take steps to decrease delays in reporting of laboratory and diagnostic tests, imaging studies, electrocardiograms, and ultrasounds, says Kobs. "In order to improve, you will need to know what your actual turnaround time is now," she says. "If you do not have this information, it would be wise to gather it starting today."

  • You must improve communication and documentation.

To meet this goal, ED nurses at Gwinnett Medical Center in Lawrenceville, GA, created a faxed admission report to show floor nurses what was done in the ED, including diagnosis, medications given, vital signs before transfer, lab results, and special needs such as non-English-speaking or paraplegic. "When giving a verbal report, you may forget to tell the nurse certain things, or the floor nurse may later say I didn’t hear that in the report,’" says Sandy Vecellio, RN, BSN, ED clinician. "The form gives you specific questions to be sure they are answered; whereas, in a verbal report, you may forget to ask them."

The form also gives the floor nurse a paper document to refer back to, says Vecellio. "We fax this report to all of the floors, wait 15 minutes, and then call to see if they have any questions," she says.

  • Identify and annually review look-alike/sound-alike drugs, and take action to prevent errors involving these drugs.

This requirement is extremely important for the ED, because staff use a greater variety of medications with increased drug interactions than other units, says Kobs. "So there is a more intense need for them to be savvy about all look-alikes and sound-alikes," she underscores.

Work with pharmacists to identify these, Kobs recommends. "Clinical pharmacists can be invaluable team members and resources," she says.

  • Assess and periodically reassess each patient’s risk for falling, including the potential risk associated with the patient’s medication regimen, and take action to address any identified risks.

No one likes to believe that there are patient falls in the ED, says Kobs. "However with an aging population, drug abuse, and unfamiliar surroundings, falls aren’t so uncommon," she says. The goal specifically requires that you assess the potential risks associated with the patient’s medication regimen, she notes.

Kobs suggests the following:

— Mark gurneys with "fall risk" tags.

— Work with pharmacy to jointly identify which medications place patients at risk for disorientation and possible falls.

— Don’t think only in terms of medications given in the ED, but also what medications patients may have taken beforehand.

The biggest practice change for ED nurses will be remembering to document the periodic reassessment of the risk for falling, says Kobs. "A simple form with check boxes at chosen intervals would be a simple solution," she recommends.


For more information about the 2005 National Patient Safety Goals, contact:

  • Ann Kobs, President, Ann Kobs & Associates, 1946 Briarcliffe Blvd., Wheaton, IL 60187. Telephone: (630) 456-4169. E-mail: aejbbk@aol.com. Web: www.annkobs.com.
  • Sandy Vecellio, RN, BSN, Gwinnett Medical Center, 1000 Medical Center Blvd., Lawrenceville, GA 30046. Telephone: (678) 442-3243. Fax: (678) 442-4531. E-mail: SVecellio@ghsnet.org.