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Medications, falls, timely reports top list of goals
Medication safety, improved communications, and reduction of falls are among the new additions to the 2005 National Patient Safety Goals of the Joint Commission on Accreditation of Healthcare Organizations. The majority of the safety goals, including the new ones, should not be a problem for home health care because they represent standard operating procedure for most agencies already, says Maryanne L. Popovich, RN, MPH, executive director of the Joint Commission home care accreditation program.
Tweaking current processes
For example, in Goal 2C, which focuses on improved communications by assessing the timeliness of reporting critical results, Popovich points out that if a patient’s digoxin level is outside a normal range, the nurse automatically contacts the physician. "While new processes won’t have to be developed, current processes may be evaluated and tweaked," she points out. The most difficult part of this requirement is that the Joint Commission has not defined "critical," she says. Just as the Joint Commission added further clarification to the requirement to identify do-not-use abbreviations after the goal was announced, Popovich says there are advisory groups working on definitions of "critical" and "timely."
Because home health nurses deal with patients on an individual basis, the requirement to identify look-alike, sound-alike medications should also pose no problem, says Popovich. "The agency does have to develop a list of look-alike, sound-alike medications that patients may use, but it is unlikely that the nurse will find two of these medications in the individual patient’s home," she points out. The benefit of developing this list will be increased awareness among home health staff, she adds. "Remember, too, that phone and verbal orders must continue to be read back to the originator to verify orders and medications," she adds. "This read-back, along with the awareness of look-alike, sound-alike medications, will increase patient safety," she says.
While other health care organizations may struggle with the new requirement that a complete list of patient medications be documented, home health has always collected this information — and has done so in a manner that other health care providers might envy, says Popovich. "Other providers have to rely upon the patient providing the information. Our nurses can simply ask to see everything, then copy the information off the prescription bottles, herbal containers, or over-the-counter packages," she points out. Because gathering an accurate list of medications is embedded in the home health nurse’s practice, Popovich says home health agencies should have no problem meeting this goal.
The challenge for home health with the medication list will be educating the patient to keep an up-to-date list with him or her in case of a visit to the physician or the hospital, says Popovich. "Other organizations will rely upon the patient to provide the information, and home health can help by making sure our patients and their caregivers know to keep the list with them," she adds.
Another patient safety goal that will provide a challenge for hospitals is the goal to reduce the risk of patient falls. "Home health is already the only health care program that automatically assesses the patient’s environment for risk of falls as a normal part of the initial assessment," points out Popovich. Although this area has always been addressed in home care, the Joint Commission’s goal for patient safety has been to highlight the areas of greatest risk to patient safety, she says. "All of our advisory committee members agreed that although reduction of the risk of falls is addressed throughout home health, it is still a serious enough risk to patients to be highlighted in the national safety goals," she adds.
As home health agencies raise questions about patient safety goals and how to meet the requirements, the Joint Commission will post updated information and responses to frequently asked questions on the Joint Commission web site, says Popovich. "We are continuously evaluating feedback and providing information that will help home health agencies comply," she says.