New patient safety goals set outpatient priorities

JCAHO adds avoiding falls, surgical fires as goals

Medications, surgical fires, timeliness of reports, and falls are new additions to the 2005 National Patient Safety Goals and Requirements published by the Joint Commission on the Accreditation of Healthcare Organizations.

Most of the new goals or requirements are similar for same-day surgery programs surveyed under hospital or ambulatory and office-based accreditation manuals, but there is one difference, says Michael Kulczycki, executive director of the ambulatory accreditation program for the Joint Commission.

Programs that are surveyed under hospital standards have a goal to reduce the risk of patient harm resulting from falls, and programs that are surveyed under ambulatory standards have a goal to reduce the risk of surgical fires, Kulczycki points out. There are many more areas within a hospital that a patient is at risk for falls than in the surgery area, so reducing the risk of falls becomes a priority for hospital organizations, he explains. Organizations that are exclusively same-day surgery do not have patient falls as a priority because patients are in the facility for such a short time, and they are monitored closely by staff throughout their brief stay, he explains.

Surgical fires were identified as a priority for ambulatory organizations, Kulczycki says. "I don’t know that we had information that surgical fires were more prevalent in an ambulatory setting than in a hospital setting, but the sentinel event and ambulatory advisory groups that contributed to these goals believed that they were more of priority than other goals that might have been considered," he says.

Because there are different advisory groups for hospital and ambulatory settings, the different perspectives do result in some differing priorities, Kulczycki explains. While falls and surgical fires were considered by both groups, the ambulatory advisory group contended that patients in the ambulatory setting were at more risk for a surgical fire than a fall, he says. The fact that surgical fires and patient falls were not included in hospital and ambulatory goals does not mean that same-day surgery programs in either setting can ignore the risk of surgical fires or falls, he points out.

Surgical fire education is an essential part of staff education for the hospital-based and surgery center-based staff at St. Joseph Regional Medical Center — Covenant in Milwaukee. Surgical fire prevention is a regularly discussed topic in staff meetings and education classes, says Connie Geigle-Mietla, RN, nurse manager of surgery and peri-anesthesia at the hospital.

Staff discuss the risk of oxygen collecting under drapes, and supervisors and managers conduct OR rounds to make sure all other electrosurgical equipment are holstered properly, she says.

Proper use of preparation solutions before electrosurgical procedures also is covered in a staff education session at least once each year, Geigle-Mietla adds. "We emphasize the need to make sure the area on which the solution is placed is completely dry before the patient is draped," she says.

Meeting the surgical fire safety goal, as well as other patient safety goals, is especially important in Wisconsin because patient safety data are collected by the state hospital association and published on a patient safety web site that members of the public can access, she points out.

A more challenging new goal will be to "accurately and completely reconcile medication across the continuum of care," Kulczycki notes.

"This general requirement to collect a complete list of medications is not new, but inclusion in the patient safety goals formalizes the requirement and emphasizes the need to communicate this information when transferring the patient to another caregiver," he says.

The requirements for this goal do not mean that a same-day surgery staff member must call all of the patient’s physicians to obtain the list, but instead can obtain this list from the patient, he adds. "The key is to ask for over-the-counter medications as well as herbal medications, in addition to prescription medications," he adds.

The goals have emphasized the need to reduce medication errors in previous years with requirements for approved or unapproved abbreviations that might lead to dosing errors and for standardizing the number of drug concentrations available in one organization. The 2005 goals point out another area of concern, Kulczycki says.

"Organizations are required to identify and review a list of look-alike/sound-alike drugs and take actions to prevent the interchange of these drugs," he explains. The creation of a list will increase staff awareness and, along with other safeguards such as read-back of verbal orders, these drugs should not get mixed up, Kulczycki notes.

Another requirement has been added to the goal of improving effectiveness of communication. The new requirement is to measure and assess the timeliness of reporting and receipt by the caregiver of critical tests and values, he points out. If the organization finds that critical information is not handled in a timely manner, actions must be taken to improve reporting and receipt of information, Kulczycki adds.

At the time of publication, the Joint Commission had not defined "critical tests and values." He suggests same-day surgery managers check the Joint Commission web site for clarification of national patient safety goal specifics during the next few months. (For information on how to access the web site, see resources, below.)

The new goals and requirements will be effective January 2005. "Our intent is to give organizations several months to review and understand the requirements and enhance any safety programs they may already have," Kulczycki says.

"Our accredited organizations are already addressing these issues, but the new goals focus our efforts on areas considered the most critical for each type of organization," he adds.

Sources and Resource

For more information, contact:

  • Michael Kulczycki, Executive Director, Ambulatory Accreditation Program, Joint Commission on the Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Phone: 630) 792-5290. E-mail: kulczycki@jcaho.org.

To find frequently asked questions and answers, as well as updates to the goals and requirements, go to www.jcaho.org, and under the "Top Spots" section, choose "National Safety Patient Goals & FAQs."