Newest JCAHO patient safety goals include falls

The newly released 2005 National Patient Safety Goals indicate that the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) will put special emphasis on efforts to reduce patient falls, infections, and misidentification of patients.

Those are among several goals recently announced as part of JCAHO’s efforts to steer health care risk managers toward the most pressing patient safety issues. The 2005 National Patient Safety Goals are specific to the various types of health care settings accredited and certified by JCAHO, including ambulatory care and surgery centers, office-based surgery, assisted living facilities, behavioral health care settings, critical access hospitals, disease-specific care program, home health care, hospitals, nursing homes, and laboratories.

The goals set forth succinct, evidence-based requirements regarding critical aspects of care, addressing for example, the accuracy of patient identification, effectiveness of communication among caregivers, safety in the use of infusion pumps, reduction of the risk of health care-associated infections, reconciliation of medications across the continuum of care, reduction of the risk of patients falls, and protection against pneumonia in older adults.

Announcing the new goals, JCAHO President Dennis S. O’Leary, MD, noted that the National Patient Safety Goals are reviewed and revised annually by the Sentinel Event Advisory Group. The goals are largely, but not exclusively, based on information from the JCAHO Sentinel Event Database. As part of the development process, candidate goals and requirements are sent to the field for review and comment before they are finalized.

Identification one goal for hospitals

The 2005 Patient Safety Goals for each type of health care provider are available on the JCAHO web site at www.jcaho.org/accredited+organizations/patient+safety/npsg.htm. Risk managers will find that some of the 2005 goals are a continuation of the current 2004 goals, while some are revised or completely new.

For hospitals, the first goal is the same as in 2004: Improve the accuracy of patient identification. JCAHO recommends using at least two patient identifiers (neither to be the patient’s room number) whenever administering medications or blood products; taking blood samples and other specimens for clinical testing, or providing any other treatments or procedures.

The second goal — improve the effectiveness of communication among caregivers — also is a continuation from 2004 but with a new recommendation. JCAHO already had advised providers that for verbal or telephone orders or for telephonic reporting of critical test results, they should verify the complete order or test result by having the person receiving the order or test result read back the complete order or test result. JCAHO also recommended that you standardize a list of abbreviations, acronyms, and symbols that are not to be used throughout the organization.

The new recommendation for that goal is this: "Measure, assess and, if appropriate, take action to improve the timeliness of reporting, and the timeliness of receipt by the responsible licensed caregiver, of critical test results and values."

The third goal also is the same as in 2004: Improve the safety of using medications. The first two recommendations are also the same: Remove concentrated electrolytes (including, but not limited to, potassium chloride, potassium phosphate, sodium chloride > 0.9%) from patient care units; and standardize and limit the number of drug concentrations available in the organization.

The third recommendation is new: Identify and, at a minimum, annually review a list of look-alike/sound-alike drugs used in the organization, and take action to prevent errors involving the interchange of these drugs.

As in 2004, the fourth and fifth recommendations involve improving the safety of infusion pumps and reducing the risk of health care-associated infections.

Reconcile medications, reduce falls

The sixth and seventh goals are new for 2005. Goal six is "Accurately and completely reconcile medications across the continuum of care." To achieve that goal, JCAHO offers this advice: "During 2005, for full implementation by January 2006, develop a process for obtaining and documenting a complete list of the patient’s current medications upon the patient’s admission to the organization and with the involvement of the patient. This process includes a comparison of the medications the organization provides to those on the list."

JCAHO’s other recommendation is "a complete list of the patient’s medications is communicated to the next provider of service when it refers or transfers a patient to another setting, service, practitioner, or level of care within or outside the organization."

Goal seven is "Reduce the risk of patient harm resulting from falls." The single recommendation for achieving that goal is "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."