Needle safety is not among JCAHO’s top goals

Surveyors still will ask about compliance

A Sentinel Event Alert that once promised to put needle safety under the accreditation spotlight will remain consultative, according to the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL.

Needle safety was not among the National Patient Safety Goals announced by the Joint Commission in July. Hospitals will be monitored for compliance with those goals, which include medication mix-ups and wrong-site surgery. However, surveyors will still ask about needle safety, says Richard J. Croteau, MD, executive director for strategic initiatives.

"The expectation is the same," he says. "The difference is what we’ll actually survey and score. It shouldn’t be interpreted that we’ve backed off from the expectation."

Five of the recommendations in the needle safety Sentinel Event Alert — which outlined the mandate to use safety-engineered devices, maintain a sharps injury log, and involve nonmanagerial workers in device selection — were included in a pool of recommendations that were judged to be "efficacious, practical, and cost-effective," Croteau says.

A complete list of the recommendations reviewed by the Joint Commission’s advisory group will be published in a future issue of Joint Commission Perspectives, he says.

Needle safety didn’t quite fit with the concept for the National Patient Safety Goals, which are geared toward reducing health care errors. "These [needle safety] recommendations are different from almost everything else that we’ve published in that they’re aimed more at staff safety," Croteau says. "It’s a little outside the defined purview of this initiative."

The Joint Commission has a standard relating to employee safety, and another that requires facilities to follow applicable laws and regulations. For several years, the Joint Commission has maintained a partnership with the U.S. Occupational Safety and Health Administration (OSHA), including cross-training of surveyors and OSHA inspectors.

Surveyors have been asked to inquire about all the alert recommendations and provide feedback on facility response. "Very often just the fact that the Joint Commission has an interest in something is a strong motivator, whether or not it’s explicitly surveyed and scored," Croteau notes.

JCAHO still could exert influence

Although needle safety experts expressed disappointment that the Joint Commission didn’t place a higher priority on needlestick prevention, they still noted that the agency could become a positive force for change.

"I think JCAHO’s going to look at [needle safety in surveys]," says Katherine West, MSEd, CIC, an infection control consultant based in Manassas, VA. "It’s a federal mandate. I don’t interpret it as completely backing off of the issue."

Increased scrutiny of needle safety efforts is needed, West emphasizes. "As I travel around the country, I find that a lot of hospitals have not yet complied [with OSHA’s revised bloodborne pathogen standard]," she says. "I have run into a lot of places that have not complied at all, and some that have minimal compliance, like they changed one item."

That experience is shared by June M. Fisher, MD, a needle safety expert and director of the TDICT Project at the Trauma Foundation of San Francisco General Hospital. "At the present time, I’m hearing that a lot of hospitals don’t have all the devices, or if they do, they don’t really have health care worker input," she says.

Fisher notes that needle safety is, in fact, a patient safety issue. A needlestick exposure may impact the continuity of care of patients while the caregiver seeks treatment. Patients also are tested for bloodborne pathogens, a situation that may cause them some unnecessary anxiety, she adds. "I think it is simplistic to think this just happens to health care workers."