Joint Commission’s 2006 National Patient Safety Goals address communications and medication safety

The two new items added to the 2006 National Patient Safety Goals were ones that received the highest marks in the first-ever field review of proposed patient safety goals for outpatient surgery programs.

"There were a significant number of ambulatory care and office-based surgery programs that commented," says Michael Kulczycki, executive director of the ambulatory accreditation program for the Joint Commission on the Accreditation of Healthcare Organizations.

In addition to input from the Sentinel Event Advisory Group, the Joint Commission board looked at comments from accredited organizations, he explains.

"While there were a number of other patient safety goals that might have at first glance seemed more important, comments from our accredited organizations showed that the goals related to label medications and ensuring communication between caregivers as more important to patient safety and implementable for all organizations," Kulczycki adds. (See list of new 2006 National Patient Safety Goal requirements, below.)

JCAHO 2006 National
Patient Safety Goals

The following new requirements apply to both hospital-based, freestanding, and office-based outpatient surgery programs. The new requirement or wording is boldfaced.

Goal: Improve the effectiveness of communication among caregivers.

  • Implement a standardized approach to handoff communications, including an opportunity to ask and respond to questions.

Goal: Improve the safety of using medications.

  • Label all medications, medication containers (e.g., syringes, medicine cups, basins), or other solutions on and off the sterile field in perioperative and other procedural settings.

Goal: Accurately and completely reconcile medications across the continuum of care.

  • Implement a process for obtaining and documenting a complete list of the patient’s current medications upon the patient’s entry 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.

For a complete list of all National Patient Safety Goals, go to www.jcaho.org and choose "accredited organizations" on the top navigational bar, then choose "ambulatory care," "hospitals," or "office-based surgery." Then on the left navigational bar, choose "National Patient Safety Goals" to go to your specific goals.

First addition

The first addition to the goals is a requirement that a standardized approach to handoff communications be developed.

"About 80% of all root causes for all sentinel events reported to Joint Commission are related to communications, so this requirement is an important step for all organizations to address patient safety," he says.

"The most important component of this goal is that the communication include an opportunity to ask and respond to questions," Kulczycki notes.

The verbal comm.unication ensures that the staff member who is transferring the patient to another person’s care can be sure that the information needed to provide care is given and understood, he adds.

This communication needs to take place throughout the surgical experience as well as through discharge if the patient is referred to another caregiver, such as a physical therapist, Kulczycki points out.

"Our process begins when we make initial contact with the patient," says Patti Moore, RN, CNOR, CASC, director of River View Surgery Center in Lancaster, OH.

Document the handoff

"We have a standard, tri-fold form that is used to collect information from the pre-admission call throughout the entire process," she explains.

"There is always a verbal report when the chart is handed to the next person, but sometimes questions come up later," Moore adds.

As the form is passed from department to department, the person completing each section signs and dates the form.

"If staff members have questions that they don’t ask when the chart is first handed over, they know who to call to get the answers," she says.

The same-day surgery staff at Greenville (SC) Hospital System also uses standardized forms and a checklist that ensure the collection of information from patients and explanation of information to patients and subsequent caregivers, says Colleen J. Trask, RN, MSN, CNOR, director of perioperative services for the hospital.

Keep all documentation with chart

It’s important to make sure that as the patient and the chart are handed off, all of the documentation that is supposed to be collected earlier in the process is in the chart, she says.

To address the problem of incomplete charts making their way into the OR, Trask removed the "no" option on some questions on the pre-op checklist.

"For example, the question that asks if the history and physical is present has a box to check "yes" but no other choices," she explains.

"We found that people would check the "no" box, but then do nothing to get the history and physical," Trask points out.

"By not giving a person a chance to check "no" and pass the chart along, we know that we get complete information down the line," she points out.

Some questions related to blood work or X-ray results have an "ordered" box with a spot for the date ordered, but once again, the staff member must follow up to get the results before the chart can be passed along, Trask explains.

"This ensures that the next nurse has the information he or she needs," she says.

Label all meds

The other new requirement for same-day surgery programs states that any medications, medication containers such as syringes or basins, or other solutions in the operating or procedure room be labeled.

"It is important to note that this requirement addresses medications and containers that are both on and off the sterile field and that are in rooms in which any invasive procedure takes place," Kulczycki notes. "This requirement doesn’t apply only to operating rooms."

Because the Joint Commission doesn’t prescribe specific methods to meet the goals and requirements, labeling doesn’t necessarily mean a peel-and-stick label, Kulczycki notes.

"As long as the medications and containers are clearly and correctly identified, the requirement will be met," he adds.

"We use an old-fashioned marker to write the name of a solution in a basin or a medication directly on the disposable cover of the table," Trask continues.

"If there is more than one container of medication or solution, we do put a label on the syringe or basin," she says.

Another safety step is the announcement of which medication is in the syringe as the surgical tech hands it to the surgeon, Trask explains.

"We performed a performance improvement study to see if we should go with pre-printed labels on the back table or if the nurses should hand write labels," Moore notes.

While she was concerned about the extra time it takes to hand write labels, Moore says her nurses believe it is safer for one nurse to read the orders, check the label on the medication, then write a label for the syringe, she explains.

"Our policy calls for a second nurse or tech to check the medication and label," Moore adds.

A word change in one requirement also is important to note, Kulczycki says.

"Last year, the first requirement for the goal to reconcile medications across the continuum of care stated that organizations must develop a process to document all medications," he says. "The 2006 goals require same-day surgery programs to implement the process."

Two requirements from the 2005 goals were eliminated, Kulczycki continues.

"The requirement to remove concentrated electrolytes from patient care areas and the requirement to ensure free-flow protection of PCA [patient-controlled analgesia] pumps were removed because our accreditation surveys have shown a high level of compliance and a reduction of risk to patient safety," he adds.

Sources/Resource

For more information about the 2006 National Patient Safety Goals, 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. Click on "Standards FAQs — Ask a Question," then under "Shortcuts," click on "National Patient Safety Goals."
For examples of how some organizations have met these goals, contact:
  • Patti Moore, RN, CNOR, CASC, Director, River View Surgery Center, 2401 N. Columbus St., Lancaster, OH 43130. Phone: (740) 681-2700. E-mail: pmoore@mchs.com.
  • Colleen J. Trask, RN, MSN, CNOR, Director, Perioperative Services, Greenville Hospital System, 701 Grove Road, Greenville, SC 29605. Phone: (864) 455-3224. E-mail: ctrask@ghs.org.