These patient safety goals were developed by the Joint Commission (the group that accredits a majority of the health care organizations in the United States). Compliance with Joint Commission Goals is one of the requirements for accreditation, thus the Joint Commission is a powerful force in directing national patient safety efforts. As is typical for Joint Commission communications, the goals tend to be expressed in very general terms, leaving interpretation and implementation up to the organization. The bold, red font goals are those that I think are directly applicable to issues of direct concern to the practice of Anesthesia. The bold underlined goals are new for FY09. The complete set of goals can be found at http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/09_hap_npsgs.htm . The ones here are the ones I think most relevant to anesthesia practice
Goal 1: Improve the accuracy of patient identification.
A. Eliminate transfusion errors related to patient misidentification.
Goal 2: Improve the effectiveness of communication among caregivers.
A. For verbal or telephone orders or for telephone reporting of critical test results, the individual giving the order verifies the complete order or test result by having the person receiving the information record and “read-back” the complete order or test result.
D. The organization implements a standardized approach to hand off communications, including an opportunity to ask and respond to questions.
Goal 3: Improve the safety of using medications.
A. Label all medications, medication containers (for example, syringes, medicine cups, basins), or other solutions on and off the sterile field.
B. Reduce the likelihood of patient harm associated with the use of anticoagulation therapy.
Goal 7: Reduce the risk of healthcare associated infections.
A. Implement evidence-based practices to prevent healthcare-associated infections due to multiple drug-resistant organisms in acute care hospitals.
B. Implement best practices or evidence-based guidelines to prevent central line-associated bloodstream infections.
C. Implement best practices for preventing surgical site infections.
Goal 9: Reduce the risk of patient harm resulting from falls. At first one might think I am wasting space listing this Goal in an Anesthesia Department e-letter, but every patient under our care in an ICU is a fall risk. Patients on the labor floor have been known to fall after we provide epidural analgesia. Consider also the large number of patients in our pain clinics all of whom have some risk of fall either because of the problem that brings them to the clinic or after many types of therapeutic blocks. Finally patients standing for the first time after general anesthesia for short procedures or day surgery are at risk of falling. Notice that the goal states that there is a need to reduce the “risk of patient harm” not just reduce the risk of falls. Is there a need to redesign patient waiting areas or rooms so that if a fall occurs the probability of injury is reduced? If so what design elements need to be incorporated?
Why care about these goals? 1) The Joint Commission’s ability to withhold accreditation gives it the power to drive the safety agenda. 2) One can expect considerable institutional resources to be devoted to meeting these goals. 3) One can expect projects, mandates and protocols to be developed and implemented as the institution attempts to come into compliance. Thus these goals may have a direct effect on practice and policy within an institution. The most important reason to care about these goals is that they do have a direct effect toward improving patient care and thus they are the right things to do for our patients.
David S. Smith, M.D., Ph.D.