The Joint Commission has released the 2010 National Patient Safety Goals (NPSG), announcing to the field a significant reduction in the number of requirements from the 2009 NPSGs.
The 2010 NPSGs for hospitals contain 11 requirements, down from 20 in the 2009 (the nine missing goals have not been removed; they are now regular standards instead.) There are no new NPSGs, although NPSGs 07.03.01, 07.04.01, and 07.05.01—which were phase-in goals during 2009 about preventing multiple drug-resistant organisms, central line-associated bloodstream infections, and surgical site infections—are now expected to be fully implemented and facilities will have to comply with them as of January 1, 2010. Additionally, many of the existing NPSGs contain significant changes for 2010.
"I really applaud the Joint Commission on making the changes they have," says Elizabeth Di Giacomo-Geffers, RN, MPH, CSHA, a healthcare consultant in Trabuco Canyon, CA, and former Joint Commission surveyor. "My perception is the NPSG are less prescriptive, clearer, and more manageable."
Medication reconciliation, NPSG 8, remains up in the air and a field review of the proposed revisions to the Goal are expected in the spring of 2010. The Joint Commission announced earlier this year that it would no longer cite facilities for failing to comply with NPSG 8 to "reduce the burden" on hospitals, although the Joint Commission has not removed the expectation that organizations comply with the Goal, which is still evaluated but "not scored" during surveys.
Some of the changes included in the 2010 NPSGs are effective immediately. These include any deleted requirements. Specifically, surveyors will not evaluate the following elements of performance for the remainder of 2009 (from the 2009 NPSGs):
- NPSG.01.01.01, EP 1, concerning patient/family participation in identification prior to medication administration or treatment
- NPSG.03.04.01, EP 7, concerning the holding of original medication containers
- UP.01.01.01, EPs 1 and 2, concerning the pre-procedure verification process
- UP.01.02.01, EPs 1- 3, and 7, concerning the marking of the surgical site
- UP.01.03.01 EPs 1, 5, and 6, concerning performing a time out prior to surgery
Additionally, NPSG.07.02.01, which required organizations to consider a healthcare-acquired infection a sentinel event, was deleted because it was already covered in the sentinel event policy, and also will not be surveyed for the rest of 2009.
According to the October issue of Perspectives, the official newsletter of The Joint Commission, the requirements that were removed from the NPSGs and placed in the standards were done so to clarify where efforts should be spent. Once a requirement is moved to the standards, there's less of a need to spotlight the issue and less emphasis will be placed on it during survey.
Those 2009 requirements moved to the standards include:
- NPSG.02.01.01 Verbal/telephone order, critical test result read back
- NPSG.02.02.01 Do Not Use entries
- NPSG.02.05.01 Handoff communication
- NPSG.03.03.01 Look-alike/sound-alike medications list
- NPSG.09.02.01 Falls
- NPSG.13.01.01 Patient involvement in care
- NPSG.16.01.01 Rapid response
Some of the EPs in the above listed standards were deleted upon their move to the standards.
"The release of the 2010 National Patient Safety Goals (NPSG) rolled back some of the difficult and unclear expectations introduced last year," says Bud Pate, REHS, vice president of content and development with The Greeley Company, a division of HCPro, Inc., in Marblehead, MA. Pate points to changes, such as eliminating the need to designate an individual to participate in the identification process on behalf of a patient (NPSG.01.01.01) and the need for an immediate pre-transfer checklist process with the Universal Protocol (UP.01.01.01) as good developments with the 2010 NPSGs.
Also an oft-cited requirement (on 38% of 2009 survey reports), NPSG.02.03.01, concerning critical results, has been relaxed. The requirement to monitor critical tests is gone, and the remaining language is intended to allow more flexibility in the way that timeliness of critical result reporting is monitored. These are all positive changes, Pate says.
The revised language addressing the scope of the Universal Protocol has created some initial confusion: the protocol now applies to all invasive procedures, not just those that place the patient at risk.
"On its face, this appears to cover many procedures not currently subject to the time out (the only part of the Protocol that is not a natural part of the treatment process)," says Pate. "However, I also understand that the Joint Commission intends to ease back on the scope of the Universal Protocol. So we're hoping for further clarification."
Another significant change is clarification about the need for two time outs (UP.01.03.01). A second time out during the procedure is only required when the surgeon changes (removing the confusing language about when the procedure requires two consent forms). On the other hand, it now appears that a pre-anesthesia time out is always required. The field is also waiting for clarification about the time out for one-person procedure, says Pate.
In summary, the Joint Commission has taken a significant step back from what many hospitals believed, and had voiced to The Joint Commission, were needlessly prescriptive and impractical solutions to major safety concerns.
"However, as with any complex issue, there are a few 'devilish details' that are up in the air," says Pate.
To find the full version of the 2010 NPSGs, click here.