The Joint Commission has announced proposed 2009 National Patient Safety Goals (NPSG) requirements and implementation expectations (IE) for field review. These proposed NPSGs affect hospitals and critical access hospitals, ambulatory care and office-based surgery, behavioral healthcare, disease-specific care, home care, laboratories, and long term care.
The Joint Commission seeks comments on these potential new NPSGs and will be accepting feedback via an online survey through February 27, 2008.
The field review focuses on the following areas:
Goal 1, patient identification
Goal 3, safe use of medications
Goal 7, hospital acquired infections focusing on methicillin-resistant staphylococcus aureus (MRSA) and clostridium difficile-associated disease (CDAD); catheter-associated bloodstream infections (CABSI); and surgical site infections (SSI) in acute care hospitals
Goal 8, medication reconciliation
Goal 13, patient involvement in their care
Universal Protocol
Last year, after the NPSGs were finalized, healthcare organizations faced one new National NPSG in preparation for 2008 requiring clinicians to respond rapidly to changes in a patient's condition, and another new requirement about anticoagulant therapy, and was intended to be a light year for NPSG changes. Unlike in previous years, the 2008 goals will be phased in throughout the year, with full implementation required by January 2009.
Goal 1 Under the proposed revisions, Requirement 1A would be expanded to include an IE requiring that the patient is actively involved in the identification process, when possible, before any venipuncture, arterial puncture, or capillary blood collection procedure. Proposed Requirement 1C aims to eliminate transfusion errors related to patient misidentification.
Goal 7 Perhaps most newsworthy is the inclusion of a new proposed requirement aimed to stop drug resistant organism infections in hospitals. Specifically, proposed Requirement 7C targets MRSA and CDAD. Among its 16 IEs, 7C requires education for healthcare workers, patients, and their families, as well as the measurement and monitoring of infection rates. It also requires lab-based alert systems when MRSA patients are detected, and a surveillance system for CDAD.
Requirement 7D proposes 13 IEs, including IEs for before and after insertion of the catheter. Requirement 7E has both general and specific IEs, seven in total, for the prevention of SSIs.
Goal 8 Proposed revisions to Goal 8 are composed of new and revised requirements and IEs intended for clarification, not alteration, of previous requirements. Revisions have been made to Requirements 8A, 8B, and 8C, for the reconciliation of patient medication across the continuum of care. A Requirement 8D has been added requiring modified medication reconciliation processes in settings where medications are not used, used minimally, or prescribed for short durations, such as outpatient radiology, ambulatory care, and behavioral healthcare.
Goal 13 Two IEs have been proposed to Goal 13, which targets increasing patient involvement in their own care. The first new IE would require facilities to provide patients with information regarding infection control (for example, hand hygiene or respiratory hygiene practices), while the latter requires facilities to provide surgical patients with information on preventing adverse events during surgery (such as patient identification or surgical site-marking processes).
Universal Protocol Proposed changes to the Universal Protocol, like those made to Goal 8, are not meant to change the overall concept of the Goal, but rather to clarify existing requirements. According to the draft 2009 NPSGs, the Universal Protocol contains the same concepts as it has in previous iterations.
Extensive clarifications have been proposed for Requirements 1A, 1B, and 1C, including four rewritten IEs under 1B (surgical site marking), and six rewritten IEs under 1C ("time out" verifications).
At press time, The Joint Commission did not respond to a request for comment.
When things get really busy, I depend on a "to-do" list to make sure that I complete everything that needs to get done in a given day.
Laundry? I can cross that one off the list.
Put the Christmas decorations away? Well, I'm making progress.
This column? Almost there.
Keeping a list not only helps me track all the things that need to get done at home and at work, but it also allows me a few moments of satisfaction every time I cross off one of the items.
I think my "list" habit is why the shutdown of a Johns Hopkins University study bothers me so much. By now you've no doubt read about the "checklist study" that the federal Office of Human Research Protections ended last month. Led by Peter Pronovost, MD, the study asked participating hospitals to use a five-item checklist for doctors and nurses in the intensive care unit. The "to-dos" were elementary--including washing hands and wearing sterile masks and gowns--but many medical professionals will tell you that they often observe their peers forgoing these simple tasks. Why? Maybe they've forgotten what they learned in medical school. Maybe they forgot to wash their hands just that one time. Maybe they were so focused on the procedure at hand that they needed a reminder to put on that mask and gown. If they're anything like me, a checklist is exactly what they need.
The OHRP says hospitals can use checklists to their hearts' content, but when an organization collects and reports data for a study without getting patients' consent, they might as well be giving them an experimental drug without their permission. OHRP says that if the 70 Michigan hospitals that participated in Pronovost's study want to start recording and reporting the data again, they must bring the study to institutional review boards for approval.
That can take months. Just imagine how many infections can be acquired in that time.
All hope is not lost. Pronovost's work has already gone a long way in proving the success of a checklist for doctors and nurses and I believe more and more hospitals will take notice of the results and implement checklists of their own. I also think the media attention that the OHRP's decision received has made patients more aware of the checklist, and it's likely they'll be asking doctors and nurses if they're following a checklist, or the steps on it.
The results the study produced are impressive and hard to dispute. At one hospital, the line-in infection rate went from 11 percent to zero in one year, and the hospital saved more than $2 million. Let's hope the industry recognizes the importance of this research and more doctors and nurses will find satisfaction in not only crossing items off their lists, but knowing they've provided quality patient care.
Atlanta Medical Center's CEO talks about how by changing the hospital's focus, his administration was able to turn an ailing hospital into one that provided quality care, has high patient satisfaction scores, and is seeing a profit.
Kansas City-area hospitals and emergency medical services providers are close to adopting new rules that would route certain heart attack patients past some hospitals to those that are best equipped to care for them. The better equipped hospitals have doctors and staff on call 24/7 to perform emergency angioplasties to rapidly restore blood flow to clogged heart arteries.
Errors reported by Minnesota hospitals dropped by nearly 20 percent last year, according to a report released by the Minnesota Department of Health. The findings suggest that new patient-safety efforts are starting to pay off, said state health officials.
A rough consensus among experts is that a projected long-term explosion of healthcare costs could force sweeping changes in both Medicare and private health insurance. This trend fuels the doubts of several baby boomers that the government will deliver the full Social Security and Medicare benefits it has promised.
A federal law may block the efforts of several states and communities to provide universal health coverage for their residents. Many of the proposals require employers either to offer health coverage themselves or pay into a public fund to help cover the uninsured. Some employers say that conflicts with a federal law that bars states from requiring or regulating employer-provided benefits.
Officials in Fulton County, GA have agreed to provide the cash-strapped Grady Memorial Hospital in Atlanta with a $30 million advance in funding--but declining to back a $200 million loan to the facility. The decisions by the Fulton arrived a week after the Fulton County Board of Commissioners budgeted Grady some $24 million below 2007's funding level.
According to a survey, two out of three Georgians say they would pay $25 or more a year to support a statewide system of trauma care. That positive response has impressed several state officials, who are considering allocating millions of dollars for trauma care. Advocates of the system say it would increase funding for hospitals with trauma units and improve communications among these centers.
Nashville-based HCA Inc., the nation's largest hospital chain, is among the several hospital chains that take advantage of economies of scale that they've realized through their large size to bring in additional revenues. For a number of hospitals, HCA is a bill collection and purchasing partner, for example.
