Snapshot: This document provides an overview of the Joint Commission’s “National Patient Safety Goals,” including a definition of what they are, why they are relevant to nursing practice, and a summary of what they mandate for healthcare organizations.
What are National Patient Safety Goals?
- National Patient Safety Goals are evidence-based standards of care established by The Joint Commission’s Patient Safety Advisory Group (PSAG) to improve the safety and quality of care provided to patientsin the United States. They are meant to help accredited organizations address specific areas of concern in regards to patient safety.
- These goals specify best clinical practice in a number of areas including: correct patient identification, communication among medical providers, the safe use of medications, infection prevention, patient safety risks, the prevention of surgical mistakes, fall prevention, and pressure ulcer prevention, among others.
- Standards are published for a variety of institutions, including hospitals, home care agencies, behavioral health facilities, long-term care facilities, outpatient surgery centers, and laboratories. While not identical, there is a great deal of overlap in goals among institution types.
- The National Patient Safety Goals grew out of the Institute of Medicine’s landmark report, “To Err is Human: Building a Safer Health System,” (http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx) which chronicled the prevalence of preventable medical errors in the U.S. healthcare system. To address these concerns, the National Patient Safety Goals emphasize system-wide healthcare problems and processes, and aim to hold organizations accountable for improving patient safety.
Why Should I Care About National Patient Safety Goals?
- The National Patient Safety Goals are safety standards that directly impact the way Registered Nurses practice, both at the bedside and within their organizations. RN’s, alongside physicians, pharmacists, risk managers, clinical engineers, and other professionals, serve on the Patient Safety Advisory Group that formulates and revises the Safety Goals.
- The National Patient Safety Goals are used by the Joint Commission (TJC) to accredit hospitals and other healthcare organizations. Organizations that fail to obtain or renew accreditation are at serious risk of closing and may not be reimbursed by Medicare and Medicaid. The National Patient Safety Goals are standards of care that all healthcare professionals must learn and practice.
- Surveys and inspections for re-accreditation occur roughly once every three years, and findings are made available to the public in an accreditation quality report on the Quality Check website (http://www.qualitycheck.org/consumer/searchQCR.aspx). Unannounced site visits/surveys are now a part of the accreditation process; organizations and healthcare professionals must therefore be ready to demonstrate compliance with the National Patient Safety Goals and other standards at all times (not just during scheduled site visits).
- The emphasis that the National Patient Safety Goals place upon system-wide processes provides a constructive framework for addressing medical errors. Rather than promote a culture of “blame and shame” that punishes individuals for mistakes, the National Patient Safety Goals focus on ways that organizations can improve their processes to help individuals avoid mistakes in the first place.
The National Patient Safety Goals: A Summary
The following is a summary and adaptation of the Joint Commission’s 2012 National Patient Safety Goals, specifically the “Chapter” documents published by the Joint Commission under the “2012 NPSG Program Links,” available on the Joint Commission’s home page.
The text below is not a complete or comprehensive version of the 2012 National Patient Safety Goals; it is intended as an introduction to vital clinical and regulatory information for Registered Nurses and future Registered Nurses. While the goals below are most applicable to hospitals, many of the goals also apply to other institutions regulated by the Joint Commission. Both full length “Chapters” and “easy to read” versions of each Chapter are accessible via the Joint Commission’s website.
Identify Patients Correctly
- Use at least 2 patient identifiers when administering medications, collecting specimens, and providing patient care.
- Acceptable identifiers include the patient’s name, an assigned identification number, or their personal telephone number. The patient’s room number or physical location is not acceptable.
- Before you begin a blood transfusion, match the blood to the order, and match the patient to the blood to be transfused. Use a two-person verification process with individuals deemed qualified by your organization (usually only other licensed clinicians may provide verification).
Improve Staff Communication
- Get test results to the right person at the right time. Your organization must have in place written policies that cover:
- The definition of critical results of tests and diagnostic procedures; by whom and to whom critical results of tests and diagnostic procedures must be reported; and acceptable lengths of time for reporting results.
Use Medicines Safely
- All medications, medication containers, and solutions must be labeled. You must immediately discard any medication or solution found unlabeled.
- This requirement specifically applies to medications removed from their original containers and placed into unlabeled containers that are not immediately administered to the patient in perioperative settings.
- This requirement applies even if only one medication is used during the procedure.
- When administering long-term anticoagulant therapies to patients, you must:
- Use oral unit-dose products, pre-filled syringes, or premixed infusion bags to reduce dosing errors.
- Before starting a patient on Warfarin, assess the patient’s baseline coagulation status, and use a current International Normal Ratio (INR) to adjust therapy; discuss the interactions between diet and Warfarin with the patient.
- Use programmable to pumps when administering continuous, intravenous heparin infusions.
- Provide and document education about anticoagulation therapies to patients, their families and/or their caregivers.
- Keep accurate records of patients’ medication information.
- When a patient is admitted to your hospital or facility, obtain or formulate a list of his or her current medications, and document it.
- Reconcile and resolve any discrepancies between the patient’s current medications and those medications ordered for the patient during their hospital stay.
- Before the patient is discharged, provide education about medications, and emphasize the importance of maintaining accurate and up-to-date personal medical records.
- Follow either the current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or the current World Health Organization (WHO) hand hygiene guidelines. (A modified version of the CDC guidelines appears below).
- Wet your hands with clean, running water (warm or cold) and apply soap. Rub your hands together until they lather and scrub vigorously; be sure to scrub the backs of your hands, between your fingers, and under your nails. (Don’t forget your thumbs).
- Continue rubbing your hands for at least 20 seconds. If you need a timer, hum the “Happy Birthday” song from beginning to end twice.
- Rinse your hands well under running water, then dry your hands using a clean towel, or air-dry them.
- Use an alcohol-based hand-rub if your hands are not visibly soiled and you don’t have immediate access to soap and water. Otherwise, use soap and water.
- Reduce infections due to multidrug-resistant organisms. (These organisms include, but are not limited to, methicillin-resistant staphylococcus aureus (MRSA), clostridium difficile (CDI), vancomycin-resistant enterococci (VRE), and multidrug-resistant gram-negative bacteria). Your organization should:
- Conduct periodic risk assessments to reduce multidrug-resistant organism acquisition and transmission, and educate staff, patients, and their families about infection prevention strategies. Staff should receive formal education when hired, and annually thereafter.
- Implement a laboratory-based alert system to identify patients who are known to be positive for multidrug-resistant organisms.
- Monitor multidrug-resistant organism prevention processes and outcomes (including infection rates) and make this data available to clinicians and other stakeholders.
- Work to prevent central line associated blood stream infections (CLABSI). (This requirement covers short- and long-term central venous catheters, and peripherally inserted central catheter (PICC) lines). You and your organization should:
- Educate clinicians, staff and patients about prevention of CLABSI. For clinicians and staff, education should occur upon hire, annually thereafter, and when involvement in these procedures is added to an individual’s job responsibilities.
- Use a checklist for central venous catheter insertion and always disinfect catheter hubs and injection ports before accessing them using a standard protocol.
- Use an antiseptic for skin preparation during central venous catheter insertion that is cited in scientific literature or professionally endorsed, and always perform hand hygiene prior to catheter insertion or manipulation.
- For adult patients, do not insert central lines into the femoral vein unless other sites are unavailable.
- Evaluate patients’ need for all central venous catheters routinely, and remove all nonessential catheters.
- Conduct periodic risk assessments for CLABSI, monitor compliance, and evaluate the effectiveness of prevention efforts. Make data about CLABSI available to key organizational stakeholders.
- Help prevent surgical site infections. You and your organization should:
- Educate clinicians, staff and patients about surgical site infections and prevention. For clinicians and staff, education should occur upon hire, annually thereafter, and when involvement in surgical procedures is added to an individual’s job responsibilities.
- Keep track of surgical site infection rates for the first 30 days following procedures that do not involve the insertion of implantable devices, and for the first full year following procedures involving implantable devices. Provide infection data/results to key stakeholders.
- Administer antimicrobial agents for prophylaxis prior to procedures; the practice must be validated by a study published in a peer-reviewed journal, a professional organization, and/or a government agency.
- Conduct periodic risk assessments related to surgical site infections, monitor compliance with best practices, and evaluate the effectiveness of prevention efforts.
- Help prevent indwelling catheter-associated urinary tract infections (CAUTI). (Note: This National Patient Safety Goal is not currently applicable to the pediatric population). You and your organization should:
- Use urinary catheters only when necessary, and only for as long as necessary. Use aseptic technique for catheter site preparation, and when handling catheter equipment and supplies. Secure catheters to ensure unobstructed urine flow and drainage and maintain the sterility of the urine collection system.
- Monitor catheter-associated UTI prevention processes and outcomes. Surveillance may be targeted to areas with a high volume of patients using in-dwelling catheters (i.e. not all patients with urinary catheters must be monitored).
Identify Patient Safety Risks
- Identify patients at risk for suicide. You and your organization should:
- Conduct a risk assessment that identifies specific patient characteristics and environmental features that may increase or decrease the risk of suicide.
- Address the patient’s immediate safety needs and most appropriate setting for treatment.
- When a patient at risk for suicide leaves the care of the hospital, provide suicide prevention information (such as a crisis hotline) to the patient and his or her family.
Prevent Surgical Mistakes
- Implement a pre-surgical procedure process to verify that the correct surgery is performed on the correct patient and at the correct location on the patient’s body. You and your organization should:
- Ensure that all relevant documentation (e.g. history and physical, signed procedure consent form, pre-procedure assessments), all diagnostic and radiology test results, and any required blood products, implants, devices, and/or special equipment, are completed and/or available prior to the start of the procedure.
- Identify those procedures that require marking the incision or insertion site. A licensed independent practitioner should mark the procedure site, if possible with the patient involved. The mark should be sufficiently permanent to be visible after skin preparation and draping.
- Conduct a time-out immediately before starting the invasive procedure or marking the incision. The time-out should be standardized, initiated by a designated team member, and involve all active participants in the procedure. At a minimum, team members must agree on the patient’s identity, the surgical site, and the procedure to be performed.
Prevent Patients from Falling
- Reduce the risk of patient falls. You and your organization should:
- Assess each patient’s fall risk, implement interventions to reduce the risk of falls, and educate both staff and patients about fall risks.
- Evaluate the effectiveness of all fall reduction activities, including assessment, interventions, and education.
Prevent Bed Sores
- Assess and periodically re-assess each patient’s risk for developing pressure ulcers (decubiti) and take action to reduce this risk.
- Your organization should create a written plan to identify and reduce the risk of pressure ulcers, and educate clinicians and staff accordingly.
- Always perform an initial assessment when you admit a patient to your unit or facility to identify individuals at risk for pressure ulcers. Then, conduct a systematic risk assessment for pressure ulcers using a validated risk tool such as the Braden Scale or Norton Scale, and periodically re-assess the patient’s pressure ulcer risk throughout his or her stay at your facility, as mandated by your organization.
- Maintain or improve your patients’ tissue tolerance to pressure ulcers (i.e using skin care and wound dressings), and use pressure-reducing devices and techniques (such as glide sheets and safe lift equipment) when moving your patients.