The Joint Commission on Accreditation of Healthcare Organizations laid out six patient-safety goals enforced by 11 specific directives to which hospitals and other provider organizations will be held accountable as of next year.
Failure to meet any of the goals will result in a Type I recommendation -- the most serious finding of noncompliance with JCAHO standards -- potentially leading to loss of accreditation if the problem isn't addressed. The 11 "recommendations" are concrete actions for achieving the half-dozen broader goals and represent the consensus of an expert panel on the first and most important patient-safety measures for providers to implement, JCAHO President Dennis O'Leary, M.D., said.
They include, for example, fail-safe verification of surgery details and removal of dangerous drug concentrations from nursing units.
The JCAHO's latest patient-safety initiative replaces an aborted attempt last year to make hospitals responsible for responding to a rising backlog of alerts to clinical dangers. Between 1998 and 2001, 20 such alerts had been published in the JCAHO's Perspectives magazine and more were coming out monthly.
The quantity of alerts created "confusion about priorities," prompting the commission to define a handful of "unambiguous" expectations as a starting point for developing a culture of safety in accredited institutions, O'Leary said. "The need to focus is the overriding issue. If we ask people to do too many things, they will do none of them well," he said.
Drawn from a JCAHO database of serious threats to patients, the goals "specifically address errors that are happening all too frequently," O'Leary said.
The goals cover activities to achieve:* more accurate patient identification;
* better communication among caregivers;
* safer use of high-alert medications;
* elimination of wrong-site, wrong-patient and wrong-procedure surgeries;
* safer use of infusion pumps; and
* more effective clinical alarm systems.
Providers will be evaluated for compliance with the goals based on whether they have implemented the listed recommendations or acceptable alternatives.
Improving the accuracy of patient identification, for example, calls for using at least two methods of identification whenever blood samples are taken or medications administered. Before surgery or another invasive procedure, clinicians will have to conduct a final verification assuring that they all understand the details: the correct patient, procedure and part of the body to be operated on.
The recommendations for high-alert medications call for removing all concentrated electrolytes, including but not limited to potassium compounds, from patient-care units. That recommendation was the first of the JCAHO's "sentinel event" alerts in early 1998, but members of the expert panel agreed it remains a problem.
Click here for the JCAHO's full recommendations.