Three months after proposing significant and costly new safety requirements for hospitals including medication bar-coding, an expert advisory committee to the Joint Commission on Accreditation of Healthcare Organizations decided to scrap most of those requirements in final recommendations for revisions to the JCAHO's National Patient Safety Goals in 2005.
The thinned-out final list was approved by the JCAHO board at its July 9-10 meeting and was released publicly last week. The accrediting agency began requiring compliance with a set of patient-safety goals in 2003 and has revised it annually in collaboration with the 23-member advisory panel.
The scaling back of requirements came after an original list in April was subjected to a field review and feedback from healthcare industry groups. The results prompted the advisory panel to call for more research and study of technology and staffing costs as well as alternatives to some of the safety requirements floated for consideration before taking them up again, said JCAHO spokeswoman Cathy Barry-Ipema.
Gone from the original list were requirements to use bar-code technology for medication checks at the bedside; institute independent double-checks of dosages for intravenous medication pumps; and either restrict IV drug preparations to the pharmacy or use commercially premixed fluids.
Neither did the final recommendations include any mention of reducing the risk of surgical fires, which had been among the additions proposed in April. A proposed goal to reduce the risk of patient falls made the final cut, but five specific courses of action to reduce that risk were deleted from the version sent to the JCAHO's Board of Commissioners.
The bar-coding system as earlier envisioned would have required hospitals to develop a bedside-scanning plan to match patients to their medications or other treatments no later than Jan. 1, 2007, at a cost of approximately $1 million for larger facilities. The American Hospital Association objected in a letter to the JCAHO that such technology is not the only way to accomplish the objective and that other means under development may prove superior.
"To specify the use of bar-code technology as the single method of implementing this goal locks accredited hospitals into adoption of a single technology solution that may not be the one most efficacious in improving the safety of the patients they serve," the AHA said.
The AHA lobbied for scratching the requirement that a second nurse check the work of a nurse charged with programming a dose into an IV infusion pump. "In an era when hospitals are having difficulty hiring nurses to fulfill current responsibilities, imposing additional responsibilities on nurses must be done judiciously," the letter to the JCAHO noted.
The requirement had raised an issue about whether a new class of "smart" IV pumps with automatic checking of dose settings could suffice as an independent check, but the issue died when dose double-checking did not survive the field study.
Several of the proposed new goals were given the go-ahead to be included for 2005. One requires hospital staff to "reconcile" medications during a patient's stay in a hospital-documenting the drugs prescribed prior to being admitted, accounting for medications taken in the hospital and making sure an accurate listing is communicated during transfers to another care setting.
Under a new requirement for an ongoing goal of improving communication among caregivers, hospitals must take action to improve the timeliness of reporting test results and values that indicate critical or life-threatening conditions.