National Patient Safety Goals 2022

To ensure the safety of using medications, which of the following must be labeled both on and off the sterile field in perioperative and other procedural settings?

- Medications - Medication containers - Other solutions

What is recommended to clean nails when performing surgical hand antisepsis?

A nail cleaner

Which of the following is a difficulty that can occur with alarms?

Alarms that are hard to detect Areas of the hospital that have too many alarm systems Too many pieces of equipment that have alarms

The Joint Commission uses the word "medication" to mean:

Any agent to treat a patient Any agent to diagnose a patient Over-the-counter preparations Herbal remedies

Safety Goals

Before discussing the patient safety goals and elements of performance to meet those goals, it is important to note that the Joint Commission has developed goals for the variety of patient care settings and programs it accredits—including home care agencies, laboratories, and ambulatory surgi-centers—not just acute care hospitals. Therefore, it is important to be aware of the specific goals that apply to your facility.

Which of the following does NOT contribute to the high risk associated with anticoagulant therapy?

Complexity of administration

Of the tasks listed below, which is NOT a major task for those responsible for patient safety to develop, coordinate and implement?

Disciplinary action for violations

Conclusion

Every patient who enters a hospital deserves to receive appropriate care that will improve his or her condition or alleviate pain, without the intrusion of mistakes or medical errors. The Joint Commission's patient safety initiative is designed to set up a framework, and take the first major steps toward assuring that all healthcare institutions meet this goal for all their patients.

True or False:? The Universal Protocol only applies to operative settings, since the parameters aren't relevant to non-operating settings.

False

True or False? Ideally, the time-out should take place prior to the introduction of anesthesia.

False

True or False? Labeling does NOT have to be done when a medication is transferred from its original packaging into a syringe.

False

Procedure and Verification

First, the institution must implement a preoperative verification process to discuss and confirm that all appropriate documentation—including the patient's history and physical, operative consent, lab results, X-rays and other images—is available, and correctly matches the patient and is consistent with the patient's and surgical team's expectations. This must be done before any surgical or other invasive procedures are performed, in all settings, including at the bedside. Verification of the correct person, correct site and correct procedure is an ongoing process and should involve the patient, if possible. Any discrepancies or missing information must be addressed before beginning the procedure. In the last verification, in the pre-procedure area immediately before transfer to the procedure room, a standardized checklist should be used to verify that the following items are present: all relevant documentation, including nursing assessment and pre-anesthesia assessment; a completed and signed consent form; all diagnostic and test results, including images and scans, that are properly labeled; and any required blood products or special equipment for the procedure.

Which Joint Commission-accredited institutions do the safety goals apply to?

Hospitals Long term care Ambulatory health care

Identify four current patient safety goals from the list provided below:

Improve the accuracy of patient identification Improve the effectiveness of communication among caregivers Improve the safety of using medications Reduce the risk of healthcare-associated infections.

Introduction

In view of recent studies that have shown an alarming number of medical errors in the United States, causing thousands of unnecessary injuries and deaths, the Joint Commission has developed an evolving set of patient safety initiatives to address some of these problems. The Joint Commission's National Patient Safety Goals (NPSG) consists of specific patient safety goals and descriptive measures to meet these goals. These goals apply to all Joint Commission-accredited institutions. This program will discuss the Joint Commission's current patient safety goals, the requirements that are mandated to meet those goals and the Elements of Performance that have been identified as methods to meet each requirement. In addition to these goals, we will also describe the Joint Commission's Universal Protocol for preventing wrong-site surgery

Adapting Protocol to Non-Operating Room Settings

One further requirement relating to the Universal Protocol is the need for facilities to adapt the three components of the protocol to non-operating room settings, such as emergency rooms, GI labs, radiology suites, newborn nurseries, labor and delivery rooms and bedside procedures. Compliance with the both the Universal Protocol and the National Patient Safety Goals are required by the Joint Commission.

What is the most important measure aimed at reducing the risk of healthcare-associated infections?

Performing hand hygiene

Two forms of patient identification must be checked. If the patient has a wristband, acceptable identifiers include all EXCEPT which of the following?

Room number

Site marking

Second, as part of all procedures that involve incision, puncture or insertion, the institution must implement a regular system to physically mark the operative site with a permanent marking that will not be removed during surgical prep. A defined procedure must be in place for instances when a patient refuses to allow site marking, or site marking is impossible, such as on mucosal surfaces, on premature infants, or procedures where the site is not predetermined. The mark itself must not be ambiguous, such as an "X". The mark used should be universal throughout the institution. The marking is to be performed by a clinician who is directly part of the team that will be performing the surgery, and the marking must occur before the patient is moved to the procedure site, while the patient is still conscious and can be involved in the process. In limited circumstances, the marking may be delegated to another participant in the surgery, such as an advanced practice nurse or a physician assistant, who is familiar with the patient and will be present during the surgery. Mark the surgical site with "Y" for "yes" or a line to indicate the incision, and preferably add your initials. Do not mark nonoperative sites. Adhesive site markers are not to be used as the sole site markers. Organizations are allowed to develop alternative processes for site marking. For spinal procedures, in addition to the general site marking, special intraoperative radiographic techniques are used for marking the exact vertebral level. For a tooth, the operative tooth can be named and numbered in documentation or marked on a radiograph, as long as the document or radiograph is available in the procedure room. For minimal access procedures entering percutaneously or through a natural orifice, the intended side can be indicated near the operative site.

The facility and nurse must be in compliance with hand hygiene guidelines laid out by which organizations:

The World Health Organization The Centers for Disease Control and Prevention

What/who defines the type of medication information that should be collected from the patient?

The hospital

What/who defines which results of diagnostic tests are critical, and sets an acceptable length of time between ordering the test and receiving the results?

The hospital

Identify Safety Risks in the Patient Population

The next goal is to identify safety risks in the patient population. This goal applies specifically to anyone being treated in any institution, including general hospitals, for emotional or behavioral disorders. The organization must use a validated screening tool to identify any emotional or behavioral patients who may be at risk for suicide. The tool must include questions about suicidal ideation, plan, intent, self-harm behaviors, risk factors and protective factors. Steps must be taken to alert those caring for the patient to watch for any signs of dangerous behavior and take hospital-approved measures to prevent a suicide attempt. Staff should also be trained in reassessment and monitoring those at high risk for suicide. The Joint Commission's Universal Protocol In addition to the National Patient Safety Goals, the Joint Commission has also developed the Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery. Errors of this nature are very infrequent, but when they do occur, they can be tragic. The Universal Protocol consists of three major requirements: Preprocedure verification Site marking Surgical time-out

Reduce the Risk of Healthcare-Associated Infections

The next safety goal is aimed at reducing the risk of healthcare-associated infections (HAIs). The first measure to achieve this goal calls for compliance with current CDC hand hygiene guidelines or the WHO hand hygiene guidelines. Comply with current CDC hand hygiene guidelines The most recent CDC guideline on hand hygiene recommends hand decontamination before and after direct contact with a patient, after wearing gloves, after touching patient care equipment or environmental surfaces, and before performing invasive procedures. In all these situations, the preferred hand hygiene technique is now decontamination with an alcohol-based hand rub. This has been shown to be more effective against microbes and quicker and easier to perform than washing with soap and water, thus encouraging greater adherence to hand hygiene. The manufacturer's recommended amount of the agent should be applied to the palm of one hand, then the hands should be rubbed together so the agent covers all surfaces of the hands and fingers. Rub until the hands are dry, and do not rinse. At the start of a shift, when hands are visibly soiled or when there is a build-up of alcohol product, hands should be washed with soap and water. The recommended washing technique is wetting the hands first, then applying soap and rubbing hands together for at least 20 seconds, covering all surfaces of the hands and fingers, followed by thorough rinsing under a stream of warm water. Hands should be dried with a disposable towel, and a towel should be used to turn off the faucet. For surgical hand antisepsis, either an alcohol-based handrub or antimicrobial soap can be used before donning sterile gloves. Nails should be cleaned with a nail cleaner under running water; the CDC no longer suggests the use of a brush. The World Health Organization completed a comprehensive worldwide study of the importance of hand hygiene for all healthcare workers. Very similar to the CDC's policy, the WHO recommendations include: Provision of readily accessible alcohol-based handrubs at every point of patient care. Access to a safe and continuous water supply at all healthcare facility faucets, and the necessary facilities to perform thorough hand washing when it is necessary. Education of all healthcare workers on correct hand hygiene technique. The display of promotional hand hygiene reminders in the workplace. Monitoring the degree of hand hygiene compliance through direct observation, with feedback to the workers involved

Improve the Safety of Clinical Alarms

The next safety measures are directed at improving the safety of clinical alarms. A variety of alarm systems are used to identify potential patient problems, but if they are not managed properly, patient care can be compromised. Some of the difficulties that can occur include: Alarms that are hard to detect; Numerous pieces of equipment with alarms, and areas of the hospital which have multiple alarm signals. This can desensitize staff and lead to missed, ignored, or the disarming or silencing of alarms; Alarms sounding at default settings that are not appropriate for the patient. Hospitals must have identified the most important alarm signals to manage by: Obtaining input from staff; Identifying risks to patients if the alarms are not answered; Deciding if specific alarms are needed, or are unnecessary and contribute to noise or alarm fatigue; Evaluating for potential patient harm by reviewing variance reports and history of internal incidents; Researching published best practice guidelines. Then, facilities must have developed alarm management policies and procedures for the alarms identified that address, at a minimum: Clinically appropriate settings; When alarms can be disabled or parameters can be changed; Who in the facility can set and change the settings and parameters; What staff is responsible for monitoring and responding to alarms; How individual alarm settings, proper operation, and detectability will be checked. In addition, staff and licensed independent contractors must be educated about the purpose and proper operation of the alarm systems for which they are responsible.

Identify six major elements of the Joint Commission-recommended patient safety plan from the list provided below:

The structure of the program How the program will be managed Program components Interdisciplinary participation Oversight to ensure that tasks are carried out Mechanisms for coordination of safety-related activities.

When does verification of the correct person, correct site, and correct procedure occur?

This is an ongoing process, and should involve the patient, if possible

Improve the Effectiveness of Communication Among Caregivers

Timeliness of critical tests and results The second goal is to improve the effectiveness of communication among caregivers, specifically the timely report of critical results of tests and diagnostic procedures. This includes the acceptable length of time between availability of results and their report, and developing procedures for managing critical results. Critical values are far outside normal levels and can be life-threatening. The hospital needs to define the level at which results of diagnostic tests are critical, and then set an acceptable length of time between ordering the test and receiving the results. The hospital will collect data on the timeliness of receipt of test results by the responsible licensed caregivers, assess this data and decide whether corrective action needs to be taken. Finally, the hospital must take any action necessary to improve timeliness and follow up to make sure the measures are working. The next goal is to improve the safety of using medications. The first measure to improve the safety of using medication calls for the labeling of all medications, medication containers or other solutions, when they are taken out of their original container. This applies on and off the sterile field, in perioperative and other procedural settings. The Joint Commission uses "medications" as a broad term to mean any agent used to treat or diagnose a patient, including over the counter drugs and herbal remedies as well as intravenous solutions and radiopaque dyes. Labeling must be done when any medication or solution is transferred from the original packaging to another container, such as a syringe. The label must include the name and strength of the medication, and the date, the amount (if not obvious from the container), diluent name and volume, date and time prepared and the expiration time, if expiration is in less than 24 hours, or the expiration date if the drug is not used within 24 hours. The person preparing the medication must initial the label. Only one medication is labeled at a time, and all labels must be verified verbally and visually by two qualified individuals. Medications both on and off the sterile field must be reviewed by entering and exiting personnel at any shift change or break relief. Labeled containers are discarded at the end of the procedure, and any medication found unlabeled must be discarded immediately. Reduce the likelihood of patient harm associated with the use of anticoagulation therapy Another measure to improve the safety of medications involves the use of anticoagulants. Anticoagulation therapy is a high-risk treatment. Adverse drug events with anticoagulants are possible due to the complexity of calculating the correct dosage, and the difficulty of monitoring the effects. And on discharge, there is the further difficulty of ensuring continued patient compliance. The facility must implement a defined anticoagulant management program that is individualized for each patient, to help reduce the risk of adverse events. This safety measure applies to the long-term use of unfractionated heparin (UFH), low molecular weight heparin (LMWH), warfarin, and Arixtra® (fondaparinux sodium). The hospital should use approved protocols for anticoagulation therapy, appropriate for the patient and the condition, including evidence-based practice guidelines for reversal of anticoagulation and management of bleeding events. For patients starting on warfarin, a current International Normalized Ratio should be used, along with ongoing testing. To reduce dosage errors, oral unit doses and prefilled syringes or prepared infusion bags should be used when these are available. Dietary services must be advised of any patient receiving warfarin and they should follow their standard measures to prevent adverse medication-food interactions. Heparin should be delivered by a programmable infusion pump if it is delivered intravenously and continuously. The hospital must have a written policy to address baseline and ongoing laboratory tests that are required for anticoagulants. The hospital must also provide education for all staff on anticoagulation therapy and its risks. Education should be provided to patients and their families, especially regarding follow-up monitoring, dietary risks and the potential for interactions. Anticoagulation safety practices should become part of the hospital's regular safety evaluations and continuous improvement measures. Maintain and communicate accurate patient medication information The last requirement of this patient safety goal is to maintain and communicate accurate patient medication information. First, a process must be established for obtaining and documenting a complete list of the patient's current medications—including any over the counter medications, vitamins, and herbal remedies—upon the patient's admission to the institution. This should be done with the involvement of the patient. This process includes a comparison of the medications the patient is currently taking to medications the facility will use to treat the patient. Any discrepancies must be reconciled and documented. When it is difficult to get a complete list from the patient, the nurse must make a good faith effort to get the information. The hospital should specify the types of medication information to be collected, such as the name, dose, route, frequency and purpose for the medication. Next, the list of the patient's medications must be communicated to the next provider of service when it refers or transfers a patient. This includes other healthcare settings, services, practitioners or level of care, either within or outside your organization. This communication of the reconciled list of medications should be documented, and the next provider should be notified of ways to clarify any questions about the list. When the patient is discharged from the facility, a written reconciled list of medications must be provided directly to the patient or the family, as necessary. Patients and families should be reminded to discard any previous lists of medications. One further requirement applies mainly to sites where medications are used minimally or generally only prescribed for a short duration—such as emergency rooms, outpatient centers or outpatient radiology. In these settings the full reconciliation procedure may not need to be followed. Even though only short-term medications are to be used, the facility must still, if possible, obtain a list of the patient's current medications to assess for potential allergies and adverse interactions

Improve the Accuracy of Patient Identification

Use two forms of identification The first goal is to improve the accuracy of patient identification. You should use at least two forms of patient identification every time you administer medications or blood products, take blood samples, or perform treatments and procedures. If the patient has a wristband, acceptable identifiers include name, ID number, or barcode if the barcode itself includes two patient-specific identifiers. The room number is never an acceptable patient identifier. The Patient Safety Goals identify that newborn patients are at greater risk of misidentification. Examples of methods to prevent misidentification of newborn patients can include: Using distinct naming systems to include the mother's first and last names with the newborn's gender (for example: Wilson, Cathy Girl or Wilson, Cathy Girl A and Wilson, Cathy Girl B for multiples) Standardized practices for identification banding Working with staff to communicate when newborns have similar names, etc. In addition, all specimen containers should be labeled in the presence of the patient.

What are examples of methods to prevent the misidentification of newborn patients?

Using distinct naming systems Standardized practices for identification banding Working with staff to communicate when newborns have similar names

When labeling medication containers, how must labels be verified?

Verbally and Visually

Which of the following would be an appropriate mark to use for a foot amputation?

Y

Surgical time out

he third component of the Universal Protocol calls for taking a "time-out" immediately before incision or before starting a procedure. During the time out, the team should focus at minimum upon assuring the correct patient, the correct procedure and the correct site. The time-out should be standardized throughout the facility, should be initiated by a designated team member, and involve the active participation of the entire team. There should be a defined process for reconciling any differences in responses. During the time-out, other activities should stop, except as necessary for patient safety, so all team members can concentrate on the verification procedures. This process should be documented and no procedure should start until any question or concern is resolved. If there are two or more procedures to be performed, there must be another time-out before each subsequent procedure.

As part of the preoperative process, institutions should implement a regular system for physicians to do what to the intended site of the surgery?

physically mark it