National patient safety goals; do-not-use abbreviations, tissue banking; patient skin preparation; patient attire

AORN Journal,  August, 2005  by Debra T. Moore

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QUESTION: How does the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) develop the National Patient Safety Goals (NPSGs)? Do you have information on the new 2006 ambulatory surgery patient safety goals? What are the requirements that have been approved by JCAHO? Will previous patient safety goals be removed?

ANSWER: The Joint Commission works with the Sentinel Event Advisory Group to systematically review literature and databases to identify new patient safety goals and requirements annually. The Joint Commission develops safety goals for each type of program that they accredit, including separate NPSGs for both inpatient and ambulatory facilities. Although each program has a distinct set of goals, all are based on the same patient safety premises and are similar in nature. All JCAHO-accredited ambulatory health care organizations will be surveyed for implementation of the new goal requirements as of Jan 1, 2006.

Following are the two new requirements for the 2006 ambulatory patient safety goals.

* Goal #2--Improve the effectiveness of communication among caregivers.

* 2E--Implement a standardized approach to "hand-off" communications, including an opportunity to ask and respond to questions. (1)

* Goal #3--Improve the safety of using medications.

* 3D--Label all medications (eg, syringes, medication cups, basins) or other solutions on and off the sterile field in perioperative and other procedural settings. (1)

The new requirement for NPSG #2 (ie, effective communication) is critical in the perioperative setting. The purpose of hand-off communication is to present appropriate, up-to-date, and accurate information to caregivers about a patient's perioperative care (eg, preparation for and type of surgical or invasive procedure, medications administered, implants). In the perioperative setting, there are many situations when patient hand-offs occur. Some patient hand-offs are temporary, and others transfer complete responsibility for the patient. For example, a temporary hand-off occurs when a perioperative staff member is relieved for break or lunch or leaves the unit for a short time. A hand-off that transfers complete care occurs when the perioperative patient is transferred from the circulating nurse and anesthesia care provider to the perianesthesia RN in the postanesthesia care unit.

Hand-offs must provide an opportunity for active communication between the person who is handing off and the person who is receiving the perioperative patient. Interruptions during handoffs should be discouraged to reduce the risk of information being forgotten. A process for verifying the hand-off should be standardized; this may include read-back or repeat-back of information.

The new requirement for NPSG # 3 (ie, improve medication safety) concerns labeling all medications and other solutions to decrease the risk of a medication error. Consistent labeling of all medications and solutions should occur whether the medications are on or off the sterile field. Tragic errors have occurred when medications or solutions became unidentifiable after being placed into unlabeled containers. Medications or solutions should be labeled even if only one medication or solution is on the sterile field. Medication containers should be labeled with the name and strength of the medication or solution, the date, and the initials of the person preparing the label. Two qualified individuals should verify the label both verbally and visually. Preprinted medication labels may be purchased from a manufacturer, or labels may be created with sterile skin closure adhesive strips and a sterile marking pen. Only one label should be prepared at a time. Any time a medication or solution is found unlabeled it should be discarded immediately. (2)

Original containers from medications and solutions should remain within the procedure room until the surgical or invasive procedure is complete. At the time of temporary or permanent staff member relief, all medications or solutions on and off the sterile field should be reviewed by entering and exiting staff members. (3) AORN's Safe Medication Administration Tool Kit was developed to help perioperative RNs and managers develop safe medication practices. The tool kit also includes Perioperative Nursing Data Set (PNDS)-based perioperative medication competencies, a PNDS-based Perioperative Medication Performance Validation Record, multimedia education and learning modules, a pocket guide to frequently used conversions and calculations, and a perioperative medication safety test. A complete description of the Safe Medication Administration Tool Kit is located at http://www.aorn.org/toolkit/safemed/ataglance.asp.

The NPSGs are modified or retired based on annual review by JCAHO and the Sentinel Event Advisory Group. The following requirements, which are part of the current ambulatory safety goals, have been designated to be retired in 2006:

* removal of concentrated electrolytes from a patient care area--although the requirement will stay in relevant accreditation manuals; and