Update on the National Patient Safety Goals—Changes for 2005

AORN Journal,  Feb, 2005  by Kathleen Catalano

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The article "Update on the National Patient Safety Goals--Changes for 2005" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared with consultation from Susan Bakewell, RN, MS, BC, education program professional, Center for Perioperative Education.

Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is Feb 29, 2008.

Complete the examination answer sheet and learner evaluation found on pages 345-346 and mail with appropriate fee to

AORN Customer Service

c/o Home Study Program

2170 S Parker Rd, Suite 300

Denver, CO 80231-5711

or fax the information with a credit card number to (303) 750-3212.

You also may access this Home Study via AORN Online at http://www.aorn.org/journal/homestudy/default.htm.

BEHAVIORAL OBJECTIVES

After reading and studying the update on the National Patient Safety Goals, nurses will be able to

1. identify the current National Patient Safety Goals,

2. describe changes to the requirements of the original goals, and

3. discuss the two new goals that were added for 2005.

Home Study Program

In February 2002, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) formed the Sentinel Event Advisory Group to develop the first National Patient Safety Goals (NPSGs) to help accredited health care organizations address patient safety concerns. The initial six goals recommended by the group were approved by JCAHO's Board of Commissioners in July 2002 and took effect Jan 1, 2003. (1) Each goal has one or more associated requirements that must be met to achieve compliance. Each year, the advisory group re-evaluates the NPSGs and recommends additions, deletions, or modifications to the goals and their specific requirements for the next year. (1) In 2004, a seventh goal was added.

For 2005, JCAHO developed program-specific goals for each of its accreditation programs to make the goals more relevant to different types of health care facilities. (2) Although the total number of NPSGs that apply to hospitals still is seven, two new goals have been added, and there are new requirements for some of the original NPSGs. In addition, NPSGs 4 and 6 from the 2003 and 2004 goals are not included in the 2005 goals.

National Patient Safety Goal 4 (ie, eliminate wrong-site, wrong-patient, wrong-procedure surgery)remained in effect until JCAHO's Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery became mandatory for all JCAHO-accredited organizations on July 1, 2004. (3) The Universal Protocol applies to all surgical and other invasive procedures that expose patients to more than minimal risk and includes procedures performed in settings other than the OR (eg, special procedure units, endoscopy units, interventional radiology suites). Compliance with the Universal Protocol is being surveyed by JCAHO as an accreditation participation requirement.

National Patient Safety Goal 6 (ie, improve the effectiveness of clinical alarm systems) has been incorporated into JCAHO's Environment of Care Standards.; This article recaps the current NPSGs that apply to hospitals, highlights changes that have been made, and details how these changes may affect perioperative services.

NPSG 1--IMPROVE THE ACCURACY OF PATIENT IDENTIFICATION

National Patient Safety Goal 1 requires staff members to confirm that they have the correct patient and are preparing to perform the specific services and treatments that were ordered for this patient. For 2005, only one specific requirement is associated with the goal of improving patient identification accuracy: at least two patient-specific identifiers, neither of which can be the patient's room number, are to be used when administering medications or blood products, taking blood samples and other specimens for clinical testing, or providing any other treatments or procedures. (2)

The two patient-specific identifiers can come from the same source (eg, a patient's armband). A patient's armband usually includes a wealth of information, such as the patient's name, account number, telephone number, social security number, date of birth, and address, and each piece of data can serve as a patient-specific identifier. The patient-specific identifiers chosen should be compared to those on the medication administration record, physician order, or requisition to ascertain that this is the correct patient.

Documenting that two patient-specific identifiers were located and compared with the medication administration record, physician order, or requisition is not necessary. The Joint Commission has stated that when surveyors are on-site at a facility, they will observe staff members to ensure that the practice is in place and is being followed. (5,6)

In 2003, goal 1 included a second requirement that before the start of any surgical or invasive procedure, a final verification process, such as a time out, be completed to confirm the correct patient, procedure, and site. The final verification was to be accomplished using active, not passive, communication techniques. (7) This requirement was included until July 1, 2004, when the Universal Protocol was adopted.