Implications of the 2004 National Patient Safety Goals - Patient Safety First

AORN Journal,  Nov, 2003  by Suzanne C. Beyea

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As of Jan 1, 2004, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) will survey health care organizations on the 2004 National Patient Safety Goals. (1) Accredited organizations must implement each goal's requirements or equally effective, acceptable alternatives appropriate to the services the organization provides. Any organization that has not implemented the requirements or an acceptable alternative for a goal will receive a special Requirement for Improvement for that goal. The Joint Commission provides organizations with these requirements in the Accreditation Participation Requirements ha the official accreditation manual.

The goals specified for 2004 include the six 2003 National Patient Safety Goals approved in July 2002 and one new goal approved in July 2003. The 2004 goals are

* improve the accuracy of patient identification;

* improve the effectiveness of communication among caregivers;

* improve the safety of using high-alert medications;

* eliminate wrong-site, wrong-patient, wrong-procedure surgery;

* improve the safety of using infusion pumps;

* improve the effectiveness of clinical alarm systems; and

* reduce the risk of health care-acquired infections.

The purpose of these goals is to provide organizations with specific areas on which to focus safety initiatives. Each goal includes one or two evidence-or expert-based requirements to achieve the goal. The goals and requirements are reviewed annually and may be updated, revised, or replaced.

GOALS AND REQUIREMENTS

The 2004 National Patient Safety Goals address clinical issues pertinent to perioperative nursing practice and common problems, issues, and risks that occur in the OR. Each of these goals provides a focus for nursing activity that can prevent near misses or adverse events from occurring. Familiarity with these safety goals and the related requirements will help maintain patient safety.

Identification. The first goal relates to improving the accuracy of patient identification. The first requirement for this goal describes using at least two patient identifiers other than the patient's room number when taking blood or administering blood products or medication. The second requirement addresses the importance of conducting final verification (eg, a "time out") using active communication before the start of any surgical or invasive procedure. In the OR, this active communication should involve the anesthesia care provider, surgeon(s), and circulating nurse. The clinicians should verify the patient's identity and the procedure that is about to be performed.

Communication. The second goal also stresses the importance of improving the effectiveness of communication among caregivers. The first requirement for this goal addresses the importance of implementing a process for reading back verbal or telephone orders or critical test results. The second requirement addresses the need to standardize abbreviations, acronyms, and symbols used throughout an organization, including a list of abbreviations, acronyms, and symbols that are not to be used.

Medications. The third goal addresses the importance of improving the safety of using high-alert medications. The first requirement for this goal discusses the importance of removing concentrated electrolytes, such as potassium chloride or sodium chloride in concentrations greater than 0.9%, from patient care traits. The second requirement addresses the need to standardize and limit the number of medication concentrations available in the organization. In the OR, nurses make various concentrations of numerous solutions. Ideally, these dilutions would be made in a satellite or central pharmacy, and the concentrations would be predetermined. Error potential increases when providers order their favorite concentration instead of a standard formula.

Wrong site, patient, or procedure. The fourth goal relates to eliminating wrong-site, wrong-patient, and wrong-procedure surgery. Despite the attention given this issue, problems and adverse events continue to occur. The first requirement for this goal mandates creating and using a preoperative verification process, such as a checklist, and confirming that appropriate medical records and imaging studies are available. The second requirement addresses the need to implement a process to involve patients in marking their surgical site.

Infusion pump safety. The fifth goal addresses strategies to improve the safety of infusion pumps. The requirement for this goal elaborates on the need to ensure free-flow protection on general-use and patient-controlled analgesia infusion pumps. In ORs across the country, there have been numerous adverse events related to the management of IV fluids. Many times, a simple slip causes a cassette to be improperly placed in the infusion pump resulting in a patient receiving a too-rapid infusion. Nurses sometimes are unaware of whether an infusion pump has free-flow protection.

Clinical alarm systems.