The Joint Commission established its National Patient Safety Goals (NPSGs) program in 2002. The first set of safety goals became effective on January 1, 2003, and was designed to identify areas of practice that require increased attention to safety, such as proper use of abbreviations in healthcare, actions to reduce the possibility of wrong site surgery, and safer practices when administering “look alike, sound alike” drugs. Let’s take a look at what’s new in the 2011 NPSGs.
Reconciling Medication Information
The Joint Commission has responded to clinicians’ feedback concerning NPSG.08.01.01, which addresses reconciling patients’ medication information. Input from the field suggested that the 2009 version of this goal was too prescriptive and detailed, making it difficult for clinicians to consistently implement. There is now a streamlined and focused version that focuses on critical risk points in the medication reconciliation process. The new version, NPSG.03.06.01, replaces all of Goal 8 [08.01.01, 08.02.01, 08.03.01, and 08.04.01], as well as its related elements of performance. It takes effect July 1, 2011, for the ambulatory, behavioral health care, critical access hospital, home care, hospital, long-term care, and office-based surgery accreditation programs.
The elements for performance for NPSG.03.06.01 include 1) clinicians make a good faith effort to obtain/update a list of a patient’s medications, including prescribed and nonprescribed medications; 2) organizations define the types of medication information to be collected, which may vary based on the setting (eg, primary care, inpatient care) and patient circumstances (eg, emergency situations, routine admission); 3) clinicians compare newly prescribed medications to those that have already been prescribed for the patient and resolve duplications, discrepancies, and contraindications; 4) organizations provide patients with written information (eg, drug name, dose, route, frequency, purpose) at the end of the episode of care; and 5) organizations explain to patients the importance of managing medication information (eg, instruct patients to carry a list with them and send the list to their primary care and other physicians).
The updated medication reconciliation goal appears much easier to implement than its predecessor, but it still presents challenges. It will be difficult to ensure that new medications are consistently compared with previous treatments. Although there are several versions of online drug interaction trackers available, entering a patient’s list of medications can be tedious and time consuming.
Another challenge is ensuring effective mechanisms for obtaining and documenting patients’ medication lists. At some facilities, patients compile the list themselves. Other institutions have medical assistants record patients’ responses to questions about medication use. Regardless of how the lists are compiled, they should be reviewed by a nurse, pharmacist, mid-level provider, or physician.
For the 2011 NPSGs, The Joint Commission has created easy-to-read documents for each area of accreditation (hospital, ambulatory care, etc). These one-page documents simplify the language of the NPSGs for the general public. For example, the goal for medication reconciliation is described in part as to “find out what medicines each patient is taking and make sure that it is OK for the patient to take any new medicines with their current medicines.”
The simplified 2011 NPSGs for hospitals are to identify patients correctly, improve staff communication, use medicines safely, prevent infection, check patient medicines, and identify patient safety risks. For ambulatory care, the basic 2011 goals are to identify patients correctly, use medicines safely, prevent infection, and check patient medicines.
Clinicians should review the revised 2011 NPSGs and determine their organization’s status with respect to implementing the goals, even if the organization is not Joint Commission accredited or pursuing accreditation. The NPSGs for each program and additional information are available on The Joint Commission’s Website at http://bit.ly/J9U0i.