2007 NATIONAL PATIENT SAFETY GOALS

Ernestine Scovens, RN BSN
MSN Director of Quality Assurance and Education
Community Care Nursing Services, Inc.
8108 Harford Road, Suite BBaltimore, Maryland 21234

Email: qa@communitycarenursing.net

For questions or assistance, please call: (410) 665-7566

National Patient Safety Goals

The purpose of the Joint Commission’s National Patient Safety Goals is to promote specific improvements in patient safety. The Goals highlight problematic areas in health care and describe expert-based solutions to these problems. Recognizing that sound system design is necessary to deliver safe, high quality health care, the Goals focus on system-wide solutions, wherever possible.
Accrediting bodies, licensing agencies, and insurance companies/payors ensure that these safety goals are met within facilities by auditing, reviewing company policies and require staff are educated on the “National Patient Safety Goals.”

National Patient Safety Goals are not exclusive to home care. The Joint Commission has specific goals for assisted living, ambulatory care, laboratories, hospitals, disease specific care facilities, and long term care facilities. It is the expectation that providers become familiar with the goals and do their part to ensure the best possible healthcare is achieved during all patient care experiences.

2007 Goal: Indentify Patients Correctly

What does this information tell you?

This information shows whether the hospital uses two different ways to identify patients before giving medications or treatments, or taking blood samples and other specimens for testing. When you work with a new patient, you would have a family member or another caregiver who knows the patient introduce you to your new patient.

 

Why is this information important?

Not identifying a patient correctly could lead to the patient getting the wrong medication, test, or procedure. Hospital staff should be using two different ways to confirm you are the correct patient. Common methods of identification used by hospitals include asking your name and checking your hospital wristband.

 

How can I help?

Take an active role in your patients’ care by:

  • Trying not to get frustrated when doctors and nurses repeat the same questions, such as asking the patients’ name; this is an important double check to confirm that information is correct.
  • Carefully reviewing the spelling of your patients’ name, age, address, and other personal information and correcting any errors at the time you enter the patients’ home.
  • Telling a doctor, nurse, or other healthcare worker if you think he or she has confused your patient with someone else. For example, if the medication that your patient is given or the procedure your patient is about to have is not what you were expecting, speak up and ask the provider to confirm that it is correct.

2007 Goal: Improve Effective Communication

What does this information tell you?

Community Care Nursing Services, Inc. has specific procedures to ensure that important information about your patient is communicated: as soon as possible, clearly, and completely so everyone caring for your patient understands your patients’ needs and plan of care.

 

Why is this information important?

Poor communication can lead to inefficient care and cause mistakes. Many people are involved in your patients’ care at home and it is important that everyone involved in your patients’ care is communicating with each other. Home care agencies use a variety of methods to promote effective communication, including:

 

  • Giving report is a way staff can communicate what has happened while reporting off from the current shift to the oncoming shift and parent/caregiver.
  • Not using certain abbreviations that can be easily misunderstood when writing in a patient’s chart.
  • Write clearly, legibly, in black ink.
  • Communicating in nurse’s notes during each shift is another means for the oncoming shift or parent to find a summary of what happened during the previous shift. Nursing documentation and signed medication administration records allows the next caregiver to know if all medications were given and which medications are due.

How can I help?

Take an active role in the care of your patient by:

 

  • Providing a verbal report to the oncoming shift, parent or other caregiver when your tour of duty is finished.
  • Reporting incidences immediately to the Director of Nursing.
  • Notify care provider if health parameters are out of normal range.
  • Always confirming unclear medication or treatment orders by getting an order of clarification from the health care provider that wrote the order.

2007 Goal: Reduce Healthcare Acquired Infections

What does this information tell you?

This information shows whether the home care agency follows the national Centers for Disease Control’s (CDC) guidelines for hand washing to prevent healthcare associated infections.

 

Why is this information important?

Hand washing is an important way to prevent the spread of infections, including in home care. The CDC guidelines recommend healthcare workers wash their hands before and after directly touching a patient.

 

How can I help?

  • All homes should have sinks or hand washing gel dispensers available to staff.
  • If you are coughing or sneezing, be sure to cover your mouth and nose while you cough/sneeze, discard any used tissues immediately, and wash your hands or use hand washing gel frequently.
  • Ask that persons who are ill to wear a face mask while visiting or not to visit until they are feeling better.
  • If you are ill, ask the office to send a replacement for you until you are feeling better.

2007 Goal: Reduce the Risk of Patients Hurting Themselves by Falling

What does this information tell you?
Community Care Nursing Services, Inc. has specific policies related to falls and fall protocols.

What does this information tell you?

All patients should be assessed for fall risks including whether the patient is taking any medicines that may make the patient dizzy, weak, or sleepy, and taking appropriate precautions if the patient is at risk.

 

Why is this information important?

Falls are one of the most common injuries. Patients who are weakened, dizzy, or sleepy from their illness or medicines are more likely to fall. Patients also are in an unfamiliar place and may be attached to strange equipment that may cause them to trip even if not weak or dizzy.

 

How can I help?

Take an active role in your care by:

 

  • If your patient is ambulatory, assist him or her to the restroom and while ambulatory.
  • Eliminate or move things on the floor in your patients’ path. Eliminate throw rugs that could cause falls.
  • Encourage your patient to ask for help when getting up, any time you feel weak, dizzy, or sleepy, don’t get out of bed without calling the nurse or nurse’s assistant for help. Our office number is: 410-665-7566.

2007 Goal: Universal Protocol

What does this information tell you?

Community Care Nursing Services, Inc. has specific policies related to Universal Precautions.

 

Why is this information important?

Universal Precautions protect healthcare workers from blood borne pathogens and infectious diseases.

  • Wear protective gear such as goggles, gloves, apron, or a mask when there is a risk of coming in contact with body fluids and mucus membranes.
  • Encourage family members to wear gloves and wash hand during the delivery of care.

 

How can I help?

Practice safe procedures using universal precautions.

2007 Goal: Minimize Risks Associated with Long-Term Oxygen Use

What does this information tell you?
Home fires can easily occur with long-term oxygen use.

Why is this information important?

It is important for staff to identify and educate the family or patient of the fire risks associated with prolonged oxygen therapy.

Staff should call the DME or oxygen supplier to request NO SMOKING signs to post at the front door and on the patient’s bedroom door.

 

How can I help?

Report any incidences related to fire hazards to the Director of Nursing immediately.

 

Below Note: Changes to the Goals and Requirements are indicated in bold.

Goal 1 Improve the accuracy of patient identification.
1A Use at least two patient identifiers when providing care, treatment or services.
1B Prior to the start of any surgical or invasive procedure, conduct a final verification process, (such as a “time out,”) to confirm the correct patient, procedure and site using active—not passive—communication techniques.
Goal 2 Improve the effectiveness of communication among caregivers.
2A For verbal or telephone orders or for telephonic reporting of critical test results, verify the complete order or test result by having the person receiving the information record and “read-back” the complete order or test result.
2B Standardize a list of abbreviations, acronyms, symbols, and dose designations that are not to be used throughout the organization.
2C Measure, assess and, if appropriate, take action to improve the timeliness of reporting, and the timeliness of receipt by the responsible licensed caregiver, of critical test results and values.
2E Implement a standardized approach to “hand off” communications, including an opportunity to ask and respond to questions.
Goal 3 Improve the safety of using medications.
3B Standardize and limit the number of drug concentrations used by the organization.
3C Identify and, at a minimum, annually review a list of look-alike/sound-alike drugs used by the organization, and take action to prevent errors involving the interchange of these drugs.
Goal 7 Reduce the risk of health care-associated infections.
7A Comply with current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines.
7B Manage as sentinel events all identified cases of unanticipated death or major permanent loss of function associated with a health care-associated infection.
Goal 8 Accurately and completely reconcile medications across the continuum of care.
8A There is a process for comparing the patient’s current medications with those ordered for the patient while under the care of the organization.
8B A complete list of the patient’s medications is communicated to the next provider of service when a patient is referred or transferred to another setting, service, practitioner or level of care within or outside the organization. The complete list of medications is also provided to the patient on discharge from the organization.
Goal 9 Reduce the risk of patient harm resulting from falls.
9B Implement a fall reduction program including an evaluation of the effectiveness of the program.
Goal 13 Encourage patients’ active involvement in their own care as a patient safety strategy.
13A Define and communicate the means for patients and their families to report concerns about safety and encourage them to do so.
Goal 15 The organization identifies safety risks inherent in its patient population.
15A The organization identifies risks associated with long-term oxygen therapy such as home fires.