Joint Commission News Release re: 2009 Safety Goals for LTC

The Joint Commission today announced the 2009 National Patient Safety Goals and related requirements for accredited long term care organizations. The National Patient Safety Goals promote specific improvements in patient safety by providing health care organizations with proven solutions to persistent patient safety problems. These Goals apply to the more than 15,000 Joint Commission-accredited and -certified health care organizations and programs.

Major changes include a new requirement related to preventing deadly central line-associated bloodstream infections. This addition builds on an existing National Patient Safety Goal to reduce the risk of health care associated infections, and recognizes that patients continue to acquire preventable infections at an alarming rate while receiving health care. The new infection-related requirement has a one-year phase-in period that includes defined milestones, with full implementation expected by January 1, 2010.

“The 2009 National Patient Safety Goals represent ongoing opportunities for improvement that can immediately benefit patients,” says Mark R. Chassin, M.D., M.P.P., M.P.H., president, The Joint Commission. “By taking action to consistently meet the Goals, health care organizations can substantially improve patient safety in America.”

A revision of the requirements for the existing medication reconciliation Goal is based on feedback obtained from a Medication Reconciliation Summit convened in late 2007 and is included in the 2009 update.

The 2009 Long Term Care National Patient Safety Goals:

Improve the accuracy of resident identification.
· Use at least two resident identifiers when providing care, treatment, and services.

· Prior to the start of any surgical or invasive procedure, individuals involved in the procedure conduct a final verification process, such as a time-out, to confirm the correct resident, procedure and site, using active, not passive, communication techniques.

Improve the effectiveness of communication among caregivers.
· For verbal or telephone orders or for telephone reporting of critical test results, the individual giving the order verifies the complete order or test result by having the person receiving information record and “read-back” the complete order or test result.

· There is a standardized list of abbreviations, acronyms, symbols, and dose designations that are not to be used throughout the organization.

· The organization measures, assesses, and, if needed, takes action to improve the timeliness of reporting, and the timeliness of receipt of critical tests and critical results and values by the responsible licensed caregiver.

· The organization implements a standardized approach to hand-off communications, including an opportunity to ask and respond to questions.

Improve the safety of using medications.
· The organization identifies and, at a minimum, annually reviews a list of look-alike/sound-alike medications used in the organization, and takes action to prevent errors involving the interchange of these medications.

· Reduce the likelihood of resident harm associated with the use of anticoagulation therapy. (Note: This requirement applies only to organizations that provide anticoagulation therapy and/or long-term anticoagulation prophylaxis (for example, atrial fibrillation) where the clinical expectation is that the resident’s laboratory values for coagulation will remain outside normal values. This requirement does not apply to routine situations where short-term prophylactic anticoagulation is used for venous thrombo-embolism prevention (for example, related to procedures or hospitalization) and the clinical expectation is that the resident’s laboratory values for coagulation will remain within, or close to, normal values.

Reduce the risk of health care-associated infections.
· Comply with current World Health Organization (WHO) hand hygiene guidelines or Centers for Disease Control and Prevention (CDC) hand hygiene guidelines.

· Manage as sentinel events all identified cases of unanticipated death or major permanent loss of
function related to a health care associated infection.

· Implement best practices or evidence-based guidelines to prevent central line-associated bloodstream infections. Note: This requirement covers short and long term central venous catheters and PICC lines.

Accurately and completely reconcile medications across the continuum of care.

A process exists for comparing the resident’s current medications with those ordered for the resident while under the care of the organization.
When a resident is referred or transferred from one organization to another, the complete and reconciled list of medications is communicated to the next provider of service and the communication is documented. Alternatively, when a resident leaves the organization’s care directly to his or her home, the complete and reconciled list of medications is provided to the resident’s known primary care provider, or the original referring provider, or a known next provider of service. (Note: When the next provider of service is unknown or when no known formal relationship is planned with a next provider, giving the resident, and family as needed, the list of reconciled medications is sufficient.)
When a resident leaves the organization’s care, a complete and reconciled list of the resident’s medications is provided directly to the resident, and the resident’s family as needed, and the list is explained to the resident and/or family.
In settings where medications are used minimally, or prescribed for a short duration, modified medication reconciliation processes are performed. Note: This requirement does not apply to organizations that do not administer medications. However, it is important for health care organizations to know what types of medications their residents are taking because these medications could affect the care, treatment, and services provided.
Reduce the risk of resident harm resulting from falls.

· The organization implements a fall reduction program that includes an evaluation of the effectiveness of the program.

Reduce the risk of influenza and pneumococcal disease in institutionalized older adults.
· The organization develops and implements protocols for administration of the flu vaccine.

· The organization develops and implements protocols for administration of the pneumococcus vaccine.

· The organization develops and implements protocols to identify new cases of influenza and to manage outbreaks.

Encourage residents’ active involvement in their own care as a resident safety strategy.
· Identify the ways in which the resident and his or her family can report concerns about safety and encourage them to do so.

Prevent health care associated pressure ulcers (decubitus ulcers).
· Assess and periodically reassess each resident’s risk for developing a pressure ulcer (decubitus ulcer) and take action to address any identified risks.

The development, annual review and modification of the National Patient Safety Goals, first introduced in 2003, is overseen by the Sentinel Event Advisory Group, a panel that includes widely recognized patient safety experts, nurses, physicians, pharmacists, risk managers and other professionals who have hands-on experience in addressing patient safety issues in hospitals and other health care settings. Each year, this panel works with The Joint Commission to undertake a systematic review of the literature and available databases to identify potential new Goals and requirements. The Joint Commission also conducts an extensive field review of candidate new Goals and seeks input from practitioners, provider organizations, purchasers, and consumer groups among others. The Joint Commission’s Board of Commissioners approves the Goals and requirements each year. Compliance with the requirements is a condition of continuing accreditation or certification for Joint Commission-accredited and -certified organizations.

The full text of the 2009 National Patient Safety Goals and requirements for all accreditation programs, along with the elements of performance, can be found on The Joint Commission’s website. Compliance with the requirements is a condition of continuing accreditation or certification for Joint Commission-accredited and -certified organizations.