THE JOINT COMMISSION'S NATIONAL PATIENT SAFETY GOALS (NPSGs) are undergoing an extensive review, but the revised and updated goals that emerge aren't likely to contain any big
surprises for nurses. The goals still will be a major element in hospitals and other healthcare settings with Joint Commission
accreditation, and they still will serve to codify and standardize all the "right things" nurses strive to do every day.
The goals are being reviewed this year through the Joint Commission's Standards Improvement Initiative (SII) rather than the
routine annual process. According to the Joint Commission, the SII process is used to clarify language, ensure that the NPSGs
are program-specific, delete NPSGs that are redundant or nonessential in specific programs, and consolidate similar NPSGs.
The Joint Commission says the process includes a baseline survey, review of potential changes by the organization's Patient
Safety Advisory Group and the Standards and Survey Procedures Committee, and final approval by the Board of Commissioners.
Revisions based on SII recommendations will be effective in 2010.
"The NSPGs highlight problematic areas in healthcare and describe solutions to these problems, which then promote specific
improvements in patient safety and the prevention of sentinel events," said Jane Schetter, RN, MSN, CNS, senior consultant,
Joint Commission Resources. "The Joint Commission, with feedback from other healthcare organizations, is reviewing evidence-based
practice, the systems and processes within organizations that have enhanced the ability of the organizations to meet the NPSGs,
and examining the language of the NPSGs and the elements of performance to ensure they are clear and not too complex to apply
to all organizations."
This Joint Commission review also takes into consideration other patient safety and quality initiatives, such as those from
the Centers for Medicare and Medicaid Services and the World Health Organization (WHO). Previously, the review was derived
from informal recommendations made in the Sentinel Event Alerts, the Sentinel Event Advisory Group (now called the Patient
Safety Advisory Group), and review of sentinel events and root cause analyses reported to the Joint Commission. "The other major shift in this review is that the Joint Commission's Standards Interpretation Group is involved, to ensure
consistency of interpretation and integration into the Accreditation Standards Manuals," Schetter added.
It's common for the Joint Commission to revise the language of NPSGs or to move certain goals onto the list of standards.
"When the Joint Commission feels that organizations are meeting one or more of the NPSGs so consistently that compliance has
basically become second nature, they frequently then will move them into the standards," Schetter said. "For example, removing
concentrated electrolytes from patient care areas and standardizing and limiting the number of drug concentrations available
in the organization were two of the original NPSGs back in 2003, and they were moved into the medication management standards
a couple of years ago. Other examples include improving the use of infusion pumps and improving the effectiveness of clinical
alarm systems, which have been moved into the Environment of Care, Equipment Management Standards."
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