Monday, July 13, 2009

Joint Commission’s Safety Goals

So I'm pretty big stuff when I go to Cleveland Clinic for my appointments.  I get my lunch in the cafeteria like I've been there a million times before (because I have!), and I grab the newest InnerPulse (their "Weekly Employee Update") like I'm the CEO.  After all, I'm going to work there someday.  

Anyways, the other week, they had a box on the front of their newsletter reminding the employees of the Joint Commission's (no groaning!) National Patient Safety Goals.  They seem so basic, and even though they're habitual in most of our caring, we should still review them again and again.  

Before you glance right on by, please take a minute to review.  Here they are, courtesy of the CCF Quality and Patient Safety Institute.  (And commentaries by me, because you know I'm never without opinion!  Plus, you know my opinions can even make Joint Commission stuff less boring!)

1. Improve accuracy of patient identification. Be sure to use the two approved patient identifiers - name and birth date - before proceeding with any interaction, from transporting a patient to performing a surgical procedure.  The medical record number can be used as one of the identifiers if either the patient name or birth date is not available.  To eliminate transfusion errors related to patient misidentification, use a two person verification process when administering blood or blood products.

First of all, patients are going to notice when you forget to identify them.  They're getting used to it now as standard protocol, and even undiscerning patients are a little smarter than you'd think.  Take the time to check.  The horror stories of wrong-site surgeries or wrong-patient med-admins aren't jokes.

2. Reduce hospital-acquired infections: Wash your hands before and after direct contact with patients, before and after gloving, after using the restroom and before eating.

Next, how many of us really wash our hands before and after direct patient contact, before and after gloving, after using the restroom, and before eating - each and every time?  Some of these are easy - of course we will wash our hands after using the restrooms or touching a "dirty" patient, but before gloving?  After just touching a patient for a split second?  Practice.

Falls.  Hearing "risk of falls" is as annoying as hearing the words "Joint Commission."  We're sick of hearing it, yet it still happens or otherwise we wouldn't still be hearing about it.  As a patient, I have to confess I'm guilty of sneaking to the bathroom myself while coming off of loads of anesthesia, weighted down by morphine, so I know sometimes this job can be much harder than at first glance, but the statistics on patient falls are enough to make you stop and wonder what's going on.

4. Encourage patient and family involvement: Talk with patients and family members about their care and safety.  Educate the patient and family on how to communicate their concerns about patient safety issues that occur before, during and after the provision of care.

I can tell you how important patient and family involvement are from both the provider and client perspective.  Many patients are used to watching their healthcare take place around them without a say, while others are so over-vigilant they're likely to miss the simplest points you may try to communicate.  I can't tell you how many times I've been at a doctor's visit when I came home and realized I'd forgotten a critical instruction just because my mind was too overloaded with everything else.  In other cases, I've seen myself depend on what a loved one took out of a visit because I knew I couldn't remember every single word myself.  Encourage questions.  Present choices.  Implement teaching - at both the patient and family level.  Write things down.  Observe your audience and tailor your discussion to their learning style and level.  Are they visual?  Draw them a picture.  Do they need to see the numbers?  Are they scared?  Put your arm around them and let them feel your dedication to their whole well-being.  If the family is scared, the patient is scared.  If the patient is scared, the family can pick it up, too.  Remind patients and families of their humanity, their place in life, the fact that they matter... they're not just that clinical number in the computer.  

• When ordering medications, review the patient's current list of medications and allergies, clarify discrepancies and contraindications to using the intended drug.
• Communicate the updated medication list to the next provider of care.
• At the time of discharge or transfer, create a complete and current list of medications to be taken at discharge.

Meds, meds, meds.  So many opinions on this one, but I just want to tell you something that happened to me a few weeks ago... one of my most trusted specialists (a doctor whom I've seen for years and years) let me begin - and remain on - a potentially hazardous medication just because, I believe, of a few too many habitual glances down my "grocery list" list of medications.   She's seen a similar list of meds for years, taking note of a few changes here and there, going with the pace, and when another doctor snuck in a new medication, I honestly just think she didn't notice it.  And I can't blame her.  But if she would have really, deliberately reviewed my list of meds at every frequent visit, she would have caught it.  Thankfully, I'm doing fine on the medication, but should I not have, potential damage could have been done.

6. Hand-off Communication: Provide up-to-date information to the next person caring for the patient when the patient is transferred/transported to another setting or level of care 

When you give report, when you transfer a patient, when you do anything that transfers your patient to the care of another, make sure the new caretaker is up-to-date on everything.  Make it a systematic process.  Go down the list - vitals, med changes, go through each body system.  If it's hard for you, keep a little notebook in your pocket and jot down important things you wish the caregiver before you would have mentioned, or any changes you observe.  We are patient advocates, and sometimes when their own guards fail them, we are all they have to keep them safe.

Listen to the Joint Commission.  Yes, they're sometimes annoying, but they know best.