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The Joint Commission has announced its 2009 National Patient Safety Goals (NPSG). The major changes for ambulatory care include new requirements for preventing deadly central line-associated bloodstream infections and surgical site infections, which build on an existing NPSG for the reduction of the risk of health care-associated infections, according to The Joint Commission.

The Joint Commission also made changes to its Universal Protocol based on feedback from last year’s Wrong Site Surgery Summit. While the basic principles are unchanged, more prescriptive requirements were added and the implementation language is significantly edited.

• Use at least two patient identifiers when providing care, treatment, and services.  
• Eliminate transfusion errors related to patient misidentification.

• 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 the 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.

• 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.
• Label all medications, medication containers (for example, syringes, medicine cups, basins), or other solutions on and off the sterile field.
• Reduce the likelihood of patient 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 patient’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 patient’s laboratory values for coagulation will remain within, or close to, normal values.)

• 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.) (Not applicable for office-based surgery.)
• Implement best practices for preventing surgical site infections.

• A process exists for comparing the patient’s current medications with those ordered for the patient while under the care of the organization.
• When a patient 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 patient leaves the organization’s care directly to his or her home, the complete and reconciled list of medications is provided to the patient’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 patient, and family as needed, the list of reconciled medications is sufficient.)
• When a patient leaves the organization’s care, a complete and reconciled list of the patient’s medications is provided directly to the patient, and the patient’s family as needed, and the list is explained to the patient 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 patients are taking because these medications could affect the care, treatment, or services provided.)

• The organizations educates staff, including licensed independent practitioners who are involved with surgical procedures and anesthesia providers, on how to control heat sources, how to manage fuels while maintaining enough time for patient preparation, and establish guidelines to minimize oxygen concentration under drapes.

• Identify the ways in which the patient and his or her family can report concerns about safety and encourage them to do so.