HAI prevention emphasized in 2009 National Patient Safety Goals
Med reconciliation requirements, Universal Protocol revised
The Joint Commission, continuing a trend among leading health care quality organizations, has placed an emphasis on hospital-acquired infections, or HAIs, in its National Patient Safety Goals for 2009.
Among the major changes for 2009 are three new hospital and critical access hospital requirements related to preventing health care-associated infections due to multiple drug-resistant organisms (MDROs), central line-associated bloodstream infections, and surgical site infections.
This is a slight change from the proposed goals issued earlier in the year, when specific mention was made of the prevention of C. difficile, one of many drug-resistant organisms, and no mention was made of central line-associated infections.
"One of the draft requirements of our field review was on MRSA (methicillin-resistant Staphylococcus aureus) and C. difficile, but we decided that the problem was more basic, so we focused on multidrug-resistant organisms, which is broader," explains Peter Angood, MD, vice president and chief patient safety officer for The Joint Commission.
'Creating a stir'
Angood notes that these new goals are "creating a lot of stir out there, and they are important to quality managers." As is often the case with these goals, he notes, there is recognition that the issues are important, but that meeting the requirements can be problematic.
"It requires [quality managers] to review systems and processes of care, and change is difficult for everybody," Angood explains. In terms of compliance, while The Joint Commission often is reluctant to spell out specific steps, Angood says there are some common themes his organization tries to promote. "These include utilizing evidence-based guidelines; providing education for staff, patients, and families; conducting a risk assessment for your institution; and evaluating processes relative to your success in taking on the problem," he says.
The Joint Commission specifically mentioned patient education and involvement in infection control for MDROs and surgical sites. And it is the education component, along with patients' involvement in their own care, that may present the greatest challenge, says Phyllis Voreis, RN, BSN, CIC, director of accreditation and regulatory readiness and quality improvement for the University of Michigan Hospital and Health Centers in Ann Arbor.
"It's a nightmare," she says."Patient involvement is obviously a safety goal, but we are being asked to not only do this, but also to document that the patient understands, which will be really tough for quality management folks," she asserts.
Voreis says this was a hot topic at a recent industry meeting she attended. "The easiest way is to check off a box, but that really does not show anything," she notes. "We have a lot of forms for assessing [patient comprehension], but when patients are really sick, you're not sure how effective these things are."
When patients are sick and stressed, she continues, their ability to understand what they are being told can be compromised. "I'm worried about where that [Joint Commission requirement] may go," says Voreis. "They say you need to demonstrate a level of understanding, but some patients may never understand. The best we can do in any situation is tell the patient that if they have any questions, they can call you back — and continually reinforce our message."
Angood says that in terms of meeting this goal "there's a variety of strategies out there. Most of them involve trying to get a baseline understanding of what the patient appreciates is their problem, then trying to provide them with background information through a variety of ways, to help improve that knowledge."
As for prevention itself, says Voreis, "the biggest challenge is to make sure we meet [The Joint Commission's] timelines, and that responsibility is clearly assigned for each of the programs." The emphasis you put on any one or all of the three goals, she notes, will depend on how high your infection rates are.
"You could probably look at these goals and believe you already meet them, but with The Joint Commission, you have to have responsibility assigned for each goal — although it could be the same person — along with a specific written action plan," notes Voreis.
The new infection control goals "are very much in line with what Medicare is encouraging through threatening not to pay [for preventable adverse events]," adds Patrice L. Spath, of Brown Spath Associates in Forest Grove, OR, "So, The Joint Commission has given people a 'prescription' for reducing nosocomial infections."
Other goals changed
In addition to adding new goals, The Joint Commission has revised some existing ones, including medication reconciliation, which had caused such a stir that a summit was called last fall to hear from key stakeholders. Now, in emergency departments and certain other facilities such as outpatient radiology, full medication reconciliation no longer is required where medications are "used minimally or prescribed for short duration." In these situations, it will no longer be necessary to document the dose, route, or frequency of use for the prior meds.
"This is a pullback for people in areas that do not administer a lot of medications," says Spath.
"Early feedback is that the revised goal is being well received," adds Angood.
Another change was made in the Universal Protocol. "The Universal Protocol still has the same three core elements: verification of the procedure, marking the surgical site, and the timeout," notes Angood, "But we have clarified our expectations as to who does what, when, and where; we are more prescriptive."
In other words, says Angood, The Joint Commission is now specific about who should be marking the site, when the timeout should occur, who should participate in the timeout, and what those people should be talking about.
"This is for all procedures that place the patient at more than minimal risk," adds Angood.
"They have made [marking the site] specific to the surgeon or licensed practitioner," adds Spath. "In the past they used the word 'shall,' but this year it is a 'must."
Some hospitals have been relying on nurses to mark the site, she says. "The reasoning here is the one who owns the responsibility for doing it the right way should mark the site," she explains.
[For more information:
Peter Angood, MD, Vice President and Chief Patient Safety Officer, The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, IL 60181. Phone: (630) 792-5000.
Patrice L. Spath, Brown Spath Associates, P.O. Box 721, Forest Grove, OR 971116. Phone: (503) 357-9185. E-mail: [email protected].
Phyllis Voreis, RN, BSN, CIC, Director of Accreditation and Regulatory Readiness, Quality Improvement, University of Michigan Hospital and Health Centers, 2101 Commonwealth Avenue, Suite 1021, Ann Arbor, MI 48109-0729. Phone: (734) 615-7243.]
The Joint Commission, continuing a trend among leading health care quality organizations, has placed an emphasis on hospital-acquired infections, or HAIs, in its National Patient Safety Goals for 2009.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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