Joint Commission revises medication safety goals

Joint Commission revises medication safety goals

Do not use’ abbreviation requirement revised

The Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, has announced its 2006 National Patient Safety Goals and related requirements. Several of the revisions to last year’s goals involve medication safety.

One new requirement, for accredited organizations that provide surgical or other invasive services, specifies that all medications, medication containers, and other solutions used in perioperative settings be labeled. This requirement is part of the goal: "Improve the safety of using medications."

The requirement is the result of several problems, says Richard J. Croteau, MD, Joint Commission’s executive director for patient safety initiatives. "There have been several reported cases of medication mix-ups in the operating/procedure room resulting in patient death (at least two were children) that occurred because the medication container was not labeled."

The following requirements will be retired for all applicable accreditation programs in 2006:

• The requirement to remove concentrated electrolytes (including but not limited to potassium chloride, potassium phosphate, sodium chloride greater than 0.9%) from patient care units. This requirement will continue to exist in relevant accreditation manuals.

Compliance has been good for this, Croteau says. "We wanted to make room for other safety goal requirements; it will continue to be a requirement in the Medication Management standards."

• The requirement to ensure free-flow protection on all general-use and patient-controlled analgesia intravenous infusion pumps used in an organization. Compliance with this requirement has been greater than 99%, and equipment manufacturing and availability issues for all health care settings have been satisfactorily resolved, the Joint Commission says.

The Board of Commissioners also affirmed its existing "do not use" abbreviations that constitute a single requirement under the goal: "Improve the effectiveness of communications among caregivers," but acted to delete a related stipulation that each organization also identify an additional three organization-specific "do not use" abbreviations. Failure to substantially eliminate the use of "do not use" abbreviations in medication orders remains — at 27% — one of the most frequent noncompliance findings during Joint Commission surveys.

"The additional three’ requirement was deleted based on consensus of the participants in the Abbreviations Summit held last November and supported by the subsequent field review of potential changes to the Requirements of Goal 2B," Croteau says. "It was generally felt that a requirement (rather than an option) for adding items beyond the official do not use’ list had no value, and we agreed."