1. Phillips, JoAnne MSN, RN, CCRN, CCNS

Article Content

THE DRIVE TO IMPROVE healthcare quality and safety has never been greater. Demands from regulatory and accrediting agencies are on the rise. You may wonder: Where do all those initiatives come from? Will they really improve patient outcomes and keep patients safer? Can't those organizations get together?


Believe it or not, the regulatory and accrediting organization standards are more alike than different. This article provides an overview of the key organizations involved in setting patient safety standards and recommendations, and shows that their goals are much more alike than different. First, take a look at the scope of the problem.


Preventing errors

The Institute of Medicine (IOM) has recommended that care be safe, effective, patient centered, timely, efficient, and equitable.1 Despite these recommendations, Americans are exposed to more preventable medical errors than patients in other industrialized nations.2 Because nurses make up the largest sector of the healthcare workforce, we have the greatest potential to impact the quality and safety of patient care.


Many organizations have developed measures that help track problems and ensure safety and quality care. Some, such as mortality, are outcome measurements; others, such as the use of beta-blockers after myocardial infarction, are process measurements. See Sorting out the alphabet soup of organizations for a sample of groups that provide guidance to ensure that nursing and medical care meets IOM recommendations.


Each of these organizations requires clinical interventions to meet certain standards. The challenge for nurses is that data collection to ensure compliance may be burdensome, and the impact on outcomes may not be clear at the time care is being delivered.


The good news? Further analysis shows that many similar interventions are required by several organizations.3,4


For an example of interventions that are comparable: The Institute for Healthcare Improvement recommends that we reduce methicillin-resistant Staphylococcus aureus infection.5 The Joint Commission's 2010 National Patient Safety Goal 7 aims to reduce healthcare-associated infections by meeting hand hygiene guidelines, preventing multidrug-resistant organism infections, and preventing surgical site infections and central line-associated bloodstream infections.6 Again, the requirements are more alike than different.


For more information, access the websites found in References.7,8 These websites will guide you not only to concrete recommendations, but also to a wealth of information on evidence-based care for such conditions as heart failure, pneumonia, and surgical site infections.




* AACN: American Association of Critical-Care Nurses


* AHRQ: Agency for Healthcare Research and Quality


* ANA: American Nurses Association


* CMS: Centers for Medicare and Medicaid Services


* HCAHPS: Hospital Consumer Assessment of Healthcare Providers and Systems


* IHI: Institute for Healthcare Improvement


* NDNQI: National Database of Nursing Quality Indicators


* NQF: National Quality Forum


* TJC: The Joint Commission




1. Committee on Quality of Health Care in America, Institute of Medicine. Kohn LT, Corrigan JT, Donaldson MS, eds. To Err is Human: Building a Safer Health System. Washington, DC: National Academies Press; 2000. [Context Link]


2. The Commonwealth Fund Commission on a High Performance Health System. Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2008. New York, NY: The Commonwealth Fund; 2008. [Context Link]


3. CMS Guidelines. [Context Link]


4. The Joint Commission. Performance Measurement Initiatives.


5. Institute for Healthcare Improvement. Protecting 5 Million Lives from Harm. [Context Link]


6. The Joint Commission. National Patient Safety Goals. Effective July 1, 1. [Context Link]


7. Agency for Healthcare Research and Quality. Making Health Care Safer: A Critical Analysis of Patient Safety Practices. [Context Link]


8. National Quality Forum. 2009 Safe Practices Released by National Quality Forum.