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The Joint Commission has announced the 2009 National Patient Safety Goals and related requirements for accredited home care organizations. The National Patient Safety Goals promote specific improvements in patient safety by providing healthcare organizations with proven solutions to persistent patient safety problems. These goals apply to the more than 15,000 healthcare organizations and programs accredited and certified by the Joint Commission.


Major changes include new requirements related to preventing deadly central line-associated bloodstream infections. These additions build on an existing goal to reduce the risk of healthcare-associated infections and recognize that patients continue to acquire preventable infections at an alarming rate while receiving healthcare. These new infection-related requirements have a 1-year phase-in period that includes defined milestones, with full implementation expected by January 1, 2010.


A complete revision of the language to the requirements for the existing medication reconciliation goal was undertaken after feedback was obtained from a Medication Reconciliation Summit convened in late 2007 and included in the 2009 update.


The 2009 Home Care National Patient Safety Goals are the following:


Improve the accuracy of patient identification.


* Use at least two patient identifiers when providing care, treatment, and services.


* Prior to the start of any surgical or invasive procedure, individuals involved in the procedure conduct a final verification process, such as a time-out, to confirm the correct patient, procedure, and site, using active, not passive, communication techniques.


Improve the effectiveness of communication among caregivers.


* 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.


Improve the safety of using medications.


* 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.


* 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, eg, 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 thromboembolism prevention, eg, 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.)


Reduce the risk of healthcare-associated infections.


* 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 healthcare-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 peripherally inserted central catheter lines.)


Accurately and completely reconcile medications across the continuum of care.


* 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/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 healthcare organizations to know what types of medications their patients are taking because these medications could affect the care, treatment, and services provided.)


Reduce the risk of patient harm resulting from falls.


* The organization implements a fall reduction program that includes an evaluation of the effectiveness of the program.


Encourage patients' active involvement in their own care as a patient safety strategy.


* The organization identifies the ways in which the patient and his/her family can report concerns about safety and encourages them to do so.


The organization identifies safety risks inherent in its patient population.


* The organization identifies risks associated with home oxygen therapy, such as home fires.



The development, annual review, and modification of the National Patient Safety Goals, first introduced in 2003, are overseen by the Sentinel Event Advisory Group, a panel that includes widely recognized patient safety experts, nurses, physicians, pharmacists, risk managers, and other professionals who have hands-on experience in addressing patient safety issues in hospitals and other healthcare settings. Each year, this panel works with The Joint Commission to undertake a systematic review of the literature and available databases to identify potential new goals and requirements. The Joint Commission also conducts an extensive field review of candidate new goals and seeks input from practitioners, provider organizations, purchasers, and consumer groups among others. The Joint Commission's Board of Commissioners approves the goals and requirements each year. Compliance with the requirements is a condition of continuing accreditation or certification for organizations accredited and certified by The Joint Commission.


The full text of the 2009 National Patient Safety Goals and requirements for all accreditation programs, along with the elements of performance, can be found on The Joint Commission's Web site. Compliance with the requirements is a condition of continuing accreditation or certification for organizations accredited and certified by The Joint Commission.