Today’s hospitals and health systems are hubs of medical activity accommodating hundreds or thousands of patients daily, and mistakes jeopardizing safety can happen. While every healthcare organization strives to reduce harm, achieving an error-free environment is a complex goal because there are so many moving parts.
Multiple workflows and handoffs must be coordinated, infection control guidelines must be adhered to, surgical safety checklists followed, and more. Health information technology adds yet another layer of complexity. Ensuring patient safety means addressing problems like duplicate medical records and alert fatigue. However, there are best practices hospitals can implement to prioritize safety.
What are hospital patient safety goals?
Healthcare organizations can’t be held accountable if they don’t know what’s expected of them. That’s where patient safety goals come in. They’re based on specific objectives with clear strategies and best practices on how to achieve success. They are the goals that every hospital must achieve as part of the regulatory compliance and accreditation processes. But more than that, they’re guideposts for hospitals’ legal, ethical, and financial obligations.
As the primary hospital accreditor, The Joint Commission (TJC) enforces National Patient Safety Goals based on emerging patient safety issues from experts and stakeholders, including:
- Provider and payer organizations
- Purchasers (e.g., supply chain)
- Medical associations
- Consumer groups and others
The purpose? To help accredited healthcare organizations address specific areas of patient safety concern. Note that a much smaller percentage of healthcare organizations follow Det Norske Veritas’ (DNV-GL) path to accreditation through compliance with its goals. And for payer organizations, the National Committee for Quality Assurance (NCQA) fulfills that role.
Meeting patient safety goals
TJC’s National Patient Safety Goals are meant to promote specific improvements in patient safety and save lives. The goals highlight problematic areas and present evidence- and expert-based solutions to various challenges to keeping patients safe and ensuring the best possible outcomes.
Committing to meet patient safety goals also mitigates the risk of legal trouble, reputational harm, and financial penalties. And research shows that patient harm increases length of stay, mortality rates, and the probability of readmission, all of which drive up the total cost of care.
New and emerging safety areas
Every year, TJC and several other industry organizations in the stakeholder groups mentioned above gather evidence on emerging patient safety issues to inform their recommended goals for the coming year. What topped the hospital patient safety goals list for 2021? For TJC, the goals addressed patient identification, staff communication, and clinical alarm systems, among others. While nothing on the 2021 list this is glaringly new, and it echoes what TJC identified in its 2020 and 2019 goals. However, the fact that the accreditor continues to identify these areas as problematic means there’s still a lot of room for improvement.
Interestingly, ECRI’s list of patient safety concerns for 2021 deviates from TJC’s and focuses on addressing racial and ethnic disparities in healthcare, supply chain interruptions, and telehealth workflow challenges, among other priorities.
Specific hospital patient safety goals
TJC’s complete list of 2021 National Patient Safety Goals include the following:
- Improve the accuracy of patient identification. Identifying patients correctly is important for many reasons, including care quality, continuity of care, and more. It’s also important for financial reasons to ensure the right bill goes to the right patient for the right services.
- Improve staff communication. This patient safety goal pertains to ensuring staff get access to important test results on time to avoid care delays and redundant care.
- Improve the safety of medication administration. Medication safety is critical, and healthcare organizations must ensure there are proper procedures in place for medication reconciliation, labeling, and more. Health literacy and patient education also play a role in the safe use of medication.
- Reduce patient harm associated with clinical alarm systems. Alert fatigue (i.e., becoming overwhelmed by system alerts to the point of ignoring them) is a significant problem in hospitals as evidenced by TJC's Sentinel Event Alert regarding the safe use of health information technology, and healthcare organizations must work with their vendors to address it.
- Reduce the risk of healthcare-associated infections. Healthcare-associated infections (e.g., central line-associated bloodstream infections, catheter-associated urinary tract infections, select surgical site infections, hospital-onset C. difficile infections, and hospital-onset methicillin-resistant Staphylococcus aureus bacteremia infections) are more common than you might think. In fact, according to the CDC, on any given day, about one in 31 hospital patients has at least one healthcare-associated infection. Addressing this problem is critical to ensuring patient safety. In its 2021 National Patient Safety Goals, TJC specifically mentions hand hygiene and its relation to hospital-acquired infections. One of the most important ways to address these infections is by improving the hand hygiene of healthcare staff.
- Better identify patient safety risks in the hospital. TJC specifically mentions suicide risk. According to a study from The Joint Commission Journal on Quality and Patient Safety, there are approximately 30,000 suicides per year in the U.S. It’s estimated that five to six percent of those suicides occur in hospitals.
- Prevent surgical mistakes. Medical errors are the third leading cause of death in the U.S., according to the CDC. Putting measures in place to prevent these errors is paramount.
Seven ways for hospitals to achieve patient safety goals
The Joint Commission provides several strategies to help healthcare organizations succeed. Consider the following best practices:
1. Re-evaluate patient identification policies and procedures.
Do they require staff members to validate patient identity using at least two methods such as the patient’s name, telephone number, date of birth, or other person-specific identifier? This should be done when administering medications; blood, or blood components; when collecting blood samples and other specimens for clinical testing; and when providing treatments or procedures. Be sure to use distinct methods of identifying newborn patients (e.g., distinct naming systems, standardized practices for identification banding, and staff communication tools).
2. Create efficient workflows to disseminate test results.
First, take the time to identify what the healthcare organization considers its most critical tests and diagnostic procedures. Then identify by whom and to whom results of those tests and procedures are reported. Also identify the acceptable length of time between availability and reporting, and alter workflows accordingly.
3. Identify gaps in processes for labeling medications.
Ideally, staff will label each medication or solution as soon as it is prepared, unless it is immediately administered. The label should include medication or solution name, strength, amount of medication or solution containing medication (if not apparent from the container), diluent name and volume (if not apparent from the container), expiration date when not used within 24 hours, and expiration time when expiration occurs in less than 24 hours.
4. Get executive buy-in to make alarm system safety a hospital priority.
Then identify the most important alarm signals to manage and establish policies and procedures for managing the alarms (e.g., when alarm parameters can be changed and who has the authority to change them).
5. Set goals to improve hand hygiene compliance at your organization.
Then strive to achieve those goals using the CDC’s or World Health Organization’s hand hygiene guidelines.
6. Make suicide risk assessment part of the workflow.
To reduce risk for suicide, conduct an environmental risk assessment to identify features in the physical environment that a patient could use to attempt suicide. Then take any necessary action to minimize the risk(s). Screening is also important. Use a validated screening tool to screen for suicidal ideation in patients who are being evaluated or treated for behavioral health conditions as their primary reason for care. Also use an evidence-based process to conduct a suicide assessment of patients who have screened positive for suicidal ideation. Document patients’ overall level of risk for suicide as well as the plan to mitigate the risk for suicide. Keep in mind that staff training is paramount.
7. Require everyone to follow protocols that reduce surgical mistakes.
Follow the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery. This protocol requires providers to take a whole host of steps before a procedure, including conducting a pre-procedure verification process, marking the procedure site, and performing a timeout before starting the procedure.
Improving patient safety requires healthcare organizations to leverage their data in real time to glean actionable insights and implement best practices. It also requires an “all hands” approach to making healthcare safe, reliable, and free from harm. Learn how symplr can help.