The safety of patients is a critical issue that the health care system is grappling with across the world. The need to improve safety of patients in the health care system emerged in the year 2000 when the Institute of Medicine highlighted in its report ‘To Err is Human’ that medical errors cause about 98,000 deaths annually in the United States (Bion, 2008). The shocking highlights revealed that medical errors contribute significantly to the mortality rates of patients in hospitals as it ranks as the eighth cause of death in the United States. The revelation did challenge healthcare providers and stakeholders to devise means of reducing medical errors while improving patient safety. Following the revelation that human errors increase mortality rates of patients, health care systems in conjunction with healthcare bodies and governments have established National Patient Safety Goals (NPSG) that are achievable and measurable quality indicators. In the United States, The Joint Commission together is a body that sets these goals, defines indicators, as well as accredits healthcare centers. The mission objective of The Joint Commission is to improve safety and quality of care that healthcare centers deliver to the patients. Therefore, this essay examines goals and quality indicators of NPSG with the view of establishing their impacts on clinical outcomes and programs.
National Patient Safety Goals
NPSG has a critical mandate of reducing medical errors and improving patient safety. The need to develop safety and quality goals emanated from the report of the Institute of Medicine, which revealed that medical errors contribute the occurrence of approximately 98,000 deaths yearly. The figure indicates that interventions and procedures that healthcare providers use in the treatment of diseases are prone to medical errors (Bion, 2008). Moreover, medical errors increase medical costs as harmed patients take longer time than necessary to recover from a given condition. Since healthcare is a complex and dynamic field, healthcare providers continually face challenging practices that require diligence. According to Juarez, Gack-Smith, Bauer, Jepsen, Paparella, Vongoerres, and McLean (2009), areas that utilize advanced technology such as laboratory and emergency units are prone to serious medical errors. The complexity of technology coupled with the competence of healthcare providers determines the occurrence of medical errors.
To reduce the occurrence of medical errors in the health care system, The Joint Commission has set goals that every healthcare center and provider should strive to achieve. In 2002, the Joint Commission established NPSG to address various issues that relate to patient safety. Watson (2009) states that the updated national patient safety goals focus on accurate identification of patients, effective communication among healthcare providers, safety of medications, reduction of nosocomial infections, reduction of patient falls, prevention of pressure ulcers, and reduction of organizational safety risks. The goals provide a comprehensive means of reducing medical errors while enhancing safety and quality of care that patients receive. To enhance patient safety in healthcare centers, The Joint Commission has established programs such as behavioral health care, ambulatory health care, laboratory services, long-term care, home care, critical access hospital, office-based surgery, and hospitals. All these programs have the common objective of improving safety and quality of care that patients receive in the health care system.
National Patient Safety Quality Indicators
Since the health care system has recognized that healthcare issues revolve around safety and quality of care, it has developed safety and quality indicators. Safety and quality indicators are evidence-based indicators, which ascertain the safety and quality of health care that patients receive. In the United States, Agency for Healthcare Research and Quality (AHRQ) has a mandate of developing and maintaining quality indicators with the view of improving safety and quality of health care in healthcare centers. Given that medical errors contribute to the occurrence of preventable deaths in the health care system, stakeholders such as healthcare providers, government, insurance companies, and accreditation bodies came together and agreed to formulate quality indicators (Agency for Healthcare Research and Quality, 2007). The concerted efforts of all stakeholders focused on preventing medical errors and improving safety and quality of care that patients receive. In modern society, the health care system has established that medical errors do not only emanate from healthcare providers, but also emanate from the systems within the health care system. Therefore, health care system should improve competencies of healthcare providers and streamline its systems.
Currently, quality indicators have proven to be effective in assessing the safety and quality of care that healthcare centers provide to patients. AHRQ derives quality indicators from best medical practices, which are evidence-based practices that are effective in measuring health outcomes. Prior to the establishment of quality indicators by AHRQ, healthcare organizations did not share quality assessment outcomes. Hence, AHRQ enhances the sharing of quality assessment outcomes for the benefit of all stakeholders in the health care system. AHRQ has formulated four categories of quality indicators, namely, “inpatient quality indicators, patient safety indicators, prevention quality indicators, and pediatric quality indicators” (p. 4). Inpatient indicators depict the quality of care that healthcare centers provide. Since safety is essential in the provision of health care, patient safety indicators depict adverse events or medical errors that health care providers can avoid. While prevention quality indicators depict the conditions of ambulatory care, pediatric quality indicators merge all the three indicators for the benefit of the pediatric population.
National Patient Safety Goals and Clinical Outcome
Enhancing safety of medications is one of the goals of NPSG. Safety of medications is an issue in the health care system because the use of medications is prone to errors, which have adverse effects on patients. When patients visit a healthcare center, healthcare providers prescribe appropriate medications. Given that healthcare providers may be unable to access medication history of the patients, new medications may duplicate current medications, omit appropriate medications, or contain inappropriate dosages, which constitute medication errors. According to Masica, Richter, Convery, and Haydar (2009), medication errors causes about 7000 deaths annually in the United States and 50% of these errors happen during transitions such as discharge, transfer, or admission. The occurrence of medication errors during transitions indicates the existence of inconsistencies in medication regimens. Hence, to prevent occurrence of medication errors, The Joint Commission formulated the goal of improving safety of medications among patients.
The goal of enhancing safety of medications has significant potential of improving clinical outcome among patients. Labeling of medications is one of the ways of enhancing the safety of medications. Tragic medication errors often emanate from misplacement of medications due to change of containers. “The labeling of all medications, medication containers, and other solutions is a risk-reduction activity consistent with safe medication management” (The Joint Commission, 2013). Adherence to the labeling rules by indicating the strength, quantity, concentration, and the expiration date is critical in promoting the safety of medications in a clinical environment. Before administering medications, the healthcare providers need to double check labels on medications to confirm if they are the right medications for a given patient. Thus, proper labeling of medications in a clinical environment helps in reducing medication errors that emanate from mismatch of medications, and thus improve clinical outcomes of patients.
Maintenance of accurate medication records aids in improving the safety of medications that patients receive. Since medications have adverse effects, which worsen when contraindications occur, healthcare providers should understand medication history of patients before administering new medications. Administration of medications without considering medication history of patients is quite dangerous because it predisposes patients to serious health risks of adverse events or contraindications. Hence, to enhance safety of medications, reconciliation of medications is necessary. According to The Joint Commission (2013), reconciliation of medication entails the resolution of discrepancies that exist between current medication and new medication with the objective of ensuring that the new medications do not elicit adverse reactions or contraindications, which are harmful to patients. Therefore, accurate keeping and appropriate use of medication records helps in preventing medical errors and improving the safety of medications among patients.
Improving safety of medications depends on the knowledge that patients have regarding their medications. Normally, patients take more than one type of medication, which can confuse them in terms of dosages and frequency. If patients do not have enough knowledge of their medications, there are high chances that they can abuse the medications. Thus, education of patients is essential so that they can understand the nature of the medications that they take. Juarez, Gack-Smith, Bauer, Jepsen, Paparella, Vongoerres, & McLean (2009) state that patients play a central role in promoting safety of medications, and thus healthcare organizations should provide accurate information about their medication. In this view, accurate information about medications is necessary for patients to improve their safety. Johnson, Mooney, Mckagen, and Robbins (2007) argue that education of patients enhances their involvement in care, thus promotes their safety in the use of medications. Overall, education of patients is critical in improving adherence to medications and consequently the safety of medications.
Impact of National Patient Safety Goals and Quality Indicators on Program
To improve safety and quality of care that patients receive in the health care system, The Joint Commission has several programs. Hospital accreditation program is one of the programs that are important in reducing the occurrence of medical errors while improving safety and quality of health care. In this view, NPSG and AHRQ have significant impact on hospital accreditation program because they formulate goals and quality indicators respectively that healthcare providers must follow so that they can deliver safe and quality care to the patients. The hospital accreditation program recommends the use of at least two ways of identifying patients to enhance accuracy of identification during the provision of health care services. Medical errors usually occur when health care providers fail to match a given therapy with the right patient. Mismatch of therapies and patients occurs due to inaccurate identification of patients. The Joint Commission (2013) asserts that accurate identification of patients and proper labeling of medications help in prevention of medical errors caused by misidentification. Therefore, accurate identification of patients and proper labeling of medications enhance effectiveness of the hospital accreditation program in the prevention of medication errors that happen in the clinical environment.
Since poor communication among healthcare providers poses significant risk to patients. Accurate communication among healthcare providers who diagnose, treat, and provide care aids in the provision of safe and quality care. Hence, the goal of enhancing communication among healthcare providers improves hospital accreditation program by ensuring that there is timely diagnosis and reporting of results. The Joint Commission (2013) recommends that healthcare centers need to develop procedures of managing communication among healthcare providers so that there is accurate and timely reporting of diagnostic results for patients to receive appropriate treatment. Thus, the goal of enhancing communication among healthcare providers will ensure that the hospital accreditation program assesses the accuracy and the urgency of sharing crucial information within the hospital environment.
Medication errors cause a considerable number of deaths in the healthcare environment. Masica, Richter, Convery, and Haydar (2009) state that medication errors cause about 7000 deaths per year in the United States, and thus prompting the need of reconciling medications that patients receive during the treatment period. The major cause of medication errors in a hospital in the environment is inappropriate labeling, which leads to their wrong use. In this view, The Joint Commission (2013) states that to improve safety of medication in a healthcare setup, healthcare providers should label all medications to prevent occurrence of mediations errors. Additionally, the goal requires hospital accreditation programs to consider reconciliation of medications as a way of avoiding adverse events or contraindications with the use of drugs. Therefore, the goal of enhancing safety of medications enables the hospital accreditation program to assess labeling and reconciliation of medications as factors that determine incidences of medication errors.
Reduction of nosocomial infections is another goal of the NPSG. Poor hygienic practices in the healthcare environment have made many patients to acquire nosocomial infections. Cather-related bloodstream infections and surgical site infections are some of the nosocomial infections that are common in the healthcare environment. Center for Disease Control and Prevention (CDC) in conjunction with the World Health Organization (WHO) have developed hand hygiene guidelines that aid in prevention of nosocomial infections. Hence, The Joint Commission (2013) demands that healthcare providers should comply with hand hygiene guidelines as recommended by CDC and WHO. Moreover, the goal recommends the use of evidence-based practices such as impregnation of catheters while following standard protocols. Thus, the goal of preventing nosocomial infections will ensure that the hospital accreditation program considers the use of evidence-based practices in prevention of nosocomial infections.
Safety of patients is paramount in the health care system because healthcare providers usually cause medical errors that threaten the lives of many patients and at times lead to death. In the year 2000, the Institute of Medicine released a shocking report, which indicated that medical errors rank as the eighth cause of death in the United States. The report compelled The Joint Commission to formulate National Safety Goals. The goals are applicable in accrediting healthcare centers so that they can provide services that meet required standards in terms of safety and quality. Additionally, AHRQ has formulated quality indicators that depict the quality of care in a given healthcare environment. Since medication errors are common, the NPSG goal of enhancing medication safety is necessary in improving clinical outcomes of patients. NPSG has significant impact on hospital accreditation program, which is one of the programs under The Joint Commission. The NPSG ensures that the accreditation program focuses on accurate identification of patients, effective communication among healthcare providers, reduction of medication errors, and prevention of nosocomial infections. Thus, NPSG and AHRQ play a central role in setting safety goals and quality indicators that are essential in improving the safety and quality of care that patients receive in the health care system.
Agency for Healthcare Research and Quality (2007). Evaluation of the Use of AHRQ and Other Quality Indicators.
Bion, J. (2008). Patient Safety: Needs and Initiatives. Indian Journal of Critical Care Medicine, 12(2), 62-66.
Johnson, S., Mooney, B., Mckagen, C., & Robbins, J. (2007). Strategies for improving safety through patient and family involvement in care. Patient Education Management, 43(1), 25-36.
Juarez, A., Gack-Smith, J, Bauer, T., Jepsen, Paparella, S., Vongoerres, B., McLean, S. (2009). Barriers to emergency departments’ adherence to four medication safety-related Join Commission National Patient Safety Goals. Joint Commission Journal on Quality and Patient Safety, 35(1), 49-59.
Masica, A., Richter, K., Convery, P., & Haydar, Z. (2009). Linking Joint Commission inpatient core measures and National Patient Safety Goals with Evidence. Baylor University Medical Center Proceedings, 22(2), 103-111.
The Joint Commission (2013). National Patient Safety Goals Effective 2013: Hospital Accreditation Program. Web.
Watson, D. (2009). National Patient Safety Goals and Implementation. AORN Journal, 90(1), 127-127.