Confusion in identifying patients, miscommunication among caregivers, wrong-site surgery, infusion pumps, medication mix-ups and clinical alarm systems will be the focus of the National Patient Safety Goals for 2003 set by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

For each of the National Patient Safety Goals, there are clear, evidence-based Recommendations to help health care organizations reduce specific types of health care errors. Beginning January 1, 2003, the more than 17,000 JCAHO-accredited health care organizations that provide care relevant to the Goals will be evaluated for compliance with the Recommendations or implementation of acceptable alternatives.

"The know-how to prevent these errors exists," says Dennis S. O'Leary, M.D., president, JCAHO. "We now need to focus on making sure that health care organizations are actually taking these preventive steps."

The 2003 National Patient Safety Goals and Recommendations are:

Goal 1: Improve the accuracy of patient identification.

Recommendations:

Use at least two patient identifiers (neither to be the patient's room number) whenever taking blood samples or administering medications or blood products. Prior to the start of any surgical or invasive 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.

Goal 2: Improve the effectiveness of communication among caregivers.

Recommendations:

Implement a process for taking verbal or telephone orders that requires a verification "read-back" of the complete order by the person receiving the order. Standardize the abbreviations, acronyms and symbols used throughout the organization, including a list of abbreviations, acronyms and symbols not to use.

Goal 3: Improve the safety of using high-alert medications.

Recommendations:

Remove concentrated electrolytes (including, but not limited to, potassium chloride, potassium phosphate, sodium chloride >0.9%) from patient care units. Standardize and limit the number of drug concentrations available in the organization.

Goal 4: Eliminate wrong-site, wrong-patient and wrong-procedure surgery.

Recommendations:

Create and use a preoperative verification process, such as a checklist, to confirm that appropriate documents, (e.g., medical records, imaging studies) are available. Implement a process to mark the surgical site and involve the patient in the marking process.

Goal 5: Improve the safety of using infusion pumps.

Recommendation:

Ensure free-flow protection on all general-use and PCA intravenous infusion pumps used in the organization.

Goal 6: Improve the effectiveness of clinical alarm systems.

Recommendations:

Implement regular preventive maintenance and testing of alarm systems. Assure that alarms are activated with appropriate settings and are sufficiently audible with respect to distances and competing noise within the unit.

The 2003 Goals were developed by an expert advisory group composed of physicians, nurses, risk managers and other professionals. The Goals and related Recommendations were drawn from the 25 issues of JCAHO's patient safety newsletter Sentinel Event Alert. The advisory groups identified a total of 44 expert- and evidence-based recommendations from the publication that include the 11 associated with the 2003 Goals. The remaining recommendations constitute an initial pool upon which future National Patient Safety Goals may be based.

"The Goals and Recommendations selected by the advisory group are all high-impact, low- cost targets," says Henri R. Manasse Jr., Ph.D., chair of the Sentinel Event Advisory Group; executive vice president and CEO of the American Society of Health-System Pharmacists; and past chair of the National Patient Safety Foundation. "This initiative should really make a difference in improving patient safety."

"The Board of Commissioners has identified patient safety as the top priority for the Joint Commission," says Rhonda Anderson, R.N., member, JCAHO Board of Commissioners, and chief operating officer, Desert Samaritan Medical Center, Mesa, Arizona. "The Board's willingness to establish these specific performance expectations underscores its commitment to the achievement of improvements in patient safety."

Five of the six National Patient Safety Goals correlate with early drafts of the core safe practices being identified by the National Quality Forum (NQF). The public/private sector-based NQF is expected to finalize its list of safe practices by year-end. Future iterations of the Joint Commission's National Patient Safety Goals will draw upon the NQF list of safe practices.

The Joint Commission expects to issue National Patient Safety Goals and Recommendations each year. Aggregate data on achievement of the Goals will be made public each year and individual organization compliance information will be disclosed when the reformatting of Joint Commission organization performance reports is completed in mid-2004.