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The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) recently released its 2008 National Patient Safety Goals in an effort to promote specific improvements in hospitals. A key change to the issuance of the 2008 National Patient Safety Goals (available at www.jointcommission.org) is the requirement that hospitals take specific actions to reduce the risks of patient harm associated with the use of anticoagulant therapy. The anti-coagulation patient safety goal is not meant to replace or substitute clinical guidelines for the use of these agents with any specific disease; instead, it provides implementation expectations that complement published guidelines. JCAHO’s goal is to individualize anticoagulation management strategies for each patient receiving the therapy. Hospitals are obligated to use approved protocols for initiation and maintenance of anticoagulation therapy.

There are two major challenges associated with using anticoagulants in the hospital: 1) delivering anticoagulation therapy in a timely manner can be difficult, and 2) ensuring that the right drug is delivered to patients in the correct dose for the appropriate duration can be challenging. JCAHO recommends the use of unit-dose products and pre-mixed infusions that are delivered via programmable infusion pumps for patients administered heparin intravenously. This should be done to prevent free flow of the infusion and to control the dosage. A baseline International Normalized Ratio, or INR, for all patients receiving warfarin should also be obtained and dietary services should be provided to patients receiving warfarin. Educating patients and their families or caregivers is also critical to improving patient safety. Physicians need to emphasize the importance of follow-up and monitoring, compliance issues, dietary restrictions (eg, vitamin K interferes with warfarin), and adverse drug events and interactions.

Other Important Reminders

Improving the accuracy of patient identification and medication safety remain the fundamentals of the 2008 National Patient Safety Goals. JCAHO requires that healthcare organizations use two patient identifiers when providing care, treatment, or services so that patients can be correctly identified and matched to the service and/or treatment required. Furthermore, under protocols created in 2004 by JCAHO, a “time out” is required immediately before any procedure begins. It’s required that the entire medical team agrees on the patient’s identity and all of the required elements of the impending procedure by using verbal communication and consulting supporting documents, such as test results.

Medication safety can be ensured by encouraging the use of standard language and by using fewer abbreviations. Hospitals should publish a list of abbreviations annually that may be easily confused and clearly label “look-alike, sound-alike” drugs. Other JCAHO goals emphasize the importance of effective communication among caregivers. Healthcare-associated infections are also addressed because they can potentially increase lengths of hospital stay, morbidity, mortality, and costs, particularly as insurers no longer want to pay for these complications. Additionally, reducing the risk of influenza and pneumococcal disease in institutionalized older adults is paramount to patient safety. It can also behoove institutions to perhaps perform mandatory screenings for patients who are elderly, immunocompromised, or suffer from chronic obstructive pulmonary disease or emphysema.

Implementation of Goals is Critical

Despite the fact that the 2008 National Patient Safety Goals are the sixth set of goals released by JCAHO, unnecessary errors affecting patient safety continue to occur. Medical facilities providing care, treatment, and services relevant to these goals are now responsible for implementing the applicable requirements or effective alternatives, but some hospitals may still be actively engaging in education, training, and retraining of medical personnel. Fortunately, JCAHO provides guidance on how to effectively comply with each goal’s requirements on its website.

Dr. Levine has indicated to Physician’s Weekly that he has or has had no financial interests to report.