National Patient Safety Goals and You!
The Joint Commission, nemesis of hospital administrators everywhere, is responsible for policing all of us health care people to make sure that things are done properly and safely. They have ALOT of rules to do their work with. These rules are not legislated rules. They’re not The Law. They haven’t been voted on by a legislature or passed by referendum. Some of their rules have scientific basis, some don’t. Why am I telling you all this? Because as a patient you will see the Joint Commissions stamp on everything that gets done. The goal is safety remember. Safety first.
The Joint Commission has identified six major areas in which patient safety is key, and designated these National Patient Safety Goals, or NPSGs. I’m going to give you the goals and then tell you why they are ineffective. They are:
1. IDENTIFY PATIENTS CORRECTLY. This means two and sometimes three identifiers. So the nurse asks you your name and birthday, compares it with a name and medical record number. If you’re having surgery, this question/answer thing will happen at least three times. It’s not lack of communication that makes us ask over and over. These are the rules that have been imposed for this goal. If you see 18 patients in a day and you don’t know any of them, you need these rules.
2. IMPROVE STAFF COMMUNICATION. Speaking of which. The rules for this goal are numerous and usually involve paperwork.
3. USE MEDICINES SAFELY. The only way you as a patient might see this is if you are getting a drug or therapy that really really really needs to be the right one, like blood and chemotherapy. In these cases we will use goals 1 and 2 to implement 3, and this is a good thing. Other rules that you won’t see involve labeling syringes, double checking with another provider on dosing, dating meds that expire etc. This goal is also the reason for the medicine reconciliation form that nurses always have to fill out. So if you coming in to have your bunion fixed and wonder why the nurse is obsessing over your cholesterol medication, that’s why.
4. PREVENT INFECTIONS. Well of course. Various rules are in place to help with this, the biggest one being the hand washing signs and ubiquitous alcohol-based dispensers every 10 inches on the walls. Other things include wiping ports with alcohol before accessing them, new ways of cleaning skin before putting in IVs and other lines, and sterile procedures of other kinds. You’ll see this goal mostly through the hand washing rituals, and this is a good thing. But remember, hospitals are full of bugs. If you don’t want to get an infection, don’t go to a hospital.
5. IDENTIFY PATIENT SAFETY RISKS. Bizarrely, this goal is elaborated on the joint comission website as only: identifying patients at risk for suicide. OK. Good goal.
6. PREVENT MISTAKES IN SURGERY. Oh yeah. This is a big one. This is probably why that kid that needed eye surgery that I talked about in a previous blog had a 37 page chart. The rules here are legion. You will see many of them in practice. The constant re-identification of your person. The constant repetition of the same questions. The pen with which your surgeon will mark “the correct side” even if it is obvious to the man on the street seeing as the “correct side” is hanging half off. The pre-time-out-time-out, when we will give you psychotropic drugs and then ask you who you are and what you are having done. There’s another time out after you’re asleep by the way. Just so you know. To be safe.
OK but here’s the problem. There are a million studies quoting all sorts of numbers about the rate of errors in hospitals, the number of lives lost, the money it costs, etc. Why, if all these goals are in place with all the rules, is this still true? BECAUSE PEOPLE ARE HUMAN! People are sick. Nurses are overworked. Doctors are rushed. Hospital care is now quite impersonal; you tend to be a medical record number, a room number, or a disease instead of a person. Money rules all. Computers are supposed to help but if you look around any hospital ward, every one is on the computer. It is entirely possible to take care of someone without knowing their name. As long as all these things are true, mistakes will happen. So again, be your own advocate. Of all the checks and balances built into our system, it doesn’t hurt to have the one that knows you the best. You.