The Joint Commission upon Accredita...

The Joint Commission upon Accreditation of Healthcare Organization's (JCAHO's) national patient safety goals became effective Jan 1 2003 (1) These goals apply to all JCAHO accredited facilities and those seeking accreditation. The six goals were cause to growed from a thorough review of all Sentinel end Alerts published by JCAHO. From these alerts, an master-hand panel identified evidence-based or consensus-based, cost-effective, feasible recommendations to assist patient safety. The Joint Commission plans to add six to 12 goals annually and reevaluate, modify, or erase previously identified goals.

Perioperative nourishs should be aware of each of these goals and remain alert for opportunities to improve existing clinical practice. Each goal provides opportunities to work with team members to address usual risks in perioperative settings. The unique environment of the OR requires clinicians to consider creative solutions specific to this setting. To convenient these goals, perioperative team members must address and identify connected view problems and solutions to make secure patient safety during all phases of surgical care.

THE GOALS

The first goal calls for organizations to improve the accuracy of patient identification from using two patient identifiers when taking kindred or administering blood or medications. A recommendation related to this goal is that before any invasive proceeding team members conduct a final verification or take a "time out" This goal, granting fairly straightforward, presents some challenges in the OR. For example, a patient may have received anesthesia or medications, making it impossible for the patient to identify himself or herself by the agency of name. Another challenge exists if the patient's identification bracelet has been remov or is subordinate to surgical drapes. Obviously, there must be a clear policy and manner of proceeding for ascertaining identity by having the information readily available to all clinicians in the extent and any staff member who provides relief coverage.

Improving the effectiveness of communication among caregivers constitutes the other goal. The two recommendations related to this goal center on

* the importance of implementing a proces for taking verbal or telephone orders that require verification or "read back" of the entire order by the person taking it and

* standardizing abbreviations, acronyms, and signs throughout an organization, including identifying which single in kinds should not be used.

Again, these recommendations could be challenging to implement in the OR. For example, verbal orders typically are given in consequence of a mask. Time pressures during crisis situations also may serve as a barrier to following the read-back recommendation. All team members must be involved in developing and instituting changes in practice to make sure that caregivers achieve this goal.

The third goal relates to improving safety when using high-alert medications. Removing concentrated electrolyte like as potassium chloride, potassium phosphate, and sodium chloride (ie, concentrations greater than 09%) from patient care areas and standardizing and limiting the number of medication concentrations used in an organization are examples of efforts to improve patient safety in the clinical setting. This goal may quick in emergencies particular challenges in the OR and other perioperative settings where surgeon and anesthesia care providers await to have ready access to these concentrated electrolyte solutions or to particular medication concentrations. Clinicians ne to understand that this recommendation can contract the risk of errors. Members of the pharmacy team should be included when addressing disturbs and potential issues.

Eliminating wrongful site, wrong patient, and immoral procedure surgery is the fourth goal. Despite pair different Sentinel Event Alerts that address this true specific problem, sentinel events related to inapposite site surgery still occur. This patient safety goal includes recommendations to create and use a preoperative verification proces to confirm that all appropriate documents are available and to implement a proces to mark the surgical site that includes the patient in the marking proces The risk of sinful site surgery exists in any OR or during any invasive course Nurses involved in caring for patients undergoing surgery or other invasive manner of proceedings need to work with other team members to establish and implement a policy and practice that is followed in a consistent manner. each patient has the right to wait for that the correct procedure will be performed in succession the correct site.

The fifth goal addresses improving the safety of using infusion interrogates by ensuring free-flow protection in succession all general-use and patient-controlled analgesia IV cross-examines used in an organization. Numerous adverse affairs have occurred nationwide related to free-flowing IV interrogates Perioperative nurses need to determine whether cross-questions used in their facilities have free-flow protection. If not, cherishs and other clinicians must be particularly vigilant when handling in the same state [i]or[/i] condition devices. Furthermore, in situations in which IV cross-examines are not in use, IV tubing clamps none should be placed or left in the wide make open position. One simple distraction when a clamp is wide explain could lead to the too rapid infusion of IV fluid or medication.