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JCAHO Adds Patient Safety Standards for Hospitals

Nancy Tarleton Landis

New hospital standards focused on patient safety and medical error reduction have been approved by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Implementation in July 2001 is planned.

JCAHO said the standards "augment the nearly 50% of current standards related directly to patient safety" by requiring hospitals to establish ongoing patient safety programs. The current standards require health care organizations to identify, report internally, and analyze sentinel events (adverse events that seriously harm patients) and to take action to prevent their recurrence.

Patricia Kienle, who represents ASHP on JCAHO's Hospital Professional and Technical Advisory Committee, says the patient safety standards will be a major focus for JCAHO this year. It is important, she said, that most of the new standards are in the leadership chapter of the hospital accreditation manual: "Bringing these to the attention of hospitals' administration and boards of directors will be a big step forward." Pharmacy directors—and all hospital pharmacists—said Kienle, "will be recognized as leaders in a very high-profile [push for patient safety]."

The leadership chapter requires hospital leaders to create an environment that encourages error identification and remedial steps for reducing the likelihood of future, recurring errors. Such an environment includes minimization of individual blame or retribution for those involved in an error or in reporting an error. The focus is to be on establishing an actual or virtual organizationwide patient safety program that uses internal and external data and experience to prevent the occurrence of errors.

New patient safety standards also occur in other chapters. Under "Improving Organization Performance," hospitals are to implement a program for proactive assessment of high-risk activities related to patient safety and to undertake appropriate improvements. These activities are to be selected by the hospital on the basis of available information, including information provided by JCAHO through its study of sentinel events.

The chapter on management of information states that hospitals are to aggregate patient safety-related data to identify risk to patients, apply knowledge-based information to reduce these risks, and effectively communicate among all caregivers and others involved in patient safety issues to guide and improve professional and organizational performance.

Standards in the chapters on patient rights, education of patients and their families, continuity of care, and management of human resources also emphasize patient safety. The standards call for the patient, patient's family, or both to be informed about the results of care, including unanticipated outcomes.

Kienle anticipates that patient safety standards may be added to other clinical and operational chapters in the future.

The new standards were reviewed by patient safety groups and representatives of government, hospitals, insurance companies, universities, and advocacy groups and evaluated by professional organizations and a sample of accredited hospitals. ASHP submitted comments.