By Gebhart, Fred
Drug Topics , Vol. 145, No. 4
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has revised its guidelines on patient safety. The commission will require hospitals and similar groups to identify problems before errors occur. The shift to prevention is based on standards long used in aerospace and other high-risk industries.
"We have built up a medical culture that is counter to patient safety because of the tendency to blame individuals," explained JCAHO safety specialist Richard Croteau, M.D. "We have to change processes and procedures to make it difficult to make a mistake. These are principles found in other high-risk industries and quite transferable to health care."
The new standards take effect in July. Changes start at the top. For the first time, hospital leaders are being pressed to create a culture of safety, said Victor Perini, director of pharmacy at Methodist Healthcare Central Hospital in Memphis.
JCAHO is almost as direct. New language requires health-care organization leaders to create an environment that encourages the identification of errors and the reduction of risk, said JCAHO spokeswoman Janet McIntyre. Health-are organizations must identify high risk activities and reduce risk before adverse events occur, she said. Organizations must aggregate data related to patient safety, analyze the data to identify risks, apply knowledge-based procedures to reduce risks, and effectively communicate the change to all caregivers and others involved in patient safety JCAHO wants organizations to share safety data to improve practices throughout the industry.
The guidelines also require hospitals to minimize individual blame and retribution for those involved in an error or in reporting an error. "These standards rely on system analysis to improve patient safety," said Don Nielson, M.D., senior vp. for quality leadership at the American Hospital Association. "They will help break down a lot of departmental barriers as the organization looks at patient safety across the board."
Those departmental barriers can't fall fast enough, Perini said. Pharmacy-- based changes such as pulling potassium chloride from floor stock have dramatically reduced specific types of medication errors, but every significant safety improvement has meant protracted battles with hospital administrators, nurses, and medical staff. …