By: Kyle Walton
The National Patient Safety Goals (NPSGs) reflect the ongoing efforts by The Joint Commission (TJC) to focus healthcare providers’ attention on those topics that are of highest priority to patient safety and quality care. Compliance with the NPSG performance elements are vital components of achieving and maintaining TJC hospital accreditation. Innovative use of clinical documentation software combined with a logical workflow process can make the right thing to do the easy thing to do for the busy clinician. Bottom line? Better charting, greater compliance, and more EMR user satisfaction!
Tools and Tips: What’s available to help the busy Clinician be successful with regulatory compliance?
Although different vendors have unique configuration capabilities, most clinical documentation software systems have inherent features that can increase compliance with structured processes like the NPSG. Standard features of the McKesson Horizon™ Clinicals suite of products include:
· Barcode technology for positive patient and medication identification.
· Real-time availability of data to multiple users in multiple locations.
· Numerous configuration options to group defined performance elements into topic-specific categories. These could include Checklists with built-in prompts that lead the clinician through the required steps while promoting the use of the desired “buzz words” in documentation.
· On-screen capabilities for tracking and trending specific data elements over time.
NPSG compliance can be enhanced with creative documentation solutions. Let’s focus on this one:
| 2011 National Patient Safety Goals |
| NPSG.01.01.01 | Use at least two patient identifiers when providing care, treatment, and services. |
| NPSG.01.03.01 | Eliminate transfusion errors related to patient misidentification. |
| NPSG.02.03.01 | Report critical results of tests and diagnostic procedures on a timely basis. |
| NPSG.03.04.01 | Label all medications, medication containers, and other solutions on and off the sterile field in peri-operative and other procedural settings. |
| NPSG.03.05.01 | Reduce the likelihood of patient harm associated with the use of anticoagulant therapy. |
| NPSG.03.06.01 | Maintain and communicate accurate patient medication information. (eff. 4/01/2011) |
| NPSG.07.01.01 | Comply with either the current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or the current World Health Organization (WHO) hand hygiene guidelines. |
| NPSG.07.03.01 | Implement evidence-based practices to prevent health care–associated infections due to multidrug-resistant organisms in acute care hospitals. |
| NPSG.07.04.01 | Implement evidence-based practices to prevent central line–associated bloodstream infections. |
| NPSG.07.05.01 | Implement evidence-based practices for preventing surgical site infections. |
| NPSG.15.01.01 | Identify patients at risk for suicide. |
What exactly are “Critical Results” and why are they significant?
Critical Results are abnormal values from diagnostics such laboratory tests, imaging studies, stress tests, EKGs, etc. that fall significantly outside normal ranges and may trigger the need for immediate medical intervention. Also known as a “critical value”, “panic value” or “red alert”, a critical result warrants rapid physician communication based on the value itself. Clinically significant changes in the patient’s condition may also be considered a Critical Result.
To determine whether immediate physician notification is warranted, a critical result is considered in context with that specific patient’s condition and diagnoses. A result that is usually considered critical may be expected and normal in certain disease states. In addition, the result of a repeat or “follow-up” test that is still within the “panic value” range but is being actively treated and is showing improvement, may not necessarily be considered a critical result reportable to the physician.
As with many other process-specific documentation configurations, it is important to first clearly define the process and the workflow in policy/procedure and then design the supporting documentation.
| Foster the adoption of consistent Critical Results documentation by simplifying the process.
Charting for Critical Values can be spot-lighted by placing it in its own Critical Values class. Events to chart in this class include: - Assessment and interventions for acute changes in patient condition.
- Acknowledgement of and interventions for critical lab and other diagnostic values.
- Urgent MD notifications for critical values and/or patient status changes.
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Sample Charting
| Acute change in condition 
| Transfusion reaction causing an acute change in condition 
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| Sometimes a Critical Result is not unexpected. The rationale is charted to explain why MD contact is not indicated. 
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