In late 1999, the Institute of Medicine issued a report regarding medical errors in United States hospitals. The report concluded that every year, as many as one million hospital patients are injured and 98,000 die as a result of preventable medical errors, costing the nation an estimated $40 billion annually. In response, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) issued uniform standards for caregivers to follow in order to reduce the occurrence of medical errors.

Joint Commission on Accreditation of Health Care Organizations

The JCAHO is an entity that develops standards for health care organizations intended to improve the safety and quality of care provided to the public. Comprised of a board of physicians, nurses, and consumers, the JCAHO is an independent non-profit organization which provides health care accreditation to health care organizations. In mid-2002, the JCAHO issued National Patient Safety Goals (NPSGs), addressing common medical error problems.

Common Types of Medical Errors

• Medication – being given the wrong drug or dose, or drugs given at the wrong time or to the wrong patient
• Wrong-site surgery – surgeries performed on the wrong part of the body or on the wrong patient; sometimes the wrong operation is even performed
• Hospital-acquired infections – infections caused by lack of proper hygiene (usually occurring when a physician or nurse fails to sufficiently wash their hands) or use of defective medical equipment

Common Reasons for Medical Mistakes

• Misplaced patient charts or illegible handwriting
• Overworked, inexperienced and unsupervised interns and residents, particularly at teaching hospitals, who may work as many as 130 hours per week
• Nationwide shortage of registered nurses
• Increasing caseload demands on emergency rooms with limited funding

Precautions a Health Care Organization Should Take – NPSGs

The NPSGs issued by the JCAHO seek to provide uniform standards by which health care organizations must comply. The JCAHO has outlined six NPSGs for 2005. The JCAHO intends to issue new or revised NPSG requirements every year.

The 2005 NPSGs include:

• Using two reliable identifiers for patients to ensure that medicines are given to the correct patient (e.g., simply using a room number is an inadequate identifier)
• Improving communication through standardized abbreviations, symbols, and acronyms to avoid serious medication mistakes (e.g., writing out “unit” instead of “U” which can be mistaken for a “0″) and by writing down and then reading back all verbal telephone orders, including medication orders
• Removing certain concentrated medications from patient care units that may be deadly if accidentally administered
• Assuring that all intravenous pumps have built-in “free-flow” protections (add-on valves are no longer acceptable) to reduce the risk of inadvertent overdoses
• Testing clinical alarm systems to make sure they can be heard at a distance and over background noises and keeping an inventory of such alarms
• Reducing health-care associated infections through proper hand hygiene including using alcohol-based hand cleaner

Compliance with NPSGs

The JCAHO evaluates more than 15,000 health care organizations including ambulatory care, assisted living facilities, behavioral care facilities, home care, hospitals, laboratories, long term care facilities, HMOs, and office based surgery facilities. In order to earn and maintain accreditation, these health care organizations must go through extensive on-site reviews by a JCAHO team at least once every three years. If the health care organization’s performance complies with the standards to the satisfaction of the JCAHO, they will be awarded accreditation. A list of accredited organizations is posted on the JCAHO’s website and updated periodically.