Clinical Geriatrics

I have found myself appreciating The Joint Commission’s National Patient Safety Goals more than ever, despite my original impression that these stated what all good doctors should already know and be following in their daily professional lives. Time and again through my frequent rounds I find patients in the hospital being discharged on the wrong medication or dosage being prescribed. Patients are not always prescribed an essential medication that they have been previously taking for a problem other than the one necessitating the hospital admission. Unnecessary urinary catheters continue to be placed in the ER, but somehow frequently remain for days without questioning their need. Slipper socks that are too tight may form tourniquets and result in constricted blood flow, discomfort, and skin breakdown. The wrong diets continue to be delivered to a patient’s bedside. Patients who are at high risk of falling may have an “as-tolerated” activity order and not benefit from appropriate supervision. The list, unfortunately, goes on, and so does the risk of injury and bodily harm to our patients.

I thought it would be worth listing the major aspects of the 2008 National Patient Safety Goals for readers to ponder, and hopefully incorporate into their daily practice. Fortunately, institutions will be working toward implementing these as well, and medical staffs will clearly benefit from the efforts made to accomplish these goals. Simply stated, the goal of this effort is “to promote specific improvements in patient safety.” The patient safety goals are tailored to specific settings such as ambulatory care, home care, hospital, and long-term care. (Visit www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/ for specific information.) The goals include the following:

•Improve the accuracy of patient identification
•Improve the effectiveness of communication among caregivers
•Improve the safety of using medications
•Reduce the risk of healthcare-associated infections
•Accurately and completely reconcile medications across the continuum of care
•Reduce the risk of patient harm resulting from falls
•Reduce the risk of influenza and pneumococcal disease in institutionalized older adults
•Reduce the risk of surgical fires
•Encourage patients’ active involvement in their own care as a patient safety strategy
•Prevent healthcare-associated pressure ulcers
•Identify safety risks inherent in one’s own patient population
•Improve recognition and response to changes in a patient’s condition

I hope that you will embrace these 2008 National Patient Safety Goals in your own way, and work with other members of your healthcare team to make them a reality. We must not minimize the importance of these initiatives. Clearly, this list represents only the “tip of the iceberg,” with many other possible initiatives capable of benefiting our patients. It is a good start, however, and one I encourage us all to strive to achieve.

Dr. Gambert is Chairman, Department of Medicine, and Physician-in-Chief, Sinai Hospital of Baltimore, and Professor of Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.