Farther Down the Path of Accreditation:
Core Measures, Health Literacy and Safety Goals

 By Molly.Procuniar,  BSN-RN, BA, FF-P

Though hospitals often struggle in preparing for an accreditation survey, this journey of self-discovery is an opportunity to learn and grow as an organization.  On the face of it, the initiatives required for achieving core measures, enhancing health literacy and meeting National Patient Safety Goals appear challenging.  However, by applying simple technologies and improving methodologies, the road to accreditation and better patient safety can be more readily achieved.  

Gain Ground with Core Measures and Disease-Specific Certifications
Core measures and disease-specific certifications are tricky subjects. The Joint Commission’s most recent annual report revealed that facilities really struggle to gain a foothold with core measures.  They reported only four measures having a 90 percent compliance rate with compliance on other measures as low as 60 percent. While data sets for core measures are reported back to The Joint Commission and to the Centers for Medicaid and Medicare Services, how does a hospital continually stay on top of what is considered best practice?  Moreover, how does it successfully attain certification in a disease-specific category?

A critical step in achieving both these goals is to ensure up-to-date, peer reviewed order sets are being used throughout the hospital.  This includes:

• Clinical Pathways (e.g. Pneumonia, Rule-Out MI, or Knee Replacement)
• Department Order Sets (e.g. Insulin sliding scales, Portland protocols, or weight-based Heparin)
• Doctors’ Personal Order Sets (e.g. Routine Orders)

Placing order sets in one easily accessible digital library can facilitate version control and allow qualified staff members to efficiently update them.  

Leverage Technology to Drive Health Literacy
Health literacy is quickly becoming a primary focus for The Joint Commission. While the registration areas of most facilities offer educational materials that accommodate one or two different nationalities, The Joint Commission’s concern is much broader.  Health literacy is focused on making sure the patient understands what is being communicated at all levels. This goes beyond registration and the language barrier. The Joint Commission is concerned about basic comprehension. Patients being admitted to the hospital have varying literacy rates – and some cannot read at all. In fact, one percent of Americans are illiterate. Yet, the primary way information is disseminated is through written documentation. The Joint Commission is challenging healthcare facilities to change the way they handle patient education.

To address health literacy, hospitals must think outside the box.  Education should start in the registration areas. Most ADT systems are capable of accepting an admission diagnosis code.  With a document management system, customized kits can be printed based on diagnosis information entered at the time of admission. Patient education materials printed at the point of entry starts the process of patient involvement and patient advocacy which enhances patient safety and leads to improved health over time.  This same type of system can address The Joint Commission’s larger concerns about health literacy.   Patient education materials can be reformatted to print in multiple languages, large text or simple text.  Even a storyboard format might need to be considered.  Stocking a wide variety of preprinted forms would be cost-prohibitive, but by leveraging a digital library and printing education materials on-demand, hospitals can readily respond to the varied needs of their patient population.

Make Headway with National Patient Safety Goals
First established by The Joint Commission in 2003, the National Patient Safety Goals change each year. Some goals are more difficult to achieve than others, but hospitals have risen to challenge.  Some implement technology.  Others invent new programs. Still others become incredibly creative at implementing new policies that work for their particular culture. Each approach attempts to give caregivers the tools they need to improve patient safety because, in the end; patient safety resides in the hands of the caregiver.

The Joint Commission’s most recent annual report indicated that hospitals have largely succeeded in being compliant with National Patient Safety Goals. However, there are always ways to make the path to compliance easier to navigate. Here are five of the 2008 Safety Goals where there are significant opportunities for technology to make an impact.

Goal 1: Accurately Identify the Patient
Goal one requires that caregivers use two patient identifiers when providing care, treatment or services.  Having access to identifiers such as name, date of birth or medical record number is essential.   Here, technology can be a tremendous aid. An application capable of directly printing patient demographics on patient forms as well as the wristband ensures that these identifiers are readily available for all caregivers. Likewise, capturing the patient’s photograph and adding it to the wristband further enhances patient identification. The wristband is the primary form of identification and placing the wrong wristband on a patient can lead to disastrous results. A photograph on the wristband can immediately identify that the patient has been incorrectly banded.

Finally, adding a barcode to the wristband increases accuracy in patient identification for Bedside Point of Care (BPOC) applications.  However, it’s important to ensure the barcode for the wristband is unique.  Facilities that have implemented wristbands without unique barcodes have found that caregivers often don’t scan barcodes while they’re with the patient.  Instead, they scan a label barcode at the nurse’s station, effectively bypassing the additional safety provided by automated patient identification.  A unique wristband barcode helps ensure the patient is automatically and correctly identified at the bedside.

Goal 2: Improve Communication
Goal two addresses both improving communication among caregivers and includes a “do not use” list created by The Joint Commission. While the heart of this initiative involves changing caregiver habits, some aspects of this goal can be assisted by technology. In the most basic sense, hospitals still using embossing systems or “blue plates” are inhibiting communication at the lowest level. How many times does the embossing plate effectively transmit the information in a legible manner? That communication can be improved with labels.  However,  it can be enhanced even further by printing patient demographics directly onto forms – eliminating the need for labels altogether. This also enhances patient safety by eliminating mislabeled forms.

 A second way technology can assist in improving communication is through a terminology audit. This audit can provide a “final review” of the form before the Review Board approves its use by the general population. All the abbreviations and “do not use” acronyms on The Joint Commission’s list can be filtered to ensure none were overlooked. Technology cannot change people’s habits, but it can help improve communication and increase compliance with Joint Commission’s initiatives.

Goal 3: Improve the Safe Use of Medications
Goal three is the “sound-alike, look-alike” drug awareness safety provision.  Like the second goal, it is aimed more at the caregiver and focuses on maintaining a high level of alertness. Technology can address this from two perspectives. First, you can use the same terminology audit to check forms for “sound-alike, look-alike” medication names to ensure these medications don’t appear on documents approved before final review.

Second, wristbands can be printed with unique barcodes for BPOC applications to facilitate more accurate medication administration. Forcing nursing workflows to use wristband barcodes rather than scanning labels outside the patient room will assure positive patient identification and enhance the safety of medication administration.

Goal 9: Reduce Patient Risk from Falls
The primary responsibility for reducing falls lies with the clinicians, but technology can assist caregivers. Most hospitals that conduct a risk assessment at the point of entry add only a few simple steps to the registration process.  This workflow can be streamlined by gathering fall risk identifiers in the ADT to trigger the creation of fall risk documents, when appropriate and on an as-needed basis. Placing these educational flyers in the patient’s hands on admission greatly enhances patient safety and addresses this important goal. Furthermore, the patient wristband can be color-coded to alert other staff members that the patient is a fall risk. These wristbands provide an immediate indicator that remains with the patient throughout his or her hospital stay.

Goal 13: Encourage Patient Involvement in their Care
Patient involvement is the central theme of goal 13. The Joint Commission feels that the more you can get a patient directly involved in their care – the better. Sometimes this is easier said than done. Patient advocacy is an uphill battle that care providers have been fighting for years. On one hand, clinicians struggle with how to get patients to take responsibility for their health and lead better, more productive lives. On the other hand, challenging patients arrive with pre-set notions about what kind of care or treatments they feel they should or should not be receiving.

Patient involvement is still the key. Educating patients and empowering them with the tools they need to live healthier, fuller lives is the pivot point on which their hospital experience turns.   Once again, the right technology can play a vital role in helping to educate patients when they first enter the hospital.  It enables the hospital to provide patients with a personalized package of information relevant to them and their condition. Hospitals have the means to speak to patients at their point of need.  At the same time, technology can ease the burden by producing information in a format patients can comprehend, languages their populations speak, text they are able to easily see, and  in an attractive medium they will want to read – so the message will really go the distance.

At one time, hospitals invested a lot of time and money to develop professional discharge instructions and patient education packets.  However, these documents are usually not in a format supported by today’s HIS systems. Thus, as hospitals transition to a new HIS system, much of that content, formatting and layout is lost.  Nonetheless, with planning and the right technology, those critical instructions and educational materials can be produced in a personalized, professional way.  By retaining the original documents in a digital library to be printed on demand, facilities can recapture control over these vital and familiar documents to communicate and engage patients during their care.

Standard Register’s SMARTworks® Clinical Enterprise offers a robust solution to help hospitals initiate improved processes for addressing core measures, health literacy, and the patient safety goals that The Joint Commission has established. To learn more about how you can leverage this technology to improve compliance and enhance patient care, contact us now

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