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Barriers to Emergency Departments' Adherence to Four Medication Safety–Related Joint Commission National Patient Safety Goals

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Background: Medication errors are a serious public health threat, causing patient injury and death and sharply increasing health care costs. Serious preventable errors are most likely to occur in areas of increased complexity and technology, such as the emergency department (ED). Although The Joint Commission in 2002 approved the first set of National Patient Safety Goals (NPSGs) to decrease the occurrence of health care errors, the literature suggests that the goals are not fully implemented. In 2006, the Emergency Nurses Association (ENA) conducted a national, multisite survey (1) to describe barriers to full implementation of the 2006 NPSGs related to medication safety (then known as Goals 1, 2, 3, and 8) as reported by ED registered nurses (ED nurses) and (2) to investigate factors related to those barriers.

Methods: ED nurses (n = 2,220), managers (n = 129), and site coordinators (n = 126) representing 131 EDs completed surveys concerning NPSG implementation, policies, and barriers. Nonparametric statistical methods were used to analyze the data.

Results: ED nurses frequently reported barriers to adherence to NPSGs. Patient safety education was not related to NPSG adherence. A complex work environment, such as that associated with residents in training, mixed-shift hours, and state designation as a trauma center, was associated with reduced NPSG adherence.

Discussion: The low response rate (4.6%) to this study inherently limits the overall generalizability of the findings to the greater population of EDs. Yet, the findings suggest that substantial barriers remain to ED adherence to the NPSGs related to medication safety. Efforts to reduce the barriers should focus on system changes that facilitate adherence. Health care providers and their organizations must commit to and enforce a zero-tolerance policy for preventable medication errors.

Document Type: Research Article

Publication date: January 1, 2009

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  • Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

    David W. Baker, MD, MPH, FACP, executive vice president for the Division of Healthcare Quality Evaluation at The Joint Commission, is the inaugural editor-in-chief of The Joint Commission Journal on Quality and Patient Safety.

    Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety
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