Solving the Top Problems in Patient Safety

The purpose of The Joint Commission’s National Patient Safety Goals is to promote specific improvements in patient safety. According to The Joint Commission, certain National Patient Safety Goals commonly account for compliance deficiencies in hospitals. These goals include improper medication reconciliation, poor communication of critical test results, and preoperative verification and time-out deficiencies. To help overcome these deficiencies, The Joint Commission recommends specific solutions for each problem area.

Solutions to improper medication reconciliation

National Patient Safety Goal 8 advocates for the development of an effective medication reconciliation process that establishes a method for comparing the patient’s current medications with those ordered while the patient is receiving care in your organization. The medication reconciliation process follows these steps:

  1. Develop a complete and accurate list of patient medications.
  2. Compare the listed medications with each new order, reconciling omitted, duplicate, or interacting medications and avoiding name, dose, and route confusion.
  3. Update the medication list as the patient moves across the continuum of care and at discharge.
  4. Communicate the list to other healthcare providers and the patient.

Common barriers to sustained compliance with the medication reconciliation process include a lack of physician buy-in, mentality that “it’s not my job,” and concern that this is just another added responsibility.

Physician buy-in

  • Collaborate with physicians about ways to ensure the success of the program before developing your policies and procedures.
  • Demonstrate the program’s value in terms of patient safety—and in terms of increased efficiency for the physician’s practice.

“It’s not my job”

  • Make medication reconciliation a team activity with clear responsibilities across the continuum of care. 
  • Communicate your policies about documentation on the medication list to all patient-care services.

Add-on responsibility

  • Avoid making this task a separate process. Instead, integrate the steps of medication reconciliation into the existing workflow.
  • Make sure that each step adds value to patient safety.

Solutions to poor communication of critical test results

  • Educate staff members so they know the policies and comply with them.
  • Commission your performance improvement team to measure the length of time from the time of the order to the report and from identification of a critical result to the time of the report.

Solutions to preoperative verification and time-out deficiencies 

Preop verification

  • Make sure the physician documents up-to-date, clinically pertinent histories and physicals that meet The Joint Commission and the Centers for Medicare and Medicaid standards for timing (obtained within 30 days of patient admission and updated within 24 hours of admission). 
  • Have the surgeon who will perform the procedure mark the operative site before the patient is moved to the operative area and, as appropriate, while the patient is awake, coherent, and able to verify the site.
  • Ensure that the site is marked directly on the skin so that the mark is visible after the patient is prepped and draped. Mark the patient by labeling a simple yes or no. Do not use ambiguous marks, such as an X.
  • Do not allow marking of any nonoperative site.


  • Make the time-out procedure a team effort, checking for the correct patient, procedure, site, patient positioning, and the presence of correct implants and equipment.
  • Ensure that the time-out happens where the procedure will be done.
  • Involve the entire team in active communication.
  • Have the nurse document the time-out, such as with a checklist. However, the nurse should never complete the checklist before actually performing the time-out procedure.
  • Develop a process for reconciling differences discovered during the time-out.

Besides these recommendations, Stephanie Bennett, RN, BSN, suggests using the online Joint Commission/OSHA Compliance course. As Clinical Editor for Nursing e-Learning, she notes, “This course was authored to help healthcare organizations meet the education and training requirements mandated by The Joint Commission, Occupational Safety and Health Administration, and the Centers for Medicare and Medicaid Services. Its lessons are designed to help hospital staff understand how to maintain compliance with accreditation and regulatory standards. The course helps staff articulate their roles in patient safety with surveyors.”

Information adapted from Joint Commission Resources. 2008 Hospital Executive Briefings. Oak Brook, IL: Joint Commission Resources; 2007.

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