2012 NPSG Presentation - Final 2-03-12

2012 National Patient Safety Goals
Copyright, The Joint Commission
New Goal for 2012

The Joint Commission has approved one new NPSG for 2012 which is being phased in with full implementation required in 2013 The NPSG focuses on catheter-associated urinary tract infection (CAUTI) Applicable to the hospital and critical access hospital accreditation programs CAUTI is the most frequent type of health careassociated infection (HAI) and represents as much as 80 percent of HAIs in hospitals
2012 National Patient Safety Goals - Pg. 5
Patient Identification
Goal 1:
Improve the accuracy of patient identification.
NPSG.01.01.01: Use at least two patient identifiers when providing care, treatment and services.
Applies to: Ambulatory, Behavioral Health Care, Critical Access Hospital, Home Care, Hospital, Lab, Long Term Care, Office-Based Surgery
NPSG.01.03.01: Eliminate transfusion errors related to patient misidentification.
Applies to: Ambulatory, Critical Access Hospital, Hospital, Office-Based Surgery

Improve Communication
Goal 2:
Improve the effectiveness of communication among caregivers.
Improve Communication
NPSG.02.03.01: Report critical results of tests and diagnostic procedures on a timely basis.
Applies to: Critical Access Hospital, Hospital, Lab

Medication Safety
Goal 3:
Improve the safety of using medications.
Medication Safety
NPSG.03.04.01: Label all medications, medication containers, and other solutions on and off the sterile field in perioperative and other procedural settings.
Applies to: Ambulatory, Critical Access Hospital, Hospital, Office Based Surgery
Medication Safety
NPSG.03.05.01: Reduce the likelihood of patient harm associated with the use of anticoagulant therapy.
Applies to: Ambulatory, Critical Access Hospital, Hospital, Long Term Care
Medication Safety
NPSG.03.06.01: Maintain and communicate accurate patient medication information.
Applies to: Ambulatory, Behavioral Health Care, Critical Access Hospital, Home Care, Hospital, Long Term Care, Office-Based Surgery
Health Care-Associated Infections

Goal 4:
Reduce the risk of health care-associated infections.

NPSG.04.01.01: Comply with either the current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or the current World Health Organization (WHO) hand hygiene guidelines.
Applies to: Ambulatory, Behavioral Health Care, Critical Access Hospital, Home Care, Hospital, Lab, Long Term Care, Office-Based Surgery

NPSG.04.03.01: Implement evidencebased practices to prevent health careassociated infections due to multidrugresistant organisms in acute care hospitals.
Applies to: Critical Access Hospital, Hospital


NPSG.04.04.01: Implement evidencebased practices to prevent central lineassociated bloodstream infections.
Applies to: Critical Access Hospital, Hospital, Long Term Care


NPSG.04.05.01: Implement evidencebased practices for preventing surgical site infections.


NPSG.04.06.01*: Implement evidencebased practices to prevent indwelling catheter-associated urinary tract infections (CAUTI).
Applies to: Critical Access Hospital, Hospital.
(Note: This NPSG is not applicable to pediatric populations. Research resulting in evidence-based practices was conducted with adults, and there is not consensus that these practices apply to children.)
*NEW 2012 NPSG with one-year phase in

Reduce Falls
Goal 5:
Reduce the risk of patient harm resulting from falls.
Reduce Falls
NPSG.05.02.01: Reduce the risk of falls.
Applies to: Home Care, Long Term Care

Pressure Ulcers
Goal 6:
Prevent health care-associated pressure ulcers (decubitus ulcers).
Pressure Ulcers
NPSG.06.01.01: Assess and periodically reassess each residents risk for developing a pressure ulcer and take action to address any identified risks.
Applies to: Long Term Care

Risk Assessment
Goal 07:
The organization identifies safety risks inherent in its patient population.
Risk Assessment
NPSG.07.01.01: Identify patients at risk for suicide.
Applies to: Behavioral Health Care, Hospital (applicable to psychiatric hospitals and patients being treated for emotional or behavioral disorders in general hospitals)
Risk Assessment
NPSG.15.02.01: Identify risks associated with home oxygen therapy, such as home fires.
Applies to: Home Care
Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery
UP.07.01.01: Conduct a preprocedure verification process.

Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery UP.07.02.01: Mark the procedure site.
Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery
UP.07.03.01: A time-out is performed before the procedure.

2012 NPSG Presentation - Final 2-03-12

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2012 National Patient Safety Goals

Copyright, The Joint Commission

New Goal for 2012

Improve the accuracy of patient identification.

2012 National Patient Safety Goals - Pg. 6

Copyright, The Joint Commission

2012 National Patient Safety Goals - Pg. 7

Applies to: Ambulatory, Critical Access Hospital, Hospital, Office-Based Surgery

2012 National Patient Safety Goals - Pg. 8

Improve the effectiveness of communication among caregivers.

2012 National Patient Safety Goals - Pg. 9

Copyright, The Joint Commission

Applies to: Critical Access Hospital, Hospital, Lab

2012 National Patient Safety Goals - Pg. 10

Improve the safety of using medications.

2012 National Patient Safety Goals - Pg. 11

Copyright, The Joint Commission

2012 National Patient Safety Goals - Pg. 12

2012 National Patient Safety Goals - Pg. 13

2012 National Patient Safety Goals - Pg. 14

Health Care-Associated Infections

Reduce the risk of health care-associated infections.

2012 National Patient Safety Goals - Pg. 15

Copyright, The Joint Commission

Health Care-Associated Infections

2012 National Patient Safety Goals - Pg. 16

Copyright, The Joint Commission

Health Care-Associated Infections

Applies to: Critical Access Hospital, Hospital

2012 National Patient Safety Goals - Pg. 17

Health Care-Associated Infections

Applies to: Critical Access Hospital, Hospital, Long Term Care

2012 National Patient Safety Goals - Pg. 18

Health Care-Associated Infections

Applies to: Ambulatory, Critical Access Hospital, Hospital, Office-Based Surgery

2012 National Patient Safety Goals - Pg. 19

Health Care-Associated Infections

*NEW 2012 NPSG with one-year phase in

Copyright, The Joint Commission

Reduce the risk of patient harm resulting from falls.

2012 National Patient Safety Goals - Pg. 21

Copyright, The Joint Commission

Applies to: Home Care, Long Term Care

2012 National Patient Safety Goals - Pg. 22

Prevent health care-associated pressure ulcers (decubitus ulcers).

2012 National Patient Safety Goals - Pg. 23

Copyright, The Joint Commission

Applies to: Long Term Care

2012 National Patient Safety Goals - Pg. 24

The organization identifies safety risks inherent in its patient population.

2012 National Patient Safety Goals - Pg. 25

Copyright, The Joint Commission

2012 National Patient Safety Goals - Pg. 26

2012 National Patient Safety Goals - Pg. 27

Copyright, The Joint Commission

Applies to: Home Care

UP.07.01.01: Conduct a preprocedure verification process.

Applies to: Ambulatory, Critical Access Hospital, Hospital, Office-Based Surgery

2012 National Patient Safety Goals - Pg. 28

Applies to: Ambulatory, Critical Access Hospital, Hospital, Office-Based Surgery