As part of its ongoing work “to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating healthcare organizations and inspiring them to excel in providing safe and effective care of the highest quality and value,” the Joint Commission hosts an annual Health Care Association Forum to educate associations about the commission’s latest initiatives and goals. Here are the outcomes that affect nursing practice in 2019.

Implement Safety Culture, High Reliability, and Quality Improvement

Three key concepts essential for high-quality health care are safety culture, high-reliability organizations, and robust process improvement (RPI). A safety culture requires an environment where staff feel comfortable reporting unsafe practices and trends. Trust between staff and leadership is foundational, and organizations need to eliminate intimidating behaviors that stop communication and reporting. A safety culture needs to focus not just on no harm to patients but also no harm to staff so that they are not afraid of repercussions for reporting concerns. High-reliability organizations balance learning and accountability to empower staff so that they feel comfortable speaking up and making recommendation for improvements. RPI requires a focus on making improvements, sustaining gains through change management, and providing staff with the skills and tools needed to look for potential opportunities. To achieve this, RPI encourages organizations to evaluate their culture and explore what happens once improvements have been made—when no one is looking.   

Enhanced Focus Areas and New Initiatives

The Joint Commission will place an enhanced focus on several areas during site surveys. Ones that may apply particularly to oncology nurses are sterile medication compounding, suicide prevention and, potentially, high-level disinfection in diagnostic and surgical areas. 

New initiatives for 2019 include: 

  • Standards for addiction treatment programs to help address the growing opioid crisis
  • Maternal-child safety, such as hemorrhage and hypertension assessment and treatment, unexpected newborn complications, and Caesarean section rates
  • Advanced chest pain center certification 

Of particular interest to oncology settings, infection prevention and control will continue to be a priority, with a focus on improvement in survey methods and sharing best practices.

National Patient Safety Goals 

Finally, the 2019 National Patient Safety Goals (NPSGs) are listed in the sidebar. Of note, the Joint Commission is expanding the NPSG related to suicide to include seven elements of performance: 

  • Reducing environmental risks for suicide
  • Identifying patients at risk for suicide
  • Developing mitigations plans
  • Documenting and communicating to appropriate personnel about at-risk patients
  • Developing evidence-based policies and procedures to ensure appropriate practice related to suicide risk

The standard will take effect July 1, 2019 and will apply only to hospitals and behavioral health settings, but consideration about how to assess for mental health issues and suicide risk in other oncology settings may be appropriate.