Hospital nurses will have the opportunity to help formulate policies to improve patient safety as a result of new standards established by the Joint Commission on Accreditation of Healthcare Organizations that took effect July 1.

The standards are designed to promote identification and prevention of patient risk factors and to encourage hospital staff to report medical errors, sentinel events and near misses.

The JCAHO defines sentinel events as unexpected occurrences involving death or serious physical or psychological injury, or the risk thereof, which signal the need for immediate investigation or response.

"The new standards are designed to improve the internal reporting process to identify areas of patient safety that need improvement," said Marta Gleneck, executive director of quality improvement at St. Jude Children's Research Hospital in Memphis, Tenn.

"They are global to ensure that a hospital incorporates patient safety into its overall strategic plan and that the specifics of that plan trickle down to everyone, including the nurses at the bedside," Gleneck said. "Nurses will be responsible for collecting and analyzing data in high-risk processes--such as medication administration--and for making suggestions for improving them."

The commission has long encouraged health care organizations to examine medical errors and other sentinel events in an effort to lessen their frequency, said Zane Wolfe, Ph.D., RN, FAAN, dean of the School of Nursing at La Salle University in Philadelphia. The new standards' emphasis on an integrated approach to patient safety codifies that aspect of patient care.

"If health care organizations encourage reporting of medical errors and sentinel events, they will have a more effective mechanism to address those errors and prevent them from happening again," Wolfe said. "Nurses will become more comfortable reporting both errors and near misses."

But hospitals will have to make nurses feel more comfortable about reporting errors, said Kathryn Wharton Ross, MS, RN, president of KWR Consulting in Durango, Colo.

"If punitive actions are taken when nurses report errors, they obviously will be less likely to report them," said Ross, who consults with hospitals and lectures nationally on topics regarding JCAHO standards compliance. "Nurses can't be afraid they're going to lose their jobs if they report an error."

The new safety standards will force hospitals to be proactive rather than reactive in the ways they identify and prevent potential sources of patient risk, Ross said.

"Over the years, hospitals haven't really looked at their processes," she said. "Now, they'll have to go back and examine how they provide care. They'll have to break down their high-risk systems, examine them and rebuild or change them," she said.

Perhaps the most controversial element of the standards is the requirement that health care providers inform patients and their families when the result of a procedure or action is not what was anticipated. Hospitals will have to train their staffs to deal with those situations, Gleneck said.

Each organization, she said, first will have to define what constitutes a normal risk of a procedure or action and then must train its staff on how to talk to patients and their families when a risk that would not be considered normal occurs.

"That includes deciding whether an apology should be included in the explanation," Gleneck said.

"Patients and families know that everyone is fallible. If the hospital staff is truly apologetic, it will go a long way toward avoiding litigation."

The standards also include patients and their families as partners in managing actual and potential safety risks, and that nurses at the bedside are in a unique position to help educate them about their roles, Gleneck noted.

"When it's time to check a patient's blood supply, for example, a parent needs to understand that it has to be done, even if it means waking her child to do it," she said.

Hospitals also should look to health-related industries, such as pharmaceutical companies, for help in complying with the standards, particularly in the area of medication errors, Wolfe said.

"Those kinds of mistakes can be reduced by working with the pharmaceutical industry to improve color coding and labeling of medications," she said.

The new standards can be found on the JCAHO Web site at www.jcaho.org/standard/fr_ptsafety.html.