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Posted October 24, 2007
Patient Safety and Quality Healthcare: News
The Joint Commission Receives AHRQ Grant to Study Pre-Operative Nursing Assessments in Ambulatory Surgery Centers
Oakbrook Terrace, IL, October 4, 2007 — The Joint Commission today announced it has received federal funding for a study of the potential risks and weaknesses of inaccurate or incomplete pre-operative nursing assessments in ambulatory surgery centers (ASCs). The 1-year study is being funded by a $198,000 grant from the Agency for Healthcare Research and Quality (AHRQ).
The Joint Commission will collaborate on the project with United Surgical Partners International (USPI) and Battelle, Pacific Northwest Division, by conducting failure mode and effects analyses (FMEA) on pre-operative nursing assessments in 10 USPI freestanding ambulatory surgery centers accredited by The Joint Commission under its Ambulatory Health Care accreditation program. Primary investigator for the study is Nancy Kupka, DNSc, MPH, RN, project director, Department of Health Services Research, Division of Quality Research and Measurement, The Joint Commission.Ý
The FMEA process, a prospective risk assessment technique to improve patient safety, will be used to examine the nursing assessment process both as it was designed to work and as it was actually implemented. By using FMEA, the study will identify where the pre-operative nursing assessment process, which was designed to promote patient safety, is most vulnerable.Ý
Pre-operative nursing assessments are crucial to patient safety. Failure to conduct or act upon the findings of the assessment increases the risks of adverse events such as perioperative complications, unanticipated transfer to a higher level of care, and even death. Surgeries conducted in more than 4,800 ambulatory surgical centers in the United States range from minimally invasive procedures such as the removal of a mole to complex procedures such as interventional cardiology. The estimated 12 million procedures performed at these centers annually involve local anesthetic agents to general anesthesia and are performed on a wide variety of patients, from infants to the elderly, who may have multiple medical conditions.
"Accurate pre-operative nursing assessment of a patient's candidacy for a procedure at an ambulatory surgery center — which can often have limited access to emergency assistance because it is not part of a hospital — is critical to providing safe care and preventing patient harm," says Jerod M. Loeb, Ph.D., executive vice president, Division of Quality Research and Measurement, The Joint Commission. "Very little is known to date, about the risk points of pre-operative nursing assessments in this setting. This work will inform strategies for reducing risk that are likely to be relevant across the population of freestanding ambulatory surgery centers."
"We're very excited about the new patient safety research projects we're funding," says Carolyn M. Clancy, M.D., director, AHRQ. "These projects build on our previous work by focusing on issues across settings and transitions of care and will further existing efforts to achieve safe, high-quality health care."
The Joint Commission requires accredited ambulatory surgical centers to conduct pre-operative assessments, and the standards also state that a registered nurse must supervise pre-operative nursing care. The study is being conducted independently of accreditation.
The AHRQ-funded study is underway and concludes August 31, 2008. For more information about the study of the potential risks and weaknesses of pre-operative nursing assessments in ambulatory surgery centers, please contact Nancy Kupka, DNSc, MPH, RN, project director, Department of Health Services Research, Division of Quality Research and Measurement at nkupka@jointcommission.org.
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