National Quality Forum (NQF) has announced the start of new projects focusing on safety issues. 

1.        Hospital Acquired Conditions (HACs)and Serious Reportable Events (SREs)

This is a new project as of September 2009 that will address HACs and SREs.  They will define the existing healthcare acquired conditions (HACs) and develop an expanded listing of HACs as well as look at the specifications for the existing SRE’s and make recommendations of potentially new ones. 

In addition to refining and adding to the current list of HACs and SREs, the project will expand the HACs to apply across the continuum of care to ambulatory care, skilled nursing facilities and home health and hospice settings.  Finally, they will address implementation of the HACs and SREs at the facility, state, and national level.  Development and maintenance of the respective listings will include bridging overlaps and complementarities of the listings with NQF Serious Reportable Events, the NQF-endorsed Safe Practices and other national health care priorities.

NQF will convene 4 technical advisory panels with expertise in the occurrence of unforeseen condition and complications in the various environments of healthcare.  The 4 panels are expected to begin work in December and have material ready for public review and comment in June 2010.  Final NQF board ratification is projected for December 2010.

Current HACs:

HACs recommended by commenters, cited in the IPPS, likely to be considered:

·         Failure to rescue

·         Ventilator-associated-pneumonia

·         Surgical site infections following implantation of devices

·         Clostridium difficile-associated disease

·         Malnutrition

2.       Review and update of the NQF Safe Practices  (34 Safe Practices)

The open comment period opens September 14 through October 13 on revisions to the 2009 Safe Practices.   In the 2009 update, many of the Joint Commission National Patient Safety Goals were incorporated into the NQF Safe Practices, e.g. prevention of catheter-related blood stream infections and VTE prophylaxis and safe use of anticoagulants.   The Safe Practices do not go out for a member vote.  They will be reviewed by the Steering Committee and presented for CSAC review and Board ratification by November 16, 2009.

NQF is recommending minimal language change to the 2009 Safe Practices.  There were no changes in target Safe Practices, except as noted for SP 22.  Leapfrog Group has asked for a revision of SP 5:  Informed Consent. 

SP 15:  Discharge System

SP17:   Medication Reconciliation

SP 22:  Surgical-Site Infection – added a specification to use a skin preparation and allow drying time

SP 28:  Venous Thromboembolism Prevention

SP 29:  Anticoagulation

SP 32:  Glycemic Control

Opportunities:

3.       Patient Safety Framework for HACs

This project will include as part of its work product a public reporting framework for HACs and recommendations for measures.    The project started September with call for nominees to the Steering Committee and a call for Candidate Standards (deadline October 1, 2009).  The public comment period is tentatively set for March 15 with final board ratification by August 1, 2010. If it meets its deadline, they could potentially identify patient safety measures that will be included in the 2010 round of Medicare Proposed Rules for inpatient, outpatient services, and nursing facilities and as part of the Physician Fee Schedule.

4.       Hospital Psychiatric Care  

This project was launched in spring 2009 in conjunction with the outpatient medication management and outcome projects.  Three measures were developed and are out for public comment now with final board ratification expected by December 2009.