Joint Commission 2023 Patient Safety Goals

Highlighting TJC Priorities for Healthcare Facilities

January 2023

By Jody Randall MSN, RN, CIC, HACP-CMS, HACP-PE

CEO and Founder

Happy New Year to all healthcare professionals from HCE! 
We are excited for 2023 and looking forward to helping our fellow colleagues work toward a more focused approach to bringing healthcare back to some normalcy after what we all know has been a rocky road over the last few years.  


With a fresh new year ahead of us we thought it would be a great time to take a look at The Joint Commission’s (TJC) National Patient Safety Goals (NSG) for 2023. Now is the time to remove the 2022 version from your facilities and familiarize your team members what TJC has identified as high priority safety concerns in health care today. 


As you review the new lists of goals you will likely find that the goals have not changed. Essentially, the issues impacting patient safety continue to occur and therefore need to be addressed by healthcare facilities to prevent perpetual reoccurrence of preventable events. TJC publishes a list of goals annually for each of the following health care settings


  • Ambulatory Healthcare
  • Assisted Living
  • Behavioral Health and Human Services
  • Critical Access Hospitals
  • Home Care
  • Hospital
  • Laboratory Services
  • Nursing Care Center
  • Office-Based Surgery 

National Patient Safety Goal 01.01.01 pertains to proper identification of a patient. Although it seems simplistic in nature this continues to be a major area for concern. Two patient identifiers should always be used prior to administering any medication or treatment to a patient. Using a patient’s location or room number should never be considered one of the identifiers. Verifying a patient’s name and date of birth are a good practice for avoiding patient identification errors. Be sure your organization’s policy address the method to be used to identify patients.


National Patient Safety Goal 03.04.01 addresses medication safety in healthcare setting where procedures are performed. Any medication that may be used in must be labeled correctly. Syringes, cups, basins or other apparatuses that hold medication must never enter a surgical or procedural field without being properly labeled. Be sure your organization addresses labeling, and team members are well trained on labeling. It is always good to perform random audits to ensure that these practices are being followed consistently.


National Patient Safety Goal 03.06.01 is another important medication safety goal. It is critical to obtain, reconcile and report a patients medication regimen with accuracy. Documentation is critical. When new medications are prescribed for patients, the patient should also receive written instruction about the medication, including how to take the medication, frequency and side effects associated with the new medication to name a few. Patients should also be instructed to keep up to date lists of all medications they are on.


National Patient Safety Goal 07.01.01 pertains to infection prevention. The focus for this goal is hand hygiene. Organizations should develop goals to improve adherence to good hand hygiene practices among health care workers. How is your organization monitoring hand hygiene compliance? Be sure to establish training programs to enforce the danger associated with non-compliance to good hand hygiene practice. Another consideration is to determine if the number of hand washing sinks and hand sanitizer dispensers are adequate for your facility.


National Patient Safety Goal 15.01.01 pertains to reducing risk for suicide. “Suicide is a major public health concern. Suicide is among the leading causes of death in the United States”, (NIIMH, 2022). Prevention efforts should not be overlooked. This goal applies to hospitals and behavioral health settings. Be sure that environmental risk assessment is completed to identify risk factors in patient care settings. Development or revision of existing policies and procedures concerning suicide are critical. Be sure that team members are well educated on identifying risk factors associated with suicide. It is also imperative to utilize a comprehensive screening tool to identify patients to exhibit risk factors associated with suicidal ideation.


For a complete list, visit TJC National Patient Safety Goals for 2023 where you can find more information on all NPSG’s for 2023. TJC provides simplified PDF versions based on facility type. You can also download chapter versions which provide a greater insight into each specific goal including rationale and elements of performance to help your organization with reduce risk that results in patient harm.


From all of us here at HCE, we would again like to wish you and yours a Happy, Safe, and Prosperous New Year!  


References: 

https://www.nimh.nih.gov/health/statistics/suicide

https://www.jointcommission.org/standards/national-patient-safety-goals/hospital-national-patient-safety-goals/


HCE is Here to Help
Healthcare Consulting Experts LLC was built based upon our understanding of the challenges that all healthcare facilities are facing today. Healthcare professionals strive to deliver the best possible care to all patients. We can help your facility through the difficult times and put you back on track to a less stressful tomorrow.
Don’t take chances! Our experts can assist with regulatory compliance requirements for whether you are building a new, state of the art project or renovating an existing structure. Be sure to visit Our Website to see a full list of the services that we provide. Contact us today at +1 (800) 813-7117 for a free initial consultation.


Please join us by clicking on any of the icons below to leave a comment or for more informati
on and updates:

Healthcare Consulting Experts LLC
AED in a white cabinet on a green tiled wall, with a heart symbol and AED signage.
February 28, 2026
February may be the shortest month of the year, but in the world of healthcare facilities and regulatory oversight, it often feels like the longest. Between the launch of the Joint Commission’s Accreditation 360 and the sudden shifting of federal staffing mandates, your compliance "To-Do" list likely looks more like a "To-Don't-Panic" list. Below is your breakdown of the critical updates, deadlines, and strategic shifts defining February 2026. Regulatory Roundup: The "Great Repeal" of 2026 The most significant news hitting desks this month is the formal pivot in Long-Term Care (LTC) staffing. CMS Staffing Mandate Repealed : Effective February 2, 2026 , CMS officially rescinded the 2024 minimum staffing requirements (the 3.48 HPRD mandate). The Fine Print : While the "one-size-fits-all" numbers are gone, the Enhanced Facility Assessment requirements are still very much alive. Regulators are moving away from rigid ratios toward a "competency-based" model. You must still prove your staffing levels match your specific resident acuity. What it means for you : It’s time to double-check your assessment documentation. Auditors aren't counting heads as strictly, but they are scrutinizing the logic behind your staffing decisions. HIPAA & Privacy: The February 16th Pivot If you haven't updated your Notice of Privacy Practices (NPP) yet, you are officially behind. February 16, 2026, marked the deadline for compliance with the final rule aligning 42 CFR Part 2 (Substance Use Disorder records) with HIPAA. Lawful Holder Doctrine : Any practice receiving SUD records is now a "lawful holder," triggering new obligations for how those records are handled in legal proceedings. Reproductive Health Privacy : New prohibitions are in place regarding the disclosure of PHI for investigations into lawful reproductive healthcare. Security Rule Modernization : Th e HHS Office for Civil Rights (OCR) is phasing out the "addressable" vs. "required" distinction. By late 2026, every safeguard will be mandatory. Tech & Sustainability: Do Less with Less The 2026 facility mantra has shifted from "do more with less" to "do less with less"—meaning we are using data to eliminate wasted effort. Unified Platforms : The era of separate spreadsheets for maintenance, energy, and compliance is over. Integrated CAFM (Computer-Aided Facility Management) tools are now the standard for audit-ready reporting. The "Heart" of the Facility : Since it’s American Heart Month, it’s the perfect time to run a Life Safety check on AEDs and Cardiac Crash Carts. Ensure your battery replacement logs are digitized—paper tags are so 2024. A Note on Candor : Let’s be real—the repeal of the staffing mandate might feel like a relief, but it’s actually a trap for the unprepared. Without a fixed ratio to hide behind, your clinical judgment is the only thing standing between you and a "Statement of Deficiencies." Don't let the lack of a mandate lead to a lack of a plan.
Person holding a red heart and wooden blocks spelling
January 2, 2026
A Special Briefing for Healthcare Leaders and Providers
December 24, 2025
Compliance, Quality, and the Path Forward