The Joint Commission's National Performance Goals (NPG) for the Hospital Program, effective January 2026, is the accreditation standards document that replaces the former National Patient Safety Goals and outlines the performance expectations hospitals must meet to maintain Joint Commission accreditation. Within this document, NPG.14.03.01 falls under Goal 14 (medication management) and addresses the labeling of medications, containers, and solutions in procedural settings. The standard requires hospitals to label all medications, medication containers, and other solutions on and off the sterile field in perioperative and other procedural settings. "Medication containers" explicitly include syringes, medicine cups, and basins.The standard has five elements of performance. EP 1 requires labeling any medication or solution that is not immediately administered which applies even when only a single medication is in use. An "immediately administered" medication is defined as one that a qualified staff member prepares or obtains, takes directly to the patient, and administers without any break in the process. EP 2 requires labeling whenever a medication or solution is transferred from its original packaging into another container. EP 3 specifies the required contents of the label: the medication or solution name, strength, amount of medication or solution (if not apparent from the container), diluent name and volume (if not apparent from the container), and expiration date and time with a note that date and time are not necessary for short procedures as defined by the hospital. EP 4 requires both verbal and visual verification of all labels, and when the person preparing the medication or solution is not the person administering it, verification must be done by two qualified individuals. EP 5 requires that each medication or solution be labeled as soon as it is prepared, unless immediately administered. [1]
The Joint Commission's National Patient Safety Goals (NPSG) for the Office-Based Surgery Program, effective January 2026, outlines the accreditation-level patient safety expectations that office-based surgical practices must meet. Within this document, the standard most relevant to IV tubing labeling is NPSG.03.04.01, which falls under Goal 3 (improving the safety of using medications). Although the standard does not specifically address IV tubing itself, it governs the labeling of IV solutions and any medications delivered through IV lines in perioperative and other procedural settings. NPSG.03.04.01 requires practices to label all medications, medication containers, and other solutions, both on and off the sterile field, in perioperative and procedural settings, with "medication containers" explicitly including syringes, medicine cups, and basins. The rationale notes that unlabeled containers are unidentifiable and have been the source of tragic medication errors, making this labeling a core risk-reduction activity. The standard contains five elements of performance: EP 1 requires labeling of any medication or solution not immediately administered, even if only a single medication is in use ("immediately administered" meaning prepared, taken directly to the patient, and given without any break in the process); EP 2 requires labeling whenever a medication or solution is transferred from its original packaging into another container; EP 3 specifies the required label contents including medication or solution name, strength, amount (if not apparent from the container), diluent name and volume (if not apparent), expiration date when not used within 24 hours, and expiration time when expiration occurs in less than 24 hours, with date and time unnecessary for short procedures as defined by the practice; EP 4 requires that all labels be verified both verbally and visually, with verification by two qualified individuals whenever the person preparing the medication or solution is not the one administering it; and EP 5 requires each medication or solution to be labeled as soon as it is prepared, unless immediately administered. [2]
A 2014 publication by The Joint Commission in Sentinel Event Alert, delves into the persistent risk of tubing misconnections in medical settings, which have been linked to severe injuries and fatalities. The report highlights the ongoing development and implementation of new ISO (International Organization for Standardization) connector standards, aimed at mitigating the risks associated with traditional luer connectors. The luer connectors, traditionally used in various medical tubing, pose a significant risk due to their ability to connect unrelated systems, leading to potentially dangerous misconnections, such as linking a feeding tube to an intravenous line. These standards are being established through an international collaboration with entities including ISO, AAMI (Association for the Advancement of Medical Instrumentation), clinicians, manufacturers, and regulatory bodies such as the FDA, to ensure engineered solutions that prevent unintended connections and enhance patient safety. The report details various adverse events, indicating the underreporting of these incidents and emphasizing the high risk stemming from the ubiquitous use of IV lines in hospital settings. Recommendations include the establishment of interdisciplinary task forces, thorough risk assessments, and comprehensive staff training to navigate the transition effectively. They also highlight some effective processes and procedures amongst which is the recommendation to label tubing at both distal (near the patient connection) and proximal (near the source container) when there are different access sites or several bags hanging. This is to prevent any chance of misconnection. For administration of high alert medications delivered via an epidural, intrathecal or arterial route, they recommend labeling the catheter and to avoid using tubing or catheters that have injection ports. The Joint Commission does not plan to introduce new accreditation standards for tubing connectors immediately, but it encourages a proactive safety culture, emphasizing reporting and learning from adverse events. This approach aims to minimize tubing misconnections and improve overall patient care quality across healthcare settings. [3]