Review Article
Prevention of errors in health care- patient (Medical customer) safety
Dr. Narra Gopal Reddy
Associate Professor, Department of Anaesthesiology, Kamineni Institute of Medical Sciences Narketpally, Telangana, India.
*Corresponding Author :
Dr Narra. Gopal Reddy,
Department of Anaesthesiology
Kamineni Institute of Medical Sciences,
Narketpally Nalgonda Dist 508 254, Telangana
E-mail: drgopalreddynarra@yahoo.com
ABSTRACT
Hospital is a people sensitive place, Providing services to sick people round the clock. People have a free access to enter any part of the hospital at any time for advice and treatment. The hospital atmosphere is filled with emotions, excitement, life & happiness, death & sorrow. Since hospital operates under continuous strain, it gives rise to irritation, confrontation, conflicts and aggression, threatening the life of hospital staff and hospital properties.
We are all painfully aware of the problem of patient safety in health care. More specifically is the growing number of preventable deaths that occur in our nation’s hospitals at an alarming rate. By Patient Safety, we mean prevention of harm to patients while receiving Health Care. Medical errors not only result in additional costs for hospitalization, litigation, hospital acquired infections, lost income and disability etc, but they also cause erosion of trust, confidence and satisfaction among the public and Health care providers.1
Key words : Health Care, Preventable Medical Errors, Preventable Deaths, Patient (Medical Customer), Medical Customer Safety
Introduction
“The 5th May is being celebrated all over the world as the Global Hand Hygiene Day” WHO. Hospitals are scary places to be in. Volumes of investigations, life saving and life threatening medications, life support devices, complex diseases, delicate interventional procedures and marathon surgeries – an error can be disastrous. Yet research shows that medical errors happening frequently.2
A medical error is a preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection, or other ailment.
Medical Errors in India [3]: In India recording 5.2 million injuries every year due to medical errors adverse events. Worldwide recording 43 million injuries, 23 million years healthy lives lost.
Topping the list are: Medication errors, followed by Hospital acquired infectionsand Deep vein thrombosis.
These findings for the first time try to quantify the global burden of unsafe medical care across a range of adverse health events.3
The United Nations body quantified the number of surgeries taking place every year globally which accounted 234 million. It said surgeries had become common, with one in every 25 people undergoing it at any given time. China conducted the highest number of surgeries followed by Russia and India. In developing countries, the death rate was nearly 10% for a major surgery.4 In US estimate there are over 400,000 preventable deaths annually according to James etal.5
Where Medical Errors occur? Medical errors can occur anywhere in the health care system:
- Hospitals, Clinics, Outpatient Surgery Centers, Doctors' Offices.
- Nursing Homes, Pharmacies, Patients' Homes.
What are Medical Errors?
Medical errors happen when something that was planned as a part of medical care doesn't work out, or when the wrong plan was used in the first place.
Errors can involve:
Medicines, Surgery, Diagnosis, Equipment, Lab reports.
They can happen during even the most routine
tasks. Most errors result from problems created
by today's complex health care system. But errors
also happen when doctors and their patients have
problems communicating.6 The World Health Organization (WHO) said on
that “millions of people die each year from medical
errors and infections linked to health care. It said
that if the checklist is effectively used worldwide,
about 500,000 deaths could be prevented each
year”.7It is worth noting that these figures are likely
to be an underestimate of the true picture; this is
because of a well-recognized culture of under-
reporting in almost all health-care systems.8
‘Assessment of Injection Practices in India’–by
the India indicates that a very large number (3 to
6 billion) of injections are administered in India
every year. Nearly two-thirds of these injections
are unsafe (62.9%). Govt. of India had signed a
pledge in July 2006 to work to reduce health care-
associated infections in collaboration with world
alliance for patient safety.9 By giving correct drug to a correct patient, correct
time, correct route, correct dose by clean and
safety method we avoid medication error. It is
important to note that at least 50% of Health Care
Associated Infections (HCAI) are preventable.
Every year unsafe injections result in 1.3 million
deaths mainly due to Hepatitis B, Hepatitis C and
HIV.10 Ten (10) Systemic causes for healthcare
errors:11 Table-1: Data regarding various errors and cost of it in developed countries, developing countries and India. Patient safety challenges As per WHO 1 in 10 patient receive harm during
the treatment process 1.4 million people worldwide
suffer from infections acquired in hospitals. Since 2009, The 5th May is being celebrated all
over the world as the Global Hand Hygiene Day
in India too; many hospitals undertook activities
to promote awareness on hand hygiene in health
care workers. 1.The prevention of health care associated
infections (HCAI)and the prevention of surgical
complications have been recognized as major
issues and taken up as global patient safety
challenges, calling for action by health care
facilities across the globe. 2. The first challenge is "Clean care is safer
care" and addresses the problem of health care
associated infection with focus on the improvement
of hand hygiene - the single most important factor
to prevent HCAI. 3. The second challenge is "Safe Surgery Saves
Lives" calling for application of standards of care
and the implementation of a simple check list
called the safe surgery check list. The check list
includes a series of simple checks to be done
before induction of anaesthesia, before making the incision and after the operation is over. The assumption of safety in the FIRST DO NO
HARM "Safety is the most provision of healthcare is as
fundamental as care itself. The basic dimension
of performance necessary for the improvement of
healthcare Safety is the underlying reason for risk
management, infection control. It is the reason we
insist on control, and environmental management
programs. Qualified clinical practitioners and
support staff, validating education, expertise, and
other credentials; providing appropriate orientation
and continuing education; and performing periodic
appraisal. B. International Patient Safety Goals we are supposed to follow, Goal 1: Identify Patients Correctly Goal 2: Improve Effective Communication Goal 3: Improve the Safety of High-Alert Medications Goal 4: Ensure Correct- Site, Correct-Procedure, Correct Patient Surgery Goal 5: Reducethe Risk of Health Care – Associated Infections Goal 6: Reduce the Risk of Patient Harm Resulting from Falls 1- IDENTIFY PATIENTS CORRECTLY Requirement: The organization a. Use and develops an approach to improve accuracy of patients’ identification. b. before administering medications, of at least two patient identifiers. c. Before taking blood and other specimens for blood, or blood products. d. Before providing treatments procedures and clinical testing. B. International Patient Safety Goals we are supposed to follow, Goal 1: Identify Patients Correctly Goal 2: Improve Effective Communication Goal 3: Improve the Safety of High-Alert Medications Goal 4: Ensure Correct- Site, Correct-Procedure, Correct Patient Surgery Goal 5: Reduce the Risk of Health Care – Associated Infections Goal 6: Reduce the Risk of Patient Harm Resulting from Falls 2-IMPROVE EFFECTIVE COMMUNICATION Requirement The organization develops an approach to improve the effectiveness of communication a. Verbal and telephone order or test result is written down among caregivers. b. The order or test result is by the receiver and read back by the receiver. Confirmed by the person who gave the order. d. Before providing treatments procedures and clinical testing. 3-IMPROVE THE SAFETY OF HIGH-ALERT MEDICATIONS Requirement: The organization develops an approach to improve the safety of high-alert a. Policies to address the location, labeling, and storage of medications. b. Concentrated electrolytes are not present in concentrated electrolytes. 4-ENSURE CORRECT-SITE, CORRECT PROCEDURE, CORRECT-PATIENT SURGERY Requirement: The organization develops an approach for to a. Ensure the correct-site, correct procedure, and correct-patient surgery b. Mark surgical site correct site, correct procedure, and correct patient c. Verify that identification and involve the patient in the marking process d. Use documents and equipment needed are on hand, correct, and functional time-out procedure before starting a surgical procedure 5-REDUCE THE RISK OF HEALTH CARE– ASSOCIATED INFECTIONS Requirement: The organization develops an approach to reduce the risk of health a. Policies to reduce the risk of health care– associated infections b. Adopt or adapt currently published and generally care–associated infections c. Implement an effective hand hygiene accepted hand hygiene guidelines program 6-REDUCE THE RISK OF PATIENT HARM RESULTING FROM FALL Requirement: The organization develops an approach to reduce the risk of patient a. Policies to reduce the risk of patient harm resulting from falls. b. Implement initial assessment of patients for fall resulting from falls. c. Implement measures to reduce fall risk and reassessment when indicated. Others are: Reducing bloodstream infections Preventing bloodstream infections from central line venous catheters. Reporting and learning systems WHO Draft Guidelines for Adverse Event Reporting and Learning Systems is designed to help countries develop or improve reporting and learning systems in order to improve the safety of patient care. Technology: Identifying and clarifying the role and
objectives of technology in improving patient safety,
both in the developed and developing world. High 5s: Addressing safety problems through
implementing standardized solutions and
measuring progress worldwide. In this document we are exploring how approaches
such as human factors can help us to make
‘Never events’ preventable errors a near reality.
Here patients, their families, clinicians and their
teams, all who thought it would never, could never
happen to them. We will then look at how we can
learn from these cases to ensure that next time
it doesn’t happen to us. Researchers say most
medical centers have long list of patient safety
procedures to place to prevent surgical mistakes
such as mandatory “time-outs” in the operating
room to make sure medical records and surgical
plans match the patient on the table. Even though
these errors are not intentional but require more
vigilance, competence and care from medical
industry. Pointers towards improved patient safety measures
Sl.No.
Events
Developed countries
Developing countries
Total
India
1
Surgeries
80 millions
154 millions
234 millions
29 millions
2
Errors
14million
27millions
43millions
5.2 millions
3
Readmissions
14.20%
12.70%
13.50%
12.50%
4
Drug errors
5%
9%
6.50%
9.50%
5
Infections
2.50%
3%
2.90%
4%
6
Temporary disability
59%
55%
56%
55%
7
Permanent disability
33%
35%
33.60%
35%
8
Deaths (major surgeries)
6.60%
10%
8%
!0%
9
Working days lost
7.2million days
15.5 million/d
22.7 million/d
3.5million/d
10
Financial implications
$1.3billion
$1.5 billion
$2.8 billion
$0.4billion
Discussion:
WHO safety goals:
Conclusion:
References