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Prioritizing Patient Safety

Patient Safety – Start up:

“Patient safety” the new mantra is now revealing out its structure as
a major component to be concentrated by the health care providers. Patient Safet
y that emphasizes the reporting, analysis, and prevention of medical error that
often leads to adverse healthcare events. Lack of patient safety – the silent kill
er having its impact more than any other disease or traffic accidents and it is
holding a record of leading position in maintaining highest mortality in the wor
ld. Lack of patient safety is not a non- curable, it is preventable. WHO realize
d this and initiated “World Alliance for Patient Safety”, was launched in October 20
05 at WHO Headquarters, as an outcome of the 55th World Health Assembly resoluti
on on patient safety. India followed the WHO and started WHO- Global Patient Saf
ety Challenge” in India by launching the National Initiative on Patient Safety (NI
PS) and it was launched by the Honourable Health Minister Shri. Ghulam Nabi Azad
on September 14th, 2009. Even the Honourable Health Minister has expressed rega
rding the lack of data regarding patient safety in the Indian Scenario and also
announced to place National Patient Safety Policy and expressed interest in incl
uding Patient Safety concepts in Medical education. Now the question is Whether
the Patient safety is –a new initiative or a part of routine medical activity.
Histories are revealing that 100 B.C. Charuka, Sushruta like medical professiona
ls in India as well as all over the world has followed strict policies in patien
t safety and they have prioritised patient safety is the key component of medica
l practice. In the long run we have only lost it, but it is not too late that we
have now recognized that is the major component to be followed. Not only as a s
pecial initiative, it is the basic component that each patient expects when they
are entering the hospital. It is also the responsibility of health care profess
ionals to deliver that without any compromise in it.

Patient Safety – Initiative:


Patient safety, the safety of the patient has to start from the entry gate of th
e hospital and till their exit. It is also not a responsibility of an individual
in a health care system; it is the part of the whole. As we have missed out pat
ient safety in long run and we want to build it back, as it cant be back in one
day and not as wholesome. We have to start it from smaller level and make it to
bigger. Even the initiative of patient safety has to start in all the levels of
hierarchy (i.e.) top level to lower level.
Common factors in Patient safety:
Infrastructure Safety:
Infrastructure plays major role in improving patient safety. Infrastructure shou
ld be constructed in a matter that it will ready to face hazards without making
any human loss. Fulfilling a commitment to safe and high-quality care will not b
e possible without significant investment in patient safety infrastructure. Even
improving the existing infrastructure by holistic integration of all systems wi
thin the building technology infrastructure – heating, ventilation, climate, cooli
ng, energy generation, emergency power and energy distribution, access control,
video surveillance, fire detection, alarming, evacuation and extinguishing. In a
ddition, further building technology systems such as lifts and escalators, water
technology systems, laboratory and medical technology systems as well as monito
ring of information and communication systems can be integrated. It will help th
e health care providers in ensuring the quality as well as safety to the infrast
ructure as well as to the patients.
Information and technology safety:
In concern to health care, most of the time errors are due to poor communication
of information or error in communication. From registration patient information
has to be entered correctly. Even small factor has big impact in treatment proc
edures. For ex, instead of 54 years it is entered as 45 while typing, the impact
has a lot of deviation in determining mortality factor while computing APACHE (
Acute Physiology and Chronic Health evaluation) tool in ICU. Communication has t
o be considered as a key issue in medical errors as the transformation of inform
ation from Doctors to nurses in medications, from lab to doctor in results, from
diet dept. to patient in food ordering etc. Patient also should cooperate in th
is information scenario, as they can get clarification about their treatment pro
cedures if they have any doubt, provide right information about their health con
ditions, expressing allergies in medicines, already consuming medicines etc. It
will help the doctor to prescribe the right combination of medicine along with a
lready consuming medicines. Technological errors has to be avoided by conducting
periodical calibration and testing of critical care equipments, evaluating the
result of the equipments in comparing with 3 or 4 hospitals nearby as a process
of counter checking, following quality assurance principles in testing systems e
tc. In concern to computers, ensuring the proper functioning of HIS (Hospital In
formation System), monitoring and reporting system. It will help us to track the
operational system error and help us to eradicate it. Periodical evaluation of
total information system and technology system help us to upgrade and to elimina
te medical errors permanently.
Medical treatment safety:
Medical treatment safety starts from patient registration itself. In patient reg
istration most common error will occur when patient data are directly entered by
the computer operator by getting oral information from patients. Key informatio
n in patient registration is name, age, sex, address etc. Error can start when t
here is a wrong entry from the above. It is important that patient information t
o be filled by patient only through patient registration form. It is important t
hat computer operator has to type correctly and it is counter checked before iss
uing file to the patient. In Doctor Consultation and treatment procedure, patie
nt has to provide correct information like history, medicines consuming, previou
s diagnostics reports etc. From doctor’s point of view, doctor has to assess the p
atient completely before concluding and also it is mandatory to check allergic c
onditions before prescribing medicines. In diagnostic medical treatment, it is m
andatory to provide right report to the right patient. It is the responsibilitie
s of the respective diagnostic department to ensure and also counter check twice
before issuing the report. It is also the responsibility of the doctor to give
guidelines to their patients to contact him / her during any complications devel
oping during treatment course. Medical treatment safety check list has to be pre
pared and maintained by respective patient relative coordinators of the respecti
ve OPD to ensure smooth and safety functioning of the system.
Medical treatment safety check list includes:
(i) Correctness of patient details
(ii) Correctness of consulting Doctor details
(iii) Correctness of information delivery provided by patient (History, treatm
ent availed, medicines consuming etc.) as well as doctor. (Treatment procedure,
medication prescribed, communication in crisis etc.)
(iv) Correctness of reports from diagnostics etc.
Social worker of the hospital can guide the patient in medical and other health
care related issues to achieve the safety as well as support in ensuring quality
health care delivery.
Surgical related safety:
Surgical safety is the major component to be concentrated to control the mortali
ty due to lack of patient safety. Surgical safety of the patient has to start fr
om Inpatient rooms itself before shifting patient to OT for starting pre surgica
l / anesthetic procedures. For this surgical safety, all the hospitals can use t
he surgical safety tool provided by WHO. Tool enclosed.
Nursing Safety:
Nurse’s main responsibility is to provide safe and effective care within constantl
y evolving health care systems. Nurses are the only set of employees interacting
with one another, doctors, aides and technicians and finally to patients to pro
vide holistic care to patients. Even nurses are the staffs spending most of the
time with patients and monitoring their care continuously.
In general medication, to avoid the errors nurses should,
- take steps to accurately identify the correct patient to receive medicat
ion before administering it.
- take steps to accurately identify the correct medication to be received
before administering it to the patient.
- take steps to accurately identify the correct dosage of medication befo
re administering it to the patient.
- take steps to accurately identify the correct route the patient is to r
eceive the medication before administering it.
- take steps to administer medication in a timely fashion as ordered by t
he physician.
- take steps to accurately document the medication administration after a
dministering it.
In concern to surgical procedure also nurses should be proactive in guiding the
doctors and ensuring the correctness of materials used before and after surgery.
Nurses should take specialized care in monitoring and documenting the activitie
s of surgical care patient every 30 minutes once to identify any complication or
difficulties faced by the patients. Nurses should develop strong communication
system to all the patient centric people (i.e.) Doctors, Diagnostics, Imaging an
d all the supportive systems. It will help them to get immediate access in crisi
s. Errors can be avoided by following standards procedures, monitoring the syste
m continuously, counter checking and documenting of all the activities in patien
t cycle (i.e. from admission of patient till discharge).
Nurses should communicate with patient periodically about the care they are prov
iding to the patient and it will help them to counter check the action plan. Che
ck list for each procedure has to be developed, monitored and controlled by qual
ity department to ensure the safety of the patient.
Medication Safety:
Medication errors can be controlled by ensuring that the right medicine in right
dosage is given to right patient in the right time through right route. Require
ment of clear understanding from Doctors regarding the medication prescribed and
also gets clarified immediately before administering it. As most of the medicin
es sounds alike if it is oral and also doctor’s handwriting is bit difficult in un
derstanding if it is written. Important point to be noted here is Medical advers
e. Few strategies in medical adverse,
• Deploy an immediate response team at the first sign a patient is getting worse.
• Prevent avoidable deaths from heart attacks by delivering reliable, evidence-bas
ed care.
• Prevent adverse drug events by double-checking medications with the patient, on
their charts and in databases.
• Prevent central line-associated bloodstream infection through a series of eviden
ce-based interventions.
• Prevent surgical site infection to all surgical patients by Surgical SOP impleme
ntation.
• Prevent ventilator-associated complications to ventilated patients by developing
and implementing SOP (Standard Operating Procedure) for ventilated patients.
Respective departmental head has to develop Standard Operating Procedure for eac
h procedure including medication procedures and also he / she should check perio
dically to ensure that the SOP’s are followed in the department.
Policy formulation and Review:
Quality of Care and patient safety are the two primary components have to be con
centrated by all the health care providers. Each hospital has to develop a commi
ttee in concentrating these 2 activities. Periodical meetings are conducted to a
ssess the system flow, discussing on incidence about medical errors, developing
strategies and policies to avoid medial errors and also periodically updating th
e policies as a part of total quality management. These committee should go On-s
ite observation round weekly once for each department to identify the right proc
ess flow and also guiding the respective department in improving their quality o
f service. Main purpose of this Patient safety initiative by WHO and India is to
give confidence to patients that they are receiving quality care and also to ex
press that every health care provider is showing keen interest in reducing medic
al errors. Every time health care organizations are united to eradicate some dis
ease, why cant this time to eradicate disease of an organization. Lets all work
together to eradicate medical errors and ensure quality to the patients.

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