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 Safety that
emphasizes the reporting, analysis, and prevention of medical error that often leads to
adverse healthcare events. Lack of patient safety – the silent killer 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 world. Lack of patient safety is not a non- curable, it
is preventable. WHO realized this and initiated “World Alliance for Patient Safety”, was
launched in October 2005 at WHO Headquarters, as an outcome of the 55th World Health
Assembly resolution on patient safety. India followed the WHO and started WHO-
Global Patient Safety Challenge” in India by launching the National Initiative on Patient
Safety (NIPS) and it was launched by the Honourable Health Minister Shri. Ghulam Nabi
Azad on September 14th, 2009. Even the Honourable Health Minister has expressed
regarding the lack of data regarding patient safety in the Indian Scenario and also
announced to place National Patient Safety Policy and expressed interest in including
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 professionals in
India as well as all over the world has followed strict policies in patient safety and they
have prioritised patient safety is the key component of medical 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 special initiative, it is the basic component that
each patient expects when they are entering the hospital. It is also the responsibility of
health care professionals 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 the 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 patient 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
Information
Policy and
formulation technology
& Review safety

Patient
Medication Safety Medical
treatment
Safety
Safety

Surgical
Nursing
related
Safety safety
Infrastructure Safety:

Infrastructure plays major role in improving patient safety. Infrastructure should 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 be possible without
significant investment in patient safety infrastructure. Even improving the existing
infrastructure by holistic integration of all systems within the building technology
infrastructure – heating, ventilation, climate, cooling, energy generation, emergency
power and energy distribution, access control, video surveillance, fire detection,
alarming, evacuation and extinguishing. In addition, further building technology systems
such as lifts and escalators, water technology systems, laboratory and medical technology
systems as well as monitoring of information and communication systems can be
integrated. It will help the health care providers in ensuring the quality as well as safety
to the infrastructure 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 procedures. 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 to be considered as a key issue in
medical errors as the transformation of information 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 this information scenario, as they can get clarification
about their treatment procedures if they have any doubt, provide right information about
their health conditions, expressing allergies in medicines, already consuming medicines
etc. It will help the doctor to prescribe the right combination of medicine along with
already 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 etc. In concern to computers,
ensuring the proper functioning of HIS (Hospital Information 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 eliminate medical errors permanently.

Medical treatment safety:

Medical treatment safety starts from patient registration itself. In patient registration most
common error will occur when patient data are directly entered by the computer operator
by getting oral information from patients. Key information in patient registration is name,
age, sex, address etc. Error can start when there is a wrong entry from the above. It is
important that patient information to be filled by patient only through patient registration
form. It is important that computer operator has to type correctly and it is counter
checked before issuing file to the patient. In Doctor Consultation and treatment
procedure, patient has to provide correct information like history, medicines consuming,
previous diagnostics reports etc. From doctor’s point of view, doctor has to assess the
patient completely before concluding and also it is mandatory to check allergic conditions
before prescribing medicines. In diagnostic medical treatment, it is mandatory to provide
right report to the right patient. It is the responsibilities 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 developing during treatment course. Medical treatment safety check
list has to be prepared and maintained by respective patient relative coordinators of the
respective 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, treatment
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 mortality due to
lack of patient safety. Surgical safety of the patient has to start from Inpatient rooms itself
before shifting patient to OT for starting pre surgical / anesthetic procedures. For this
surgical safety, all the hospitals can use the surgical safety tool provided by WHO. Tool
enclosed.

Nursing Safety:

Nurse’s main responsibility is to provide safe and effective care within constantly
evolving health care systems. Nurses are the only set of employees interacting with one
another, doctors, aides and technicians and finally to patients to provide 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 medication 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 before
administering it to the patient.
- take steps to accurately identify the correct route the patient is to receive the
medication before administering it.
- take steps to administer medication in a timely fashion as ordered by the
physician.
- take steps to accurately document the medication administration after
administering 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 activities 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 and all the supportive systems. It will help them to
get immediate access in crisis. Errors can be avoided by following standards procedures,
monitoring the system continuously, counter checking and documenting of all the
activities in patient cycle (i.e. from admission of patient till discharge).

Nurses should communicate with patient periodically about the care they are providing to
the patient and it will help them to counter check the action plan. Check list for each
procedure has to be developed, monitored and controlled by quality 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. Requirement of clear
understanding from Doctors regarding the medication prescribed and also gets clarified
immediately before administering it. As most of the medicines sounds alike if it is oral
and also doctor’s handwriting is bit difficult in understanding if it is written. Important
point to be noted here is Medical adverse. 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-based
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
evidence-based interventions.
• Prevent surgical site infection to all surgical patients by Surgical SOP
implementation.
• 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 each
procedure including medication procedures and also he / she should check periodically 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
concentrated by all the health care providers. Each hospital has to develop a committee in
concentrating these 2 activities. Periodical meetings are conducted to assess the system
flow, discussing on incidence about medical errors, developing strategies and policies to
avoid medial errors and also periodically updating the policies as a part of total quality
management. These committee should go On-site observation round weekly once for
each department to identify the right process flow and also guiding the respective
department in improving their quality of 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 express that every health care provider is showing keen interest in
reducing medical errors. Every time health care organizations are united to eradicate
some disease, why cant this time to eradicate disease of an organization. Lets all work
together to eradicate medical errors and ensure quality to the patients.