Medicosnext
Dr Prasanna Rajbhandari
“Patient safety is not just a legal and ethical obligation; it is the cornerstone for building trust in healthcare systems.”
Patient safety is the foundation of good patient care. The unnerving fact that healthcare can harm us as well as heal us is the reason for suggesting that patient safety is the heart of healthcare quality. Effectiveness, access to care, timeliness, and the other dimensions of quality are all important. Patient safety plays a significant role in the healthcare industry since it directly affects patients’ well-being and trust. Providing a safe environment for patients is a primary goal for healthcare organisations all around the world.
Patient safety means reducing healthcare-related harm. Patient safety is defined as “the absence of preventable harm to a patient and reduction of risk of unnecessary harm associated with health care to an acceptable minimum.” One in every ten patients suffers from harm associated with health care, and unsafe care leads to more than 3 million deaths annually. The deaths in low- and middle-income countries are proportionately higher, with four deaths in every hundred patients. Approximately half of this harm is preventable and caused by medications. The common adverse events that result in avoidable patient harm are medication errors, unsafe surgical procedures, health care-associated infections, diagnostic errors, patient falls, pressure ulcers, patient mis-identification, unsafe blood transfusion, and venous thromboembolism.
“One in every ten patients suffers harm from healthcare, with unsafe care leading to more than 3 million deaths annually.”
World Patient Safety Day (WPSD), observed annually on September 17, aims to raise global awareness about patient safety and call for solidarity and united action by all countries and international partners to reduce patient harm. World Patient Safety Day was established in May 2019 when the 72nd Health Assembly adopted resolution WHA 72.6 on ‘Global action on patient safety’. This global campaign builds on a series of annual Global Ministerial Summits on Patient Safety initiated in 2016, as well as the high-level advocacy and commitment of major international and national stakeholders. This year the theme is “Improving diagnosis for patient safety” with the slogan “Get it right, make it safe!highlighting the critical importance of correct and timely diagnosis in ensuring patient safety and improving health outcomes.
“In Nepal, patient safety is often overshadowed by sensational headlines, but it’s time to focus on long-term solutions to prevent harm.”
Factors that highlight the importance of patient safety in hospitals:
- Patient well-being: Patient safety has a direct impact on the overall well-being and health of people receiving medical care. The hospital should implement safety rules, and health practitioners should emphasise best practices to reduce unwanted problems, infections, and damage during treatment.
- Trust and Confidence: Patients and their families are more likely to trust healthcare providers and follow therapies when they are confident in their safety, which is essential for efficient care delivery.
- Cost Reduction: Avoiding medical errors and serious complications reduces the need for extended hospital stays, readmissions, and extra treatments overall, saving money and is beneficial to both the patient and healthcare providers.
- Quality Improvement: Patient safety is the driving force for overall improvement in quality service and treatment. Analysing safety data and learning from adverse events allows for evidence-based strategies to be implemented for better patient care.
- Legal and ethical responsibility: Patient safety is a legal and ethical obligation for hospitals and healthcare providers. Maintaining patient trust and confidence is the ethical responsibility of healthcare professionals.
Causes of Patient Harm:
1. Medical Errors: Errors occurring during diagnosis, treatment, medication administration, and surgical procedures result in patient harm. Inadequate training and fatigue among health practitioners lead to errors.
“Patient safety is the foundation of good patient care, ensuring that healthcare heals rather than harms.”
2. Inadequate Communication: Failures in communication among healthcare personnel result in patient harm. Miscommunication about treatment plans, medication orders, and patient information has serious consequences.
3. Medication Errors: An inappropriate dosage of medication or incorrect drug administration harms patients. Factors like lookalike or soundalike medications and illegible handwriting contribute to medication mistakes.
4. Systemic Issues and Resource Limitations: Understaffing, lack of resources, and time pressures compromise patient safety. Overburdened health care providers are likely to commit medical errors.
5. Inadequate Patient Assessment: A missed diagnosis or delayed diagnosis due to poor patient assessment or inaccurate assessment leads to patient harm, which delays necessary timely interventions.
6. Healthcare-associated infections (HAIs): Inadequate infection control measures, poor hand hygiene, and improper technique of sterilisation pose a high risk for HAIs.
“Addressing patient safety requires a comprehensive approach, from preventing medical errors to fostering a culture of safety.”
7. Patient-related Factors: Non-compliance with treatment programs or allergies worsens the condition of the patient. Limited patient engagement leads to missed opportunities to identify potential risks and safety concerns.
8. Technological and Equipment Failures: Malfunctioning medical devices or outdated technology pose risks to patients.
Measures to Improve Patient Safety:
1. Prevention of Medical Errors: Prevention of medical errors in making diagnosis, treatment, medication administration, and other healthcare processes.
2. Infection Control: Proper infection control measures to reduce healthcare-associated infections (HAIs)
3. Medication Safety: accurate drug prescription, dispensing, and administration of medications to avoid adverse drug events.
4. Communication and Handover: Effective communication among healthcare providers and during patient handovers to prevent misunderstandings and preventable errors.
5. Patient Engagement: Involving patients and patient parties in their care decisions, offering education about their diseases, and encouraging them to participate in their treatment plans actively.
6. Staff training and competency: Proper staff training and developing competency in their roles helps in improving patient care.
7. Safety Culture: Fostering a culture within healthcare institutions that prioritises patient safety, encourages reporting of safety issues, and promotes a non-punitive learning and improvement environment.
8. Reporting and Analysing: Establishing systems for reporting and analysing adverse events and near-misses, leading to improvements in healthcare processes and patient safety.
Patient safety in the context of Nepal:
Patient safety in our context has been rarely uttered, seldom heard, and occasionally thought of; however, it is an important part of the healthcare system. Nevertheless, Nepal has not been entirely quiet on patient safety issues. The newspaper and news channel often raise safety issues, but these ‘buzz’ are often masked by the ‘bangs’ of sensational headlines such as ‘Hospital vandalised after patient’s death’ that usually ends with monetary compensation to the patient’s party. Although the hospital management denies negligence during the treatment, in most cases the hospital ends up paying to the patient’s family.
It’s high time to work on major issues for prevention of medical errors, developing a less stressful working environment, formation of a multidisciplinary team for endorsement of patient safety action plans, review and monitoring, and formation of an accreditation body with safety standards and spreading awareness. Some key points that can be put in our practice are proper use of patient safety checklists developed by WHO, application of minimum service standard scoring in all public and private hospitals, use of continuous professional development programs in upgrading knowledge, implementation of antimicrobial stewardship programs in all health institutes, implementation of electronic health record systems, and establishment of infection prevention and control departments in all workplaces. A proper handover between two working shifts, transparent communication between the management and health care staff as well as between senior staff and their subordinates, coordination between doctors involved in individual patient care and self-examination of clinical errors and patient outcomes resulting from error, and timely conversation with patients and families regarding their health concerns minimise the gap.
Conclusion:
Patient safety is a fundamental aspect of healthcare that ensures patients receive safe, effective, and high-quality care. It involves preventing harm, reducing medical errors, and improving systems within healthcare settings. While many countries, including Nepal, face significant challenges such as limited resources, inadequate infrastructure, and inconsistencies in care, patient safety remains a critical priority for enhancing overall health outcomes.
Addressing patient safety requires a comprehensive approach, including robust policies, better training for healthcare workers, effective infection control, improved communication, and patient education. Leveraging technology, enforcing standards, and fostering a culture of safety within healthcare institutions are essential steps. Ultimately, patient safety should be viewed as a shared responsibility, requiring collaboration among healthcare providers, policymakers, patients, and communities to ensure that all individuals receive safe and equitable care. Strengthening patient safety is not only an ethical obligation but also a cornerstone for building trust in healthcare systems and achieving universal health coverage.
Dr Prasanna Rajbhandari
He is a specialist in Emergency Medicine and Pre-Hospital Care. Dr Rajbhandari has been actively involved in frontline care, ensuring rapid and effective responses in critical situations at GIH. He completed his MBBS at Universal College of Medical Science, Tribhuvan University, and went on to pursue an MD in General Practice and Emergency Medicine at the prestigious Institute of Medicine (IOM), Tribhuvan University Teaching Hospital. His academic background, combined with his extensive experience in emergency medicine, positions him as a key figure in providing quality patient care under high-pressure environments.
Dr Rajbhandari is passionate about advancing patient safety in the healthcare system. He highlights the importance of reducing preventable harm in healthcare settings, advocating for improved systems and safety protocols. Through his work, he emphasizes the need for effective communication, proper training, and a culture of safety in ensuring patient well-being.
