Enhancing Skills for Patient Safety in Nepal

Dr. Kshitij K Shrestha

 

 

“Patient safety is the cornerstone of healthcare, ensuring not only the well-being of patients but also fostering trust in healthcare services.”

Patient Safety is the avoidance of mistakes and unfavourable consequences for patients related to patient safety. It is important to recognize that many errors that occur do not actually result in measurable adverse effects. WHO defines patient safety as “The absence of preventable harm to a patient and reduction of risk of unnecessary harm associated with health care to an acceptable minimum.” Within the broader health system context, it is “a framework of organised activities that creates cultures, processes, procedures, behaviours, technologies and environments in health care that consistently and sustainably lower risks, reduce the occurrence of avoidable harm, make error less likely and reduce impact of harm when it does occur.”

“In Nepal, resource constraints make it challenging to implement safety protocols, but infection control and medication safety are crucial in preventing harm.”

Patient safety involves minimising the risk of errors and adverse effects during medical treatment. It’s essential not only for the well-being of patients but also for maintaining trust in healthcare services. Ensuring patient safety is a cornerstone of healthcare, particularly in evolving systems like Nepal’s. As healthcare providers strive to deliver effective care, improving clinical skills related to patient safety is paramount. Healthcare professionals in Nepal can enhance their skills to improve patient safety and reduce risks in clinical settings. Major focuses on the practices and protocols that prevent harm to patients during medical treatment. A strong focus on safety not only benefits patients but also elevates the reputation of healthcare facilities, enhancing patient satisfaction and trust in the system, likely to achieve better clinical results, leading to higher patient satisfaction and confidence in the healthcare system.

By addressing key challenges in the healthcare system, professionals can foster a culture of safety and implement standardised practices to reduce harm. Patient safety encompasses a wide range of practices aimed at preventing errors and reducing risks. Key areas include infection control, minimising medication errors, and improving communication between healthcare teams. In Nepal, where resource constraints are common, ensuring adherence to safety protocols can be a challenge, but it is crucial to delivering effective care. Infection control and medication safety are particularly important in Nepalese hospitals, where studies have highlighted the prevalence of hospital-acquired infections and medication-related errors most. Also, surprisingly, the Landmark Report on Patient Safety 1999 by the Institute of Medicine reported that deaths associated due to medical errors were higher than road traffic accidents, breast cancer and AIDS combined.

“Improving safety outcomes requires education, training, and leadership to address gaps in patient safety, especially in rural areas.”

Current Challenges in Patient Safety

Nepal’s healthcare system faces several challenges when it comes to patient safety, they are listed below-

• Inconsistent standard protocols for managing infections and medications.
• Overworked medical staffs in the hospital settings of Nepal, especially in the government hospitals
• Medication errors, especially due to communication gap between health care professionals and patient or patient party.
• Under trained staff or lack of skilled health care professionals in safety practices of infection, prevention and control.
• Limited resources in rural areas, making it difficult to implement standardised care.
• Low reporting rates of medical errors, reducing opportunities for system-wide learning.
• Patient safety is not being included in the government’s priority.

Improving safety outcomes requires a focus on addressing these gaps through education, training, and leadership.

Importance of patient safety

In healthcare settings, patient safety is essential for a number of reasons:

1. Prevention of Harm: Patient safety prevents patients, suffering from threatening procedures, unfavorable side effects, or medical mistakes that could cause fatalities.
2. Better Outcomes: Promotes safe and efficient medical interventions, which lowers complications and enhances general health outcomes.
3. Trust and Confidence: Promotes patient confidence in healthcare practitioners and systems, which is necessary for collaborative care and successful outcomes and even following all the guidelines effectively, gives confidence to health care professionals for management of the patient.
4. Standards Compliance: Follows the law, moral principles, and government regulations requiring safe practices.
5. Cost reduction: Lessens the need for extra treatments, re-admissions, or extended hospital stays as a result of safety incidents, which lessens the financial burden on healthcare systems and patients.
6. Enhanced Quality of Care: Promotes a culture of ongoing development and alertness, which enhances the overall quality of care.
7. Making Well-Informed Decisions: Patients are empowered when they are provided with correct information about their care, which allows them to make knowledgeable decisions regarding their health.
8. Preventing Legal Issues: Reduces the possibility of lawsuits and the negative legal effects that can result from carelessness or misconduct.
9. Workplace safety: Increases workplace safety, which in turn reduces burnout and increases job satisfaction among healthcare professionals.
10. Cultural Shift: Encourages everyone working in the healthcare system to disclose and handle safety concerns without worrying about facing consequences. This fosters a culture of safety.

“A strong commitment to patient safety, supported by standardized protocols and a culture of open communication, is essential for building a reliable healthcare system in Nepal.”

Effective measures to promote patient safety

Education, practice, and institutional changes are all part of improving patient safety skills. By enhancing following skills, patient safety can be done effectively:

1. Accurate diagnosis and evidence based practices: Healthcare professionals in Nepal must prioritise accurate diagnosis and treatment protocols. Adhering to evidence-based practices helps reduce errors and ensures consistency in care.
2. Ongoing Education: Various training sessions, conferences, and workshops can be conducted frequently to stay up to date on the newest procedures, industry standards, and cutting-edge developments in patient safety. Regular training on updated medical guidelines is essential to prevent misdiagnosis and ineffective treatment for all health care professionals
3. Practice and Simulation: To hone skills in a safe setting and get experience reacting to life-threatening events, participate in role-playing games and simulation exercises.
4. Standardisation of Procedures: To lower variability and errors in patient care, continuously adhere to established rules and protocols. After establishing the standard rules and protocols, it should be followed compulsorily and effectively especially focusing on the field of Infection, Prevention and Control majorly focusing on hand-washing practices, injecting syringes safely, minimising risks of surgical site infections, sepsis prevention and management, safely discarding hospital wastes, etc. Standardised checklists and procedures should be done. Checklists are a proven way to ensure consistency in clinical care and prevent errors. Healthcare institutions in Nepal should implement Surgical safety checklists to avoid errors during procedures and medication administration protocols to ensure accurate dosages and reduce medication-related mistakes.
5. Communication skills: To guarantee that information is communicated to patients, patient parties, and healthcare teams in a clear and accurate manner, we have to develop our communication skills. Also, developing our critical thinking skills to assess patient circumstances, foresee possible risks, and make well-informed decisions to reduce safety concerns. Training of all healthcare workers for clear, concise and patient-centric communication must be prioritised.
6. Critical Thinking: Healthcare providers in Nepal often work under high pressure due to limited resources and large patient volumes. Developing critical thinking and decision-making skills enables providers to assess risks and respond quickly to emergencies, minimising harm to patients. Developing our critical thinking skills to assess patient circumstances, foresee possible risks, and make well-informed decisions to reduce safety concerns.
7. Error Reporting: Participate actively in fostering an environment where errors and near-misses are disclosed without reluctance or concern for the consequences. Encouraging healthcare workers to report errors without fear of punishment is key to fostering a culture of safety. By analysing incidents, hospitals can identify common risks and prevent future errors.
8. Cooperation and coordination: Encourage cooperation and coordination among coworkers to guarantee coordinated and secure patient care. Promote multidisciplinary meetings to discuss safety-related issues.
9. Patient Engagement: Educate patients about their treatment plans and encourage them to express any questions or concerns in order to involve them in their own care.
10. Use of new technologies: Familiarise yourself with and effectively use technological tools and systems, such as electronic health records (EHRs), Clinical Decision Support System (CDSS) and Telemedicine to improve accuracy and efficiency in patient care.
11. Risk assessment: Consistently evaluate and control the risks related to patient care, recognizing possible dangers and putting plans in place to mitigate them.
12. Be updated: To incorporate the most recent information into the practice, health care professionals should stay abreast of guidelines, research, and developments in the field of patient safety. Health care professionals must be updated with the latest news and enhancements of healthcare.
13. Leadership Skills: To effectively promote patient safety, carry out safety procedures, and set an example for others, professionals need to develop leadership skills. The leadership of hospital is essential to create a culture of safety. Leaders must set clear expectations, invest in safety initiatives, and actively engage staff in safety improvements.

Healthcare workers can greatly improve their abilities and help create a safer and more efficient patient care environment by concentrating on these areas.

“The Swiss Cheese Model emphasizes the importance of multiple layers of defense in healthcare, ensuring that safety measures work together to prevent errors.”

The Swiss Cheese Model in Patient Safety The Swiss Cheese Model is a concept used in patient safety and risk management to illustrate how errors can occur and how they can be prevented. It was developed by James Reason, this model uses the analogy of Swiss cheese to represent the layers of defence or safeguards in a system.

1. Layers of Defense: Imagine each layer of Swiss cheese represents a different defence mechanism or safety measure designed to prevent errors. Each layer has holes, which represent weaknesses or potential points of failure in that layer.

2. Accidental Alignment: In an ideal system, the holes in each layer of cheese are misaligned, so any potential problems are stopped by the defence in other layers. However, if the holes in all layers align perfectly, a problem can pass through all the defence and result in an error or accident.

3. Incident Prevention: The goal is to minimise the number and size of the holes in each layer of defence, and to ensure that these holes do not align. This involves improving safety measures, protocols, and training to reduce the chances of errors passing through all layers. In patient safety, the Swiss Cheese Model emphasises that while individual safety measures (like protocols, checks, and balances) may have flaws, having multiple layers of protection can prevent errors from reaching the patient. It also highlights the importance of continuous improvement in safety systems and the need for a culture that encourages reporting and addressing potential weaknesses.

Conclusion

Thus, prioritising patient safety and enhancing skills to develop patient safety in Nepal is essential for enhancing the quality of healthcare and protecting patient well-being. To achieve this, it is crucial to implement comprehensive training programs for healthcare professionals, establish standardised protocols, and foster a culture of safety that encourages open communication and error reporting. Engaging patients in their care and leveraging technology can further improve safety outcomes. Additionally, a collaborative approach involving healthcare providers, institutions, and government agencies, alongside adequate resource allocation, is necessary to support and sustain these initiatives. By focusing on these key areas, Nepal can build a more effective and reliable healthcare system, ultimately ensuring safer and higher-quality care for its population. As Nepal’s healthcare system continues to develop, a strong commitment to patient safety will be essential for delivering effective, reliable care. Healthcare providers, leaders, and institutions must work together to foster a culture of safety that prioritises patient well-being at every step.

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Dr. Kshitij K Shrestha

He is a medical professional with expertise in patient safety. He has completed the Patient Safety, Quality, Informatics, and Leadership (SQIL) program at Harvard Medical School in Boston, USA, and currently serves as the Principal Staff Officer and Chief Medical Officer at the Nepalese Army Institute of Health Sciences. In addition, he works as an Assistant Lecturer at the Nepali Army College of Health Sciences. He has been honored with the Prabal Janasewashree by the Honourable President and the Chief of Army Staff Commendation Medal by the Chief of the Army Staff.