Patient Safety in Healthcare

Patient Safety Definition

• Patient safety involves preventing harm to patients during healthcare.
• It is a framework of organized activities creating a culture, processes, procedures, behaviors, technologies, and environment.
• These elements consistently lower risks, reduce avoidable harm, and make errors less likely, reducing their impact.

Importance of Patient Safety

• Reduces morbidity and mortality, ensuring patients recover without additional harm.
• Improves patient outcomes leading to better health and satisfaction.
• Builds trust between patients and healthcare providers.
• Nurses have a legal and ethical duty to protect patients from harm.

SAFETY Acronym

• S: Sense the error.
• A: Act to prevent errors in the future.
• F: Follow safety guidelines.
• E: Enquire into accidents or deaths.
• T: Take appropriate remedial measures.
• Y: Your responsibility.

Factors affecting Patient Safety

• Patient safety is critical but influenced by various factors broadly categorized.

Human Factors

• Healthcare provider competence is an element, lacking knowledge, skills, or training can lead to diagnostic, treatment, or medication errors.
• Fatigue and Stress from long work hours, high workload, and emotional distress impair judgment and increase mistakes.
• Communication breakdowns can cause misunderstandings, missed information, and errors.
• A lack of accountability, complacency, or resistance to protocols can compromise patient safety.
• Human error includes mistakes like misreading labels, forgetting steps, or misinterpreting symptoms

System-Related Factors

• Understaffing or high nurse-to-patient ratios lead to burnout and reduced care quality.
• Outdated or unclear protocols create confusion and increase error risks.
• Malfunctioning or poorly maintained equipment poses risks to patients.
• A punitive culture can discourage the reporting of errors or near misses thus, prevents learning and improvement.
• Insufficient funding or resources for patient safety initiatives limit the ability to implement best practices.

Environmental Factors

• Cluttered workspaces can increase the risk of accidents, like trips and falls.
• Inadequate cleaning, sterilization, or hand hygiene can lead to healthcare-associated infections (HAIs).
• A noisy or chaotic environment can disrupt concentration and lead to errors.
• Poor lighting causes mistakes in reading labels/administering medications, while inadequate ventilation can increase infection risks.

Patient-Related Factors

• Low health literacy can cause patients to misunderstand treatment plans or safety instructions, leading to non-compliance or errors.
• Multiple chronic conditions or complex medical needs increase the risk for adverse events.
• Elderly patients, infants, and immune-compromised individuals are more susceptible to harm.
• Patients who do not follow prescribed treatments or safety recommendations are at greater risk.
• Miscommunication due to language differences or cultural misunderstandings can compromise care.

International Patient Safety Goals (IPSGs)

• Goal 1: Identify patients correctly by using at least two patient identifiers and eliminating transfusion errors.
• Goal 2: Improve staff communication by reporting important test results promptly.
• Goal 3: Use medicines safely by labeling medications and reducing harm for patients taking anticoagulation therapy.
• Goal 4: Ensure correct-site, correct-procedure, correct-patient surgery using safe practices.
• Goal 5: Reduce the risk of health care-associated infections by following hand hygiene guidelines and preventing multidrug-resistant organism infections.
• Goal 6: Reduce the risk of patient harm resulting from falls.
• Check patient medicines to Identify current medicines and confirm any new medicines are safe to take.
• Give lists of meds to providers and patients at discharge and include an explanation of the list.
• Identify patient safety risks, and individuals at risk for suicide.

National Patient Safety Goals

• Patient Identification
• Prevention of HAI
• Safe Medication
• Safe Clinical Blood Transfusion
• Prevention of Pressure Ulcer
• Patient Fall Prevention
• Safe Patient Hand Over
• Patient Safety Incident Reporting
• Surgical Safety & Checklist (SSC) Used in OT
• Care of the Medical Equipment and Devices

Patient Identification

• Identify the patient correctly.
• Use at least two ways to identify the patients, for example - use the patient’s name and date of birth for identification purposes.
• All registration numbers should be tagged with CID details.
• Cross check with patient's file and patient ID before labeling any container used for blood and other specimen.
• Provide wristbands for all patients going for any procedures/surgery.
• Provide clear protocols for identifying patients who lack identification and for distinguishing the identity of patients with the same name.
• Develop and use nonverbal approaches for identifying comatose or confused patients.
• Tag babies without CID/hospital registration number with mother's CID.

Prevention of Healthcare-Associated Infections (HAIs)

• Healthcare-associated infections (HAIs) are infections acquired during the process of receiving health care, not present at the time of admission.
• Examples include catheter-associated urinary tract infections, Escherichia coli, surgical site infection, and ventilator-associated pneumonia.
• The most common HAI is surgical site infection.

Strategies for HAIs prevention

• Hand hygiene
• Environmental hygiene
• Screening and cohorting patients
• Surveillance
• Antibiotic stewardship
• Following guidelines
• Safety Culture

Hand Hygiene

• Cleaning hands can prevent the spread of microorganisms, including antibiotic-resistant ones.
• The WHO "5 Moments for Hand Hygiene" defines when healthcare workers should perform hand hygiene.
• These moments include before touching a patient, before clean/aseptic procedures, after body fluid exposure risk, after touching a patient, and after touching patient surroundings.

Environmental Hygiene

• Contaminated hospital surfaces play an important role in the transmission of micro-organisms.
• Appropriate hygiene of surfaces and equipment patients and healthcare personnel touch is necessary to reduce exposure.
• Hospital environment involves physical cleaning, chemical disinfection (alcohol, sodium hypochlorite), and fumigation (formaldehyde, carbon sulphide, hydrogencyanide).

Screening and Cohorting Patients

• Early detection of multidrug-resistant organisms is an important component of any infection control program.
• The purpose is to prevent transmission from infected/colonized patients to others.
• Isolation measures should be an integral part of any infection prevention and control program

Surveillance

• Surveillance systems (i.e., regular health screening and lab tests) contribute to the early detection of HAIs and antimicrobial-resistant (AMR) organisms, including identifying clusters and outbreaks.

Antibiotic Stewardship Programs (ASP)

• ASPs are efforts to measure and improve how antibiotics are prescribed by clinicians and used by patients.
• ASPs are performed to stem overuse of antibiotic drugs to prevent antimicrobial resistance (AMR).

Following Guidelines

• Many infection control interventions focus on reducing organism transmission.
• Identifying measures to reduce infection risk is equally important.
• The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have recently published guidelines for preventing surgical site infections (SSIs).