Health & Safety in Healthcare PDF

Patient safety – Not a new concept “It may seem a strange principle to enunciate as the very first requirement in a health setting is that it should do the sick no harm.”  First do no harm Classic call that puts patient safety at the heart of your pra...

Patient safety – Not a new concept “It may seem a strange principle to enunciate as the very first requirement in a health setting is that it should do the sick no harm.”  First do no harm Classic call that puts patient safety at the heart of your practice. Modern practice with its huge array of powerful drugs invasive treatments Superbugs the risk of harm is still present. Greater emphasis on patient safety.  What is patient safety Patient safety is a relatively new research discipline and may be defined as “theavoidance, prevention and amelioration of adverse outcomes or injuries arising from the process of healthcare”.  How safe is our practice NHS compensation bill last year touched £2.35 billion for the first time Slips and trips most common cause of claim Medication errors second and represent 11% of all claims Source of largest claims remains Surgery Obstetrics and midwifery  Errors Most health services in most countries have an adverse event rate of about 10%. In primary care there is much less published information. Adverse events may occur following discharge from hospital in as many as one fifth of patients – stresses the importance of the need for primary and secondary care to work closely.  Consequences Adverse events result in a number of problems – Pain, disability and death. Psychological harm Financial burden Personal cost to individual practitioners Driving change  Defining error Error The term has been used in three different senses as a cause (my errors caused the death of this patient) as an event or action (I picked up the wrong syringe) as a consequence or outcome (there are 800 injectable medicine errors each month in the UK)  Errors tend to occur when there is a combination of active failures and latent failures  Active Failures Usually associated with human factors and Occasionally, sudden and unexpected failure of equipment. Incorrect decisions and actions that contribute to unsafe patient care errors of commission Omit key steps in a clinical task errors of omission  Main types of error due to human factors Slips: unintentional failure to execute a routine task correctly: for example failure to transfer information about a drug allergy from the clinical record to the prescription chart. Lapses: unintentional failure to follow a guideline, rule or protocol: for example failing to prescribe aspirin for a patient who has had a myocardial infarction would be a lapse, an act of omission.  Mistakes: a failure of judgement due to insufficient knowledge about the problem, diagnosis or treatment, or application of the wrong rule or guideline to a problem (rule based mistakes): Violation: a deliberate decision or action not to follow accepted rules or steps:  Latent failures are errors waiting to occur and have not been identified in policies, procedures and guidelines associated with the healthcare system. These latent failures are the root cause of most active failures  No Caption Found Reason, J. BMJ 2000;320:768-770 Copyright ©2000 BMJ Publishing Group Ltd.  Communication and patient safety Failures in communication feature in about 90% of claims for compensation. Patients have their own set of values and beliefs and these are frequently determined by the particular cultural groups to which they belong. Identifying these will help you understand the individual and their unique perspective on the world.  What does this mean? Pat male 73 PH DM II, AH, IC att 4 pain in tx  New technology challenges Majority of consultations are still face to face but there are increasing numbers of consultations by telephone and e-mail. Lack nonverbal cues, and the patient’s condition and context cannot be readily determined Errors during transitions in care are one of nine key safety areas being targeted by the World Health Organisation  Referral processes between primary and secondary care or between clinicians in different specialties are often important parts of the patient pathway. A failure to refer or delay in referral can pose threats to patient safety. WHO – medication errors occur in 76% of transitions in care between primary and secondary care  Practical tips Patient safety should be a principle theme in your day to day practice. Do not exceed the limits of your competence and be prepared to seek help from colleagues in the face of uncertainty. Familiarise yourself with your local guidelines and protocols: if no such guidelines exist, then consider how you would start setting them up Familiarise yourself with local arrangements for risk management and critical incident reporting: if no such arrangements exist, then consider how you would start setting them up  Law and Patient Safety Duties imposed under Statute law Health and safety at work etc Act 1974 and its regulations Common law Duty of care expressed through the law of negligence  Defining a duty Duty considered in terms of Rights and Obligations A right is an interest recognised and protected in law Where an individual is the recipient of rights then others have an obligation – A DUTY – to respect those rights.  Annually 235 fatalities 159,809 RIDDOR reported injuries An estimated 2.2 million people suffering from an illness caused or made worse by their current or past work An estimated 39 million working days lost - 30 million due to ill health & 9 million due to injury Health and Safety at Work etc Act 1974 Duties on all at work To protect all affected by work Ambulance drops patient at wrong address Two NHS trusts fined a total of £27,500 over the death of a 93-year-old woman, dropped off at the wrong house by an ambulance crew. She fell breaking her leg after being left at a house in Cardiff. She died five weeks later in hospital  Legal Requirements  Health & Safety at Work etc Act 1974  Management of Health & Safety at Work Regulations 1999 Control of Substances Hazardous to Health Regulations 2002  Failure to comply is a criminal act  Employers CANNOT insure against failure to comply  Section 2 Section 2(1) - employers’ general duty  Duty to ensure so far as is reasonably practicable, the health, safety and welfare at work of employees and any others who may be affected by the undertaking….  Section 7 Duty of Employees at Work It shall be the duty of every employee whilst at work:- to take reasonable care of their own health and safety and of any other person who may be affected by their acts or omissions to co-operate with their employer so far as is necessary to enable that employer to meet their requirements with regards to any statutory provisions Infection Prevention and Control  Manual Handling Manual Handling Operations Regulations 1992 Manual handling any transporting or supporting of a load (including the lifting, putting down, pushing, pulling, carrying or moving thereof) by hand or by bodily force Load includes any person and any animal Duty on employers to avoid hazardous manual handling operations as far as is reasonably practicable.  No lift policies Health boards now implement manual handling procedures through no-lift policy. Seen as the only means of reducing injury when handling patients. Duty to assess risk more precisely Physical ability of the handler will need to be assessed against the needs of the patients for manual handling. Assessment must focus on particular circumstances of the individual case. Just as context is everything, so the individual assessment is all. Thus, assessment must take into account the particular person’s personal physical and mental characteristics, be ‘user focussed’ and ‘user led’ and should be part of the wider care-planning process for that particular individual; must be an assessment of the particular person’s autonomy interests; assessment must be based on the particular workers involved (not workers in the abstract); assessment must be based on the pattern of lifting in the particular case  Control of Substances Hazardous to Health Regulations 2002 Seek to control exposure to hazardous substances which arise out of work under an employer's control. Apply to all work in which persons are exposed to substances hazardous to health. The requirements of these regulations include that the exposure of his employees to substances hazardous to health is either prevented or, where this is not reasonably practicable, adequately controlled (COSHH Regulation 7,1)  Alison Dugmore established for the first time that employers are strictly liable for injuries caused by hazardous substances. £345,00 damages Alison a nurse forced to abandon her career due to an allergy to latex Gave up nursing in 1997 after experiencing asthma, skin problems and anaphylactic attacks - the most severe form of allergy - after using hospital gloves.  Cost can be higher in human terms South West London Primary and St Georges Mental Health NHS Trust fined £28,000 and £14,000 costs at the Central Criminal court following a prosecution brought against it by the Health and Safety Executive (HSE) after a nurse was killed by a psychiatric patient A junior member of staff working alone on a ward at a University Hospital without clear procedures and with inadequate measures in place to check on his safety. He suffered multiple injuries, from a psychiatric patient, which resulted in the loss of his life.