IPC-FINALS PDF - Patient Safety Guide

PATIENT SAFETY International Patient Safety Goals (IPSGs) - To promote speci c improvements in patient safety...

PATIENT SAFETY International Patient Safety Goals (IPSGs) - To promote speci c improvements in patient safety - Highlight problematic areas in health care - Patient safety is the absence of preventable harm to - Describe evidence- and expert-based consensus solutions patients and prevention of unnecessary harm by to these problems healthcare professionals (WHO). - Primum non necere = rst do no harm (Hippocrates Goal 1: Identify patients correctly 460AC-377AC) - Using two patient identi ers, not including patient’s room - To Err Is Humane: One unwillful error is a miss or location repeated error is a crime Patient name Date of birth or medical record number S - sense the error - Before administering medications, blood, or blood products A - act to prevent it - Before taking blood and other specimens for clinical testing F - follow safety guidelines - Before providing treatments and procedures E - enquire into accidents/deaths - Policies and procedures support consistent practice in all T - take appropriate remedial measure situations and locations Y - your responsibility Patient Safety as a Global Health Issue - Loss of 64,000,000 disability-adjusted life years each year across the globe due to unsafe care The Burden of Unsafe Care - 1 In 10 patients is subject to an adverse event while receiving hospital care in high-income countries, with 50% of them being preventable - In high-income countries, up to 15% of hospital expenditure due to system failures (NHS-£1.63 billion) - In low and middle income countries, 134 million adverse events occur annually due to unsafe care in hospitals, contributing to around 2.6 million deaths. Goal 2: Improve e ective communication Patient Harm During Provision of Healthcare - The complete verbal and telephone order or test result is - One of the top 10 causes of disability and death written down by the receiver of the order or test result. - The complete verbal and telephone order or test result is US: Medical errors are the third leading cause of death. read back by the receiver of the order or test result. UK: An average of one incident of patient harm is reported - The order or test result is con rmed by the individual who every 35 seconds. gave the order or test result. - Get important test results to the right sta person on time Due to.. Understa ng, inadequate structures and overcrowding Goal 3: Improve the safety of high-alert medications. Weak safety and quality culture High-Alert Medications are: Lack of health care commodities and shortage of basic - Medications involved in a high percentage of errors equipment and/or sentinel events Flawed processes of care - Medications that carry a higher risk for adverse Poor hygiene and sanitation outcomes Disinterested leadership teams - Look-alike/sound-alike medications Patient Safety in the Philippines - Policies and/or procedures are developed to address the Philippines National Policy on Patient Safety - AO identi cation, location, labeling, and storage of high-alert 2008-0023 medications. - Patient safety is highly regarded as one of the key elements - The policies and/or procedures are implemented. in achieving quality care. - Concentrated electrolytes are not present in patient care - Institutionalization of patient safety programs and units unless clinically necessary, and actions are taken mechanisms for monitoring and evaluation were inadvertent administration in those areas where permitted highlighted. by policy. - Philippine Alliance for Patient Safety, Joint Commission - Concentrated electrolytes that are stored in patient care International (Center for Patient Safety) and the Department units are clearly labeled and stored in restricted areas of Health (DOH) corroborated to support patient safety programs. High Risk Medications: A-PINCH - Philippine Alliance on Patient Safety in Surgery was - High Alert Double Check launched to introduce the culture of safe surgery in the - The acronym “APINCH” is designed to serve as a reminder Philippine hospitals that even routinely administered medicines pose a high risk to a patient safety fi ffi fi ff fi fi fi ff  the ability of health care systems and organizations to A - Anti-infectives ensure provision of safe health care. P - Potassium and other electrolytes I - Insulin International Patient Safety Goals (IPSGs) N - Narcotics and other sedatives - The purpose of the National Patient Safety Goals is to C - Chemotherapeutic agents improve patient safety. The goals focus on problems in H - Heparin and other anticoagulants health care safety and how to solve them. Goal 4: Ensure safe surgery Ensure correct site, correct procedures, correct patient surgery - Make sure that the correct surgery is done on the correct patient and at the correct place on the patient’s body. - Uses an instantly recognized mark for surgical-site identi cation and involves the patient in the marking process. - Uses a checklist or other process to verify preoperatively the correct site, correct procedure, and correct patient and that all documents and equipment needed are on hand, correct, and functional. - The full surgical team conducts and documents a time-out procedure just before starting a surgical procedure. - Policies and procedures are developed that support uniform process to ensure the correct site, correct procedure, and correct patient, including medical and dental procedures done in settings other than the operating theatre Goal 5: Reduce the risk of health care- associated infections - The organization has adopted or adapted currently published and generally accepted hand-hygiene guidelines. - Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization - Use proven guidelines to prevent infection of the blood from central lines, to prevent infection after surgery and to prevent infection of urinary tract that are caused by catheters Goal 6: Reduce the risk of patient harm resulting from falls - Implements a process for the initial assessment of patients for fall risk and reassessment of patients when indicated by a change in condition or medications, among others. - Measures are implemented to reduce fall risk for those assessed to be at risk. - Measured are monitored for results, both successful fall injury reduction and any unintended related consequences Summary - Patient safety is the absence of preventable harm to patients and prevention of unnecessary harm by healthcare professionals. - Patient safety is highly regarded as one of the key elements in achieving quality care. - Understa ng, inadequate structures and overcrowding, lack of health care commodities and shortage of basic equipment, and poor hygiene and sanitation, contribute to unsafe patient care. - A weak safety and quality culture, awed processes of care, and disinterested leadership teams further weaken fi ffi fl  PROFESSIONALISM Professional Key Elements Profession - de ned as a vocation or ‘calling’, especially one involving a degree of skill, learning or science Professional - Professionals are governed by codes of ethics and profess commitment to competence, integrity and morality, altruism and the promotion of the public good within their expert domain. Professionals are accountable to those they serve and to society. Professionalism in Medicine - Professionalism refers to guidelines and attributes that Behaviors of Professionalisms require the physician to serve the interests of the patient - Professionalism fosters respect and trust among students, above his or her self‐interest. faculty and sta , and includes willing compliance with the - It embodies the relationship between medicine and society highest ethical standards. as it forms the basis of patient –physician trust. It attempts to make tangible certain attitudes, behaviors , and characteristics that are desirable among the medical profession Why Professionalism is Important? Being productive E ective patient care and management Being mission-minded Professionalism denotes a way of behaving in accordance to certain normative values Professional Attributes ff ff fi  Professionalism Fundamental Principles of Professionalism - The conduct, aims or qualities that characterize a 1. Patient Welfare profession or a professional - Health workers must be altruistic: cornerstone of - More than doing a particular type of job but more about professionalism being a particular type of person - Health workers must always provide care that is in - Involves “professing” openly that you are that type of patient’s best interest – NOT his own self interest person, usually by taking an oath - Care should NOT be dictated by any other outside - Moral Code - often basis of professionalism forces: market, society, administrative exigences etc. Professionalism: Basis of Medicine’s Contract with 2. Patient Autonomy Society - Health workers MUST be honest with their patients - Demands the following: - Empower patients to make informed decisions about Placing interests of the patients above those of the health their care workers. - Health workers should respect patient’s decisions Setting and maintaining standards of competence and provided they are ethically sound and do not lead to integrity demands for inappropriate care Providing expert advice to society on matters of health 10 Professional Responsibilities “Professionalism aspires to altruism, accountability, 1. Commitment to professional competence excellence, duty, service, honor, integrity and respect for - Lifelong learning others” - Maintaining knowledge and clinical skills - Professional organizations must ensure appropriate Altruism mechanisms for health workers to accomplish this goal - Essence of professionalism - Profession, as a whole, must ensure all its members are - The best interest of the patient, NOT self interest, is the competent! rule 2. Commitment to honesty with patients Accountability - Informed consent - Required at many levels-patients, society and the - Involve patients in healthcare decisions profession - Accidents happen! Inform patients immediately - We are accountable to pts to uphold the patient/ Failure to do so compromises patient and societal physician contract trust - We are responsible to society for public health needs 3. Commitment to patient con dentiality Excellence - Elevator conversations - Entails conscientious e ort to exceed ordinary - Verbal sign-outs in community areas expectations and to make a commitment to life-long - Leaving paper sign-outs easily accessible learning - Electronic information systems - Commitment to excellence is an acknowledged goal 4. Commitment to maintaining appropriate relations Duty - Patients are vulnerable/dependent - Acceptance of commitment to service - Never exploit patients for: - Being available and responsive when “on call,” a. Sex accepting inconvenience and risk to meet the needs of b. Financial Gain the patient c. Personal Interests - Providing the best possible care regardless of the ability to pay and volunteering one’s skills and expertise for the 5. Commitment to improving quality of care welfare of the community - Health workers must be dedicated to continuous quality improvement Honor and Integrity - Work together w/ society and professional organizations - Highest standard of behavior and refuse to violate one’s to reduce error, improve safety, optimize outcomes and own personal and professional code: fair, truthful, and minimize overuse of health care resources meeting commitments - Also require recognition of con icts of interest and 6. Commitment to improving access to care avoiding relationships that allow personal gain to - Objective of ALL healthcare systems is the availability of supersede best interest of the patient uniform and adequate SOC - Health workers should work to reduce any barrier which Respect prevents access to health care based on education, - Essence of Humanism: We must respect patients, nances, geography and social discrimination families, nurses, medical students and colleagues - Entails promotion of public health and preventive - Humanism in turn is central to professionalism and medicine fundamental to enhancing collegiality among healthcare workers 7. Commitment to a just distribution of nite resources fi ff fi fl fi  - Health workers should work together to develop 6. Lack of Conscientiousness guidelines - Failure to ful ll responsibilities - Goal is to provide health care based upon wise and - This is the health worker who is committed to doing the cost-e ective management of limited clinical resources bare minimum for cost e ective care Takes least amount of history Re lls medications without reviewing chart 8. Commitment to scienti c knowledge Does not return patients phone calls - Much of our contract w/ society based upon integrity Reviews charts rather than the patient and appropriate use of knowledge and technology - The health worker who is too busy to ful ll his/her - Duty to uphold scienti c standards, to promote responsibilities to subordinates, comes late for rounds research, search for new knowledge and ensure its or conferences and shifts the care of patients to trainees appropriate use not yet prepared for unsupervised responsibility, etc. - The profession is responsible for the integrity of - Avoid situations in which the interest of the physician is knowledge, based on scienti c evidence and placed above that of the patient experience Self referral Acceptance of gifts 9. Commitment to maintaining trust by managing Utilization of services con icts of interest - Many opportunities to compromise professional responsibilities thru pursuit personal gain or advantage - Avoiding compromising one’s integrity by entering ETHICS AND VALUES relationships w/ for-pro t industries medical equipment manufacturers, insurance companies and drug Ethics companies etc. - Ethics are guiding moral principles that direct an - Obligation to recognize, disclose and deal w/ these individual's behavior in his or her activities. con icts of interest - The term "ethics" is frequently used in reference to professional conduct 10. Commitment to professional responsibilities - Expected work collaboratively to maximize patient care Values/Ethics Sub-Competencies - Be respectful of each other - Work with Individuals of other professions to maintain a - Participate in self regulation, including remediation/ climate of mutual respect discipline of members who have failed to meet professional standards 1. Place interests of patients and populations at center of - Profession de ne/organize standards and processes interprofessional health care delivery and population Accept internal assessment and external scrutiny health programs and policies, with the goal of promoting health and health equity across the life span Challenges to Professionalism 2. Respect the dignity and privacy of patients while 1. Abuse of Power maintaining con dentiality in the delivery of team-based - Interactions w/ patients and colleagues care. - Bias and sexual harassment 3. Embrace the cultural diversity and individual di erences - Breech of con dentiality that characterize patients, populations, and the health team. 2. Arrogance 4. Respect the unique cultures, values, roles/responsibilities, - O ensive display of superiority and expertise of other health professions and the impact - Destroys professionalism by: these factors can have on health outcomes. Losing empathy for the patient 5. Work in cooperation with those who receive care, those Removing the bene cial role of self-doubt who provide care, and others who contribute to or support the delivery of prevention and health services and 3. Greed programs. - Money or power become the driving force 6. Develop a trusting relationship with patients, families, and - Lose understanding, compassion and personal integrity other team members (CIHC, 2010). - Must always ask “is this in the best interest of the 7. Demonstrate high standards of ethical conduct and patient or my own nancial interest?” quality of care in contributions to team-based care. 8. Manage ethical dilemmas speci c to interprofessional 4. Misinterpretation patient/ population centered care situations. - Consists of lying and fraud 9. Act with honesty and integrity in relationships with - Both are conscious e orts patients, families, communities, and other team members. - Fraud 10. Maintain competence in one’s own profession appropriate to scope of practice. 5. Impairment - Drug addicted, alcoholic or mentally impaired health Principle of Ethics worker protected or unnoticed by colleagues and 1. Bene cence allowed to care for unsuspecting patients - To do good ff fi fl fl fi ff ff fi fi fi fi fi fi ff fi fi fi fi fi fi ff  - Health care providers have a duty to be of a bene t to NOT ALL LEGAL ARE ETHICAL? the patient, as well as to take positive steps to prevent and to remove harm from the patient. Four Basic Principles of Medical Ethics 2. Non-Male cence - To do no harm - The principle of non-male cence requires of us that we not intentionally create a harm or injury to the patient, either through acts of commission or omission. - Providing a proper standard of care that avoids or minimizes the risk of harm is supported not only by our commonly held moral convictions, but by the laws of society as well 3. Autonomy - Requires that the patient have autonomy of thought, intention, and action when making decisions regarding health care procedures. - Decision-making process must be free of coercion or 1. Autonomy coaxing. - Patient has freedom of thought, intention and action - In order for a patient to make a fully informed decision, when making decisions regarding health care she/he must understand all risks and bene ts of the procedures procedure and the likelihood of success. - For a patient to make a fully informed decision, she/he must understand all risks and bene ts of the procedure 4. Con dentiality and the likelihood of success - Identi es the con dentiality of information pertaining to - Always respect the autonomy of the patient - then the clients, patients, students, and research subjects as a particular patient is free to choose matter of ethical obligation, not just as a matter of legal - Such respect is not simply a matter of attitude, but a or workplace requirements. way of acting so as to recognize and even promote the autonomous actions of the patient 5. Veracity - The autonomous person may freely choose loyalties or - Maintain competence in one’s own profession systems of religious belief that may adversely a ect him appropriate to scope of practice - Full, honest disclosure 2. Bene cence - The practitioner should act in “the best interest” of the 6. Fidelity patient - the procedure be provided with the intent of - One should keep his/her promises to others and doing good to the patient maintain the trust necessary to retain the relationships which binds them together. 3. Non-Male cence - This principle captures in a special way the element of - “Above all, do no harm,“ – Make sure that the trust which must exist between persons who are procedure does not harm the patient or others in society mutually bound to each other by circumstances or choice. 4. Justice - The distribution of scarce health resources, and the Ethics and It’s Nature decision of who gets what treatment “fairness and - Greek word: ETHOS - a characteristic way of acting equality” - Ancient Romans translated ethos - The burdens and bene ts of new or experimental - This is an area of philosophical study that examines values, treatments must be distributed equally among all actions, and choices to determine what is right and wrong. groups in society - Core principles that have been foundational for ethical behavior were established millennia ago by the great Basis of Ethical Principle philosophers Aristotle, Plato, and Socrates. 1. Utilitarianism/Consequentialism - In the fourth century B.C., they de ned ethics as “the - Holds your action where in the majority will bene t the science of morals.” people. - Advocates that actions are morally correct or right when Ethics - is a combination of the attributes of: the largest number of persons are bene ted 2. Deontology - Action based on duty - “Judge action by deciding if it is an obligation” - Advocate that rules to be followed at all times by individuals fi fi fi fi fi fi fi fi fi fi fi fi ff fi fi  Need for the Professional Ethics Professional Etiquette - manners and attitudes generally Professional Ethics accepted by members of a profession - Is the branch of moral science which treats of the obligation which a member of the profession owes to Respect for Property - keeping patients belongings safe the public, to his profession, to his brethren, and to his and free from damage clients - It embraces the basic principles of right action or norms Rights - justi ed claims that an individual can make on of conduct which exemplary and honorable in the individuals, groups or society practice of profession - Divided into legal rights and moral rights Terms Related to Ethics Sanctity of Life - belief that life is the highest good Habit – is an acquired mode of behavior involving the tendency to repeat and to reproduce certain actions Values - ideals and customs of a society toward which the members of a group have an a ective regard Custom - it is an ordinary or usual manner of doing or - A value may be a quality desirable as an end in itself acting, or the habitual practice of a community or people Veracity (Truthfulness) - duty to tell the truth and avoid Ideals - it pertains to perfection deception - is conceived as perfect, supremely excellent and very desirable Virtue - trait of character that is socially valued, such as courage Etiquette – French word meaning “ticket” - rule of behavior, form of ceremony, decorum and social Values graces - Values are your ideas and beliefs. - Each person has di erent values Tradition- transmission of knowledge, opinions, doctrines, - Our values are based on many aspects including family, customs and practices from generation to generation religion, peers, culture, race, social background, gender, - it includes a body of beliefs and usages etc. - Our values help us decide what is important, or not, in our Justice - all person must be treated equally (fairness) life - Values impact our decisions every day. Con dentiality - discloses factual information - Knowing your values is important because values guide - Refers to the concept of privacy decisions about our future - Not only is the career itself important, but sometimes what Double E ect - refers to the fact that some action may the career can o er (i.e. lots of money, status, relationships, produce both good and bad e ect meaningful work) satis es a person’s values Code of Ethics - articulated statement of role morality as Sources of Values seen by the members of a profession Family Friends Fidelity - strict observance of promises or duties, loyalty Culture and faithfulness to others Employer Religion Legal Rights - rights of individuals or groups that are School and etc. established and guaranteed by law Moral Principles - general, universal guides to action that are derived from so-called basic moral truths that should be respected unless a morally compelling reason exists not to do so, also referred to as ethical principles Moral Rights - rights of individuals or groups that exist separately from government or institutional guarantees, usually asserted based on moral principles or rules Morality - widely shared social conventions about right and wrong human conduct Morals - generally accepted customs, principles, or habits How does Values Relate to Ethics? of right living and conduct in a society and the individual’s - Values determine what is right and wrong, and doing what practice in relation to these is right and wrong is what we mean in ethics - To behave ethically is to behave in manner consistent is Paternalism - attitude to promptly decide on one’s-health what is morally upright. even without consulting the patient a ected fi ff fi ff ff fi ff ff ff