Quality and Safety in Healthcare PDF

Health and Disease in Society Session 1 Lecture 2 Quality and Safety in Healthcare Dr. Ronahi Younis College of medicine Zakho university  Duties of medical doctors Knowledge, skills and performance Safety and quality Communication, partnership and te...

Health and Disease in Society Session 1 Lecture 2 Quality and Safety in Healthcare Dr. Ronahi Younis College of medicine Zakho university  Duties of medical doctors Knowledge, skills and performance Safety and quality Communication, partnership and teamwork Maintaining trust  Why have quality and safety become so important? Need to ensure patients get best possible care and avoid harm S. S) >; f - Variations in healthcare 5 S 4 so t. I Evidence of medical errors Policy imperatives – linked to scandals - ↓ exi many complaints against a hospital  What is clinical governance? A system through which all of the organizations in the health system are accountable for continuously improving the quality of their clinical services and ensuring high standards of patient care by creating a facilitative environment in which excellence will flourish ↳oughhoring Clinical governance In UK Since April 1999 NHS trusts have had a legal duty to put in place systems for monitoring and ensuring quality of care provided. Clinical governance means delivering on this duty. All doctors work under duties of clinical - - governance.  What is quality? "…the degree to which health services for individuals & populations increase the likelihood of desired health outcomes & are consistent with current professional knowledge." US institute of Medicine  Dimensions of quality 1. Safety – have the risks of avoidable harm to patients been minimised? 2. Accessibility – can patients get the services they need, where and when they need them? 3. Equity – do patients with the same need get the same care? 4. Patient‐centered – is care respectful and sensitive to In terms of patient's story back ground individual patients? , > - and secrets 5. Effectiveness ‐ are patients given interventions that work? 6. Efficiency – are services provided at reasonable cost? -  How do we know quality is NOT optimal? Presence of high rate of adverse events or interventions that could be prevented Variation in rate of expenditures These variations have no basis in clinical science but if there are variations in clinical science between two hospitals , that means one I - them is using unscientific measures to cure patients is Inacceptable Presence of gaps between what is known to be which simply effective and what is practiced  Cont….. Not everyone getting the best care.Medical care provision is not equitable Medical care provision is not accessible Medical care is not efficient Risk being higher in one place than the other Variations in healthcare examples There are over 70 amputations a week in England, of which 80% are potentially preventable in 2007/2008, nearly a quarter of people with diabetes did not have a foot check foot amputation risk is double fold in area A than area B.  What is patient safety? is the absence of preventable harm to a patient during the process of health care and reduction of risk of unnecessary harm associated with health care to an acceptable minimum  WHO facts about patient safety 1. One in every 10 patients is harmed while receiving hospital care 2. The occurrence of adverse events due to unsafe care is likely one of the 10 leading causes of death and disability across the world 3. Four out of every 10 patients are harmed in primary and outpatient health care 4. At least 1 out of every 7 dollars is spent treating the effects of patient harm in hospital care 5. Investment in patient safety can lead to significant financial savings. 6. Unsafe medication practices and medication errors harm millions of patients and costs billions of US dollars every year 7. Inaccurate or delayed diagnosis is one of the most common causes of patient harm and affects millions of patients 8. Hospital infections affect up to 10 out of every 100 hospitalized patients 9) More than 1 million patients die annually from complications due to surgery 10)Medical exposure to radiation is a public health and patient safety concern.  What are the international patient safety goals 1. Identify Patients Correctly 2. Improve Effective Communication j(g) /; D 3. I Improve Safety of High Alert Medications - > & - - 4. Ensure Correct Surgery, Site, Patient ex : Insulin 5. Reduce Risk of Infection 6. Reduce Risk of Harm from Patient Falls  Types of error/active failures 1. Slips and lapses – error of action Person knows what he/she wants to do but action does not turn out as intended due to attentional slip or lapse of memory wanted to give the baby 0.05mg but gave 0.5 mg instead 2. Mistake: errors of knowledge/planning Action goes as planned but fails to achieve intended outcome because wrong - diagnosis. Perfect administration of migraine treatment but problem was a brain tumour. 3. Violation Intentional deviations from protocols, standards, safe operating procedures, or other rule e.g not using aseptic technique when inserting a catheter.  Root cause analysis RCA RCA is a systematic methodology to identify the gaps in hospital’s systems and processes of care that may not be immediately apparent and which may have contributed to the occurrence of the incident or near miss. Goals: What happened? Why did it happen? What can be done to prevent it from happening again?  Adverse event: ‘an injury that is caused by medical management (rather than the underlying disease) and that prolongs the hospitalisation, produces a disability, or both  Examples of preventable adverse events Operations performed on the wrong part of the body – Transfusion of blood with the wrong blood group Wrong dose of medication given Wrong type of medication given Medication administered incorrectly Example Patient is very ill and is prescribed antibiotic on Friday afternoon Pharmacy does not deliver it as it needs a special order Nurse notes “drug not available” on Friday evening. This is repeated by every nurse until Monday morning and no‐one realizes significance By Monday morning, patient is close to death. He subsequently dies  How common are adverse events? Harvard Medical Practice Study (HMPS) Reviewed 30,121 records Almost 4% hospital admissions led to adverse events In 7% of these the disabilities caused were permanent In 14% of these death resulted that was caused by management errors, among which nearly half attributed to negligence. Thank You