Romania National Health Quality Management Authority Vasile Cepoi, - - PowerPoint PPT Presentation
Patient safety in Romania National Health Quality Management Authority Vasile Cepoi, President January 14, 2020 AGENDA O Patient Safety - concept O International context O Role of ANMCS in increasing patient safety O Problems identified by
National Health Quality Management Authority Vasile Cepoi, President January 14, 2020
O Patient Safety - concept O International context O Role of ANMCS in increasing patient
safety
O Problems identified by ANMCS in the
O Actions carried out by ANMCS O ANMCS actions ongoing
The safety measurement was compared to the fabula in which five blind people describe an elephant in very varying terms (as a wall, fan, spear, snake or tree), depending on which part of the animal has touched In this analogy, the opinion
issues inevitably depends on the method used to measure safety, and a comprehensive picture can
be
by integrating several methods.
O The Institute of Medicine report of 1999 To
Err Is Human drew international attention to the problem of patient harm, which can be prevented in medicine and has led to the creation of the modern concept of patient safety.
O The impact of the To Err Is Human report
demonstrates the importance
rigorous measurement
the incidence and prevalence of preventable injury (EAAAM).
O The size of the phenomenon - up to 4 out of
10 patients are affected in primary and
O Incidence-134 million adverse events occur
every year in hospitals in low and middle income countries, contributing to 2,6 million deaths annually due to unsafe care
O
(The economics of patient safety in primary and ambulatory care – Flying blind (OECD study)
O Medication - Medication Errors cost about
$42 billion annually
O
(The third WHO Global Patient Safety Challenge: Medication Without Harm )
O The
risk
patient-related healthcare errors has led many countries to invest in more measures to strengthen healthcare systems and improve patient safety.
O The efforts started in 2015 and culminated
in the launch of The Global Ministerial series Safety Summit. (The first summit was held in London in 2016, followed by Bonn in 2017, Tokyo in 2018 and Jeddah, Kingdom of Saudi Arabia in 2019)
O The participants of the meeting in the Kingdom of Saudi
Arabia (March 2019) decided on the following lines of action:
O
Promoting the concept of patient safety
O
Involving the patient in providing their own care and their safety
O
Implementing and supporting national reporting and learning systems for patient safety
O
Promoting medication safety
O
Safety in use of medical devices
O
Implement infection prevention control strategies (IPC) and antimicrobial resistance (AMR) for safety the patient
O
Sustainable implementation and extension
effective national and global patient safety interventions.
Five lines of action for ensuring the quality and safety of health services proposed by IOM-SUA
O The accreditation of hospitals and outpatient services O Measuring and improving clinical performance O Ensuring patient safety O Involvement of the patient in the provision of his own care O The fifth dimension is the time of changes.
O
The continuity of measurement of performance over time of each dimension, from benchmarks to achievable goals, validates continuous improvement.
(Quality in Healthcare: A Five-Dimensional View, December 4, 2012 ‐ Brooke Schmidt, November / December 2012, Quality in Healthcare: A Five-Dimensional View, By Daniel L. Cohen, MD, FRCPCH, FAAP)
O Council recommendation of 9 June 2009 on
patient safety, including the prevention and control
programs on patient safety
identification and reporting systems on adverse events
healthcare workers on patient safety
mutual cooperation and with the Committee
cooperation and with the Committee, as well as with relevant European and international bodies
healthcare associated infections
Patient Safety Identified problems
O
The need for healthcare is not identified
O
There is no strategy to develop USP to meet needs
O
The buildings in which hospitals operate do not meet the conditions for authorization (ISU, Health Authorization, Environmental Authorization) and do not meet the requirements to ensure patient privacy, to protect information about the patient's health, etc.
budgetary provisions, without being interested in clinical results
O
The objectives in the strategic plans are unrealistic and do not respond to the national health strategy
O
Management is not concerned about ensuring conditions and the environment conducive to ensuring quality and safe services
O
Management has no responsibility for ensuring and continuously improving the quality of health services and patient safety
O
Employees in quality management Structures do not have appropriate training to the specific nature of the work and are not supported in the performance of their duties
O
Does not stimulate clinical performance
O
Managers do not make clinical management
O
It does not monitor costs on the disease
O
Tariffs do not reflect the real costs of medical assistance - Amounts collected for admitted cases are
500 1000 1500 2000 2500 3000 3500 4000 4500 1 2 3 4 5 6 7 8 9
Average cost variation/diagnostic-Chronic B Viral Hepatitis without Delta agent
Cost mediu/diagnostic mediana
2000 4000 6000 8000 10000 12000 14000 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
Average cost variation/diagnostic- unspecified, acute Appendicitis
Cost mediu/diagn
mediana
2000 4000 6000 8000 10000 12000 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Average cost variation/diagnostic-Essential hypertension (primary)
Cost mediu/dia gnostic mediana
1000 2000 3000 4000 5000 6000 7000 8000 9000 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37
Average cost variation/diagnostic - congestive heart disease
Cost mediu/diag nostic mediana
245.6 867.81 377.62 771.71 1574.83 439.29 5436.25 6807.89 4065 3563.99 7875.92 7523.76 7951 5691.13 Apendicita acuta, nespecificata Hepatita virala cronica B fara agent Delta Hipertensiunea esentiala (primara) Insuficienta cardiaca congestiva Insuficienta cardiaca, nespecificata Insuficienta ventriculara stanga Tumora maligna colonul ascendent
Average rage cost/di /diagnostic gnostic
minim maxim
50000 100000 150000 200000 250000 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33
Contract with C.A.S.- Total staff expenditure
mediana-Contract cu C.A.S.-Spitalizare continuă Contract cu C.A.S.- Spitalizare continuă TOTAL Cheltuieli cu personal mediana-TOTAL Cheltuieli cu personal
In its activity, ANMCS found that :
O
Taking care according to the hospital’s competence and the patient’s care needs
O
Ensuring continuity of healthcare
O
Integrated case Management
O
Implementing rules of good practice through protocols and procedures specific to each specialty
O
Evaluation and certification of medical practice
O
Preventing and limiting potential harm to patients in healthcare
O
Collaboration with the organizational pole to maintain the financial balance
The share of compliance with these requirements, in the 199 evaluated in cycle II accreditation, is below 70%
O The efforts of ANMCS to achieve its objectives of improving
the quality of healthcare and patient safety have resulted in the following actions:
O
The development of a new edition of hospital accreditation standards in line with international principles and has internationally accredited them through ISQua
O
Promoting the principle of self-regulation and accountability of the USP on how to implement quality of healthcare and patient safety assurance requirements
O
Development of an IT tool kit for implementation of standards, post-accreditation evaluation and monitoring of the USP to minimize bureaucratic work on quality management
O
Training more than 1000 doctors and nurses in clinical risk management within regional conferences and workshops
O Increase the level of professionalism of health care
evaluators by organizing training courses and debates on specific quality management topics
O Working
with institutions and
interested in improving the performance
healthcare
O Working
with patients' associations and professional societies to identify shortcomings in the delivery of healthcare that are addressed by central institutions, has set up working groups to produce analysis reports and recommendations to correct them.
O Example: Recommendations to remedy deficiencies
in healthcare of patients with haemophilia
O ANMCS has developed a common format (common definitions and
reporting mode) to help with uniform reporting of patient safety
and eliminate potential. The reporting template includes:
O Precise definitions of patient safety events that include cause injury O Examples of patient safety reports O Recommendations to guide the development of data collection tools O National register of Adverse Events with two sections — for the initial
reporting of the suspicion of EA and for the analysis carried out for confirmation or the disapproval of EA and the identification of causes and solutions to prevent or limit the consequences
O At present, the system is addressed only to hospitals
National Register of Adverse Events :
O Helps providers to report patient safety
O Standardization
O
Setting up the National Council of Patient Safety, in collaboration with the Academy
Medical Sciences, professional societies and patient associations, as an advisory body for health decision-makers with a role in the implementation and monitoring of good practice in every medical and research specialty in the field of quality of health services
O
Creation of the National Center for Nuclear Medicine, building on the research of IFIN and the ELI – Np laser, in Collaboration with SRMN and IFIN to increase the performance of nuclear medicine and introduce theranostics.
O
As an observer member of the OCDE Working group on health quality indicators, the A.N.M.C.S initiated and established, through the government-approved memorandum, the National Committee for the Surveillance of the Health Information System and Reporting at the
so that it can become a useful tool in decision-making at central government level and in the efficient allocation of resources, as well as in reporting indicators on health services in Romania, as required by the OECD and EUROSTAT
O Initiation and participation in projects funded by grants from
Committee Level (SRSS). These projects aim to increase the quality of health services and patient safety
O Organization and initiation of the first cycle of accreditation
O The ISQua accreditation of the organization and the training
O Developing
standards for the accreditation
health establishments as a basis of education for the training of residents
O Cooperation
with public and private higher education institutions for introduction into clinical risk management training curricula
O Informed decision-making:
O
providing data on the quality of care that different stakeholders, policy makers, managers, clinicians and the public can use to guide their decisions.
O Identification of organizational deficiencies in health
establishments as well as deficiencies that are consequences of central regulation or lack of regulation O Improved responsibility and regulation:
O
empowering healthcare organizations to statutory agencies or
patient groups and society at large, and regulating their behavior to protect the interests of patients and other stakeholders.
O Establish market surveillance mechanisms for health services O Cooperation between the institutions and the organizations
concerned, within the ANMCS CD
O The effective implementation of the quality
management system requires the collaboration of all responsible factors for:
O Harmonization of regulations at national level and
to correct those causing malfunctions
O Improvement of managerial competence through
continuous training and evaluation
O Improvement of professional practice through:
O Monitoring and control of compliance with good
clinical practice
O Implementation of clinical risk management O Real implementation of error learning mechanisms O Objective certification of professional competence
O Extending the process into primary and
secondary care