Safe Healthcare Safe Healthcare Dr J N Srivastava Advisor Quality - - PowerPoint PPT Presentation

National Health Systems Resource Centre

Saf afety i isn’t e expensive, i it’s p priceless.

Safe Healthcare

Dr J N Srivastava Advisor – Quality Improvement

Safe Healthcare

Patients’ Expectations

• Cure
• Correct, speedy, low cost, lasting treatment
• Emergency care
• No new disease
• No harmful procedure/ complication
• Care
• Psychological well being &

courteous behaviour

• Clean, inviting atmosphere
• Personalised approach

It takes too long!! Nobody Cares!!

How Safe is Health Care?

Global Burden

• Occurrence of adverse events due to unsafe care is likely to be one
• f the 10 leading causes of death & disability.

§ 70 Lakhs* surgical patients suffer significant complications each year, resulting into death of 10 Lakh such patients § 1.7 Lakhs* admissions annually in USA due to Patient harm § 15% of hospital expenditure on treatment of safety failure in OECD countries

• 50% of such harm is preventable

*1 million = 10 lakhs

Indian Scenario

qIn India around 5.2 million injuries occur due to medical errors, resulting in around 3 million preventable deaths every year. qFor every 100 Hospitalization, approx. 12.7 adverse events occur. (Ashsih Jha, BMJ Quality & Safety, Sept 2013)

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Global age-standardized incidence rates per 100,000 population due to AEMT

Adverse Event of Medical Treatment (AEMT): “unintended injury due to medical care leading to an extended hospital stay, disability at the time of discharge, serious and devastating long-term irreversible consequences or death”.

121.99 128.68 141.02 167.26

100 110 120 130 140 150 160 170 180 300 320 340 360 380 400 420 440 460 1990 2000 2010 2017

Global India

System Issues Environ- mental Issues Clinical Issues

Patient Safety-Multiple facets

• Reporting and learning
• Safety culture
• Patient engagement
• Competence based training
• Leadership and governance
• Human Factors and

Ergonomics

• Safety Surveillance
• Psychological Safety
• Disaster preparedness
• Fire Safety
• Electrical safety
• Structural Safety
• Hygiene and Environment
• Seismic Safety
• Illumination
• Infectious waste management
• Medication Safety
• Medical Device Safety
• Infection Prevention and Control
• Falls
• Patient identification
• Bed sores
• Venous Thromboembolism
• Personal Protection
• Injection Safety
• Diagnostic safety
• Sepsis
• Communication during transition
• f care
• Radiation safety
• Safety in mental health care
• Blood safety
• Surgical Safety
• Anaesthesia safety

Three Common Safety Incidents

qRelated to Surgical Procedures (27%) qMedication Errors (18.3%) qHealthcare Associated Infections (12.2%)

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Existing Initiatives supporting Patient Safety

• National Quality Assurance Standards
• ‘Kayakalp’ Initiative – Infection Control, Needle Stick Injury
• National Patient Safety Implementation Framework
• Pharmacovigilance Programme of India – Medication Safety
• Haemovigilance Programme of India – Blood Safety
• Health Management Information System (HMIS) – SSI, Needle Stick

Injuries, Performance of Health Facilities (ALS, BOR), Audits, etc.

• Facility Level Audits – MDR, CDR, Death Audits, Prescription audits

LaQshya

National Quality Assurance Standards

Kayakalp

Patient Safety NATIONAL QUALITY ASSURANCE PROGRAMME CENTRAL QUALITY SUPERVISORY COMMITTEE

STATE QUALITY ASSURANCE COMMITTEE

DISTRICT QUALITY ASSURANCE COMMITTEE FACILITY LEVEL QUALITY TEAM

KA Y AKALP

An award scheme for improving sanitation, hygiene, infection control and BMW management

PA TIENT SAFETY

Patient Safety Implementation Framework Patient safety standards

LAQSHY A

Improve QOC around birth. Respectful maternity care

MERA ASPT AAL

An IT based application to measure and improve Patient satisfaction..

BIOMEDICAL WASTE MANAGEMENT

Implementation and monitoring Monitoring committees. at districts .

ST ANDARD TREA TMENT GUIDELINES

Formulation and dissemination.

AEFI

Surveillance Standards. Certification

NA TIONAL QUALITY ASSURANCE PROGRAM

NQAS (DH/CHC/PHC/UPHC/CLMC/AEFI/HWC) Certification..

Patient Safety : An Integral Part of NQAS systems

Physical Safety Patient Identification Medication Safety Infrastructure Safety, Electrical Safety, Fire Safety, Diester Management, Secure & comfortable Environment for Staff, Visitors & Patients Patient Identification, Identification of high risk & vulnerable patients, Identification & continuity of care of during transition & referral Rationale prescription, Safe drug administration, medication reconciliation, review & optimization Procedure Safety Promoting Safe clinical processes, Use of safe surgery checklist, safe anaesthesia checklist & safe birth checklist, etc.

Patient Safety : An Integral Part of NQAS systems

Blood Safety Screening of donated blood, compatibility testing, Adverse reaction associated with blood transfusion.

Health Care Associated infections

Reporting of HAI, HAI surveillance, Hand hygiene, Use PPE, Instruments processing, Environmental safety, Bio medical waste management Risk Management Risk management framework & plan, identification of existing & potential risks, risk assessment, reporting, evaluation and its mitigation as per plan Staff Safety Staff protection from infections, radiations and other Hazards, provision of medical check ups, immunization, prophylaxis, etc.

Patient Safety components under National Quality Assurance Standards (NQAS)

Safety in clinical care (Medication, Injection, Surgical, Anesthesia)

Green marketing is a

Strongly

Infection Prevention and Control Physical safety and environment Infectious waste management

Green marketing is a

Moderately

Patient engagement Safety along life cycle Ability at point of care Leadership and governance

Green marketing is a

Needs strengthening

Reporting and learning Safety in specific clinical concerns (Radiation, Medical Device, etc.) Human Factors and Ergonomics Safety Surveillance

Kayakalp

Making Progress - Kayakalp

13.6 25.8 36.4 49.7 35.6

5.6 13.5 20.2 18.9 6.8 10 15.7 14.5

10 20 30 40 50 60

2015-16 2016-17 2017-18 2018-19 2019-20*

Percentage

Financial Years

Percentage of health facilities scoring 70% and above in Kayakalp External Assessment

DH SDH/CHC PHC * Result incomplete

JMP Report (WHO & UNICEF) 2019 – 97% DHs have some form of waste management facilities. 76% DHs have full system of BMW mgt.

NPSIF Released on 19th April 2018

NPSIF – Strategic Objectives

Establishing Institutional Framework Assessment & Reporting of Adverse Events Competent Healthcare Workforce Infection Prevention & Control Safety in Programs and Clinical Domains Patient Safety Research

Health Worker Safety: A Priority for Patient Safety

• Ensuring Availability of PPEs and Masks
• Helpline
• Insurance for Rs. 50.00 Lakhs
• Chemoprophylaxis for Frontline staff
• Ordinance to prevent the violence

National Q u a l i t y Assurance Standards `

S a f e c a r e e n v i r

• n

m e n t Antimicrobial Resistance Infection Control Safe point of care

Safety of Clinical processes (Facility level)

Safe High-risk clinical process Quality & Safety programmes Use of Indictors for decision Making Safety Surveillance Education and Training

Monitoring & Supportive Sup. (District level) Standards for patient safety Reporting & Learning System Institutional Framework (NPSIF) Circle of continuous learning (State level) Safe System High Quality system Culture of Safety- ‘No blame’ Human Resource Strengthening Enabling Policy Framework (National level) Competence Improvement

Challenges

• Culture Change – shift from punitive to ‘Just’ culture
• Creating Enabling Environment
• Robust Learning & Reporting System
• Health system-based approach in addressing safety issues

Thank you

“To err is human, to cover up is unforgivable and to fail to learn is inexcusable”

Sir Liam Donaldson

Let’s commit together for building SAFETY across health systems!!