Patient safety has emerged as an important issue in healthcare facilities in Pakistan

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Patient safety has emerged as an important
issue in healthcare facilities in Pakistan
Under qualified, ill-trained, inexperienced paramedics,
nursing staff, irresponsible attitude of some HCPs and lack
of monitoring, accountability is leading to numerous Medical 
Errors, professional negligence which at times prove fatal
Blaming and punishing individuals, closing of hospitals
won’t solve the problem but we need to put the proper
systems in place

By Shaukat Ali Jawaid

Karachi: Patient Safety has once again emerged as an important issue in healthcare facilities in Pakistan. Every day numerous medical errors and at times cases of professional negligence are taking place due to greedy attitude of the hospital owners, underqualified, ill-trained, in-experienced paramedics, nursing staff which they have hired at low pay besides irresponsible attitude of some healthcare professionals which results in increased morbidity and at times fatal cases many of which are preventable. Instead of doing Fire Fighting, blaming and taking action against individuals or closing down of the hospitals is not going to solve the problem but what we need is putting appropriate systems in place.

Lack of any self-monitoring and accountability initiated by the professional organizations, institutions has made the matters worse. Increasing greed of hospital owners has no limit. Unethical medical practices go un-noticed and once in a while when some case is highlighted by the media, it creates a little storm but then gradually everything settles down with the passage of time and things remain the same as they had been for the last many years.

Chairman of the Sindh Healthcare Commission Prof. Tipu Sultan while speaking at a medical conference few years ago had himself presented the findings of a study which revealed the over 70-80% of Intensive Care Units in hospitals in a city like Karachi were either understaffed or staffed with ill-trained, inexperienced medical and nursing staff and they were also ill equipped but they keep on fleecing the patients. Some of these ICUs, it is alleged are reservoir of infections, many hospitals do not have any Infection Control Committee or measures in place. Almost all the small and big hospitals in the country also make lot of money on just medications. It so happens that they purchase drugs from the pharmaceutical companies at very high discount at times 35-40% and then add another 15% service charges when they dispense these drugs. Not only that another malpractice which is going on for the last many years is that these hospitals use the low priced generics but charge the patients the price of brand leaders in their bills. This practice was first started by a leading Five Star private hospital in Karachi which was soon picked up and implemented by other healthcare facilities as well.

First of all it should be the Private Hospital Owners Association and provincial health departments which must ensure that all healthcare facilities employ properly qualified, experienced paramedics, nursing, medical and other support staff. Secondly there should be an in-house continuous training and refresher courses on patient safety, how to detect and prevent medical errors. Regular monthly mortality meetings can be used to discuss in detail all the deaths and see if something wrong had happened and some of those deaths could have been avoided. A sincere efforts should be made to learn from these mistakes. Reporting of Medical Errors, Adverse Drug Reactions should be encouraged rather than discouraging and punishing those who report it. Many mistakes occur due to use of under dose, over dose, wrong route of administration of drug which at times prove fatal. Good nursing plays a vital role in patient safety and there should be no compromise on this but it is also important that the nursing staff is given due importance, respect and accepted as an important member of the healthcare team alongwith the paramedics and technicians. At times what happens is that nursing staff sitting on the nursing counter hands over few pills to ward boys or technicians to give to a patient on certain bed or to a patient in a certain room but he might pass on these drugs to some other patient. This often happens in a large number of private as well as public hospitals because nursing staff do not take it seriously. It is extremely important that qualified pharmacists are appointed in all the healthcare facilities, at Chemists Shops and Pharmacies, healthcare professionals recognize their importance and they should be consulted, fully involved in monitoring prescriptions to avoid any wrong dosage being administered. They can also take care of any likely drug interactions.

Emergency is the face of any healthcare facility. Patients and attendants who report in the emergency are always impatient and wish the patients to be examined and managed immediately. Hence, only very experienced and competent medical and nursing staff should be appointed in the Emergency who have also attended some courses or workshops on communication skills, how to handle patients in such a situation, how to communicate with them and what preventive measures should be taken to avoid any violent behaviour on the part of the patients and their attendants. Involve the patients and their attendants in their management and keeping them informed of the steps being taken to reduce their miseries, refrain from giving any false hops in serious cases but try to convince them that everything best possible was being done to look after the patients.

Patient Safety culture needs to be promoted at every forum and all healthcare professionals including paramedics, nurses and other support staff needs to be sensitized on these issues. Cases of professional negligence should be separated from the medical errors and those found responsible including the healthcare facilities must be given exemplary punishment. Self-monitoring and accountability is the best option but if the healthcare professionals and healthcare facilities failed to do that, someone else is going to do that, hence it is still time for all those concerned to wake up, listen to their conscience and take appropriate measures at every level to save human lives, reduce morbidity and mortality, promote health education, health seeking behaviour and proper judicious utilization of the facilities present.

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