Patient Safety means Doing Right Things on Right Patients-Dr. Ole Tjomsland


 Patient Safety Conference Proceedings-II

Patient Safety means Doing Right Things on
Right Patients - Dr. Ole Tjomsland

We should provide cost effective healthcare using Information
and Communication Techniques - Najib Al Shorbaji

Hospitals should not work for accreditation but their aim
should be continued quality improvement ensuring
patient safety - Dr. Salma Jaouni

KARACHI: The first scientific session of the Second International Conference on Patient Safety held at Aga Khan University was chaired by Prof. Shabbir Ahmed Lehri President of PM&DC along with Lt. Gen. Azhar Rashid Principal IIMC while Mr. Haroon Qasim moderated the session. Prof. Ole Tjomsland from Norway was the first speaker who spoke about “Unwarranted variations in healthcare-present and future challenges”.  He was of the view that we spend almost 34% in healthcare which is just waste because of over use of facilities or due to lack of collaboration. He emphasized the importance of improving the quality and reducing unacceptable practices.  There is always a learning curve in any procedure and studies have shown that after five years the mortality from laparoscopic colorectal surgery reduced considerably. We should be mindful of learning curve in any new procedure. He laid emphasis on standardization of surgical techniques. In orthopedic surgery studies have shown lot of variation in mortality. Patient safety means “Doing Right Things on Right Patients”, he added.

Dr. Najeeb Al Shorbaji former Director of Knowledge Management, Research and Ethics in WHO was the next speaker who talked on “Improving Patient Safety through health”.  He highlighted the use of Information, Communication and Technology for patient safety and felt that it has come a long way and now patient safety has emerged as a discipline in Medicine in itself. He then talked about eHealth, eLearning, Health Information on internet, Telemedicine, Tele Health in Health in detail.  WHO promotes cost effective secure healthcare using information and communication techniques in support of health. He pointed out that to err is human but we must prevent harm to the patient. Patients admitted to a hospital should not come out with another disease because of wrong treatment, wrong medication and procedures. E Health is being used as a part of treatment by some healthcare professionals successfully. He then referred to antibiotic resistance and ADRs. Electronic Health Records has some implications like abuse of patient data, maintaining confidentiality, Computer Physicians Order Entry for prescribing drugs can minimize the mistakes in dispensing as at time it is difficult to read doctor’s prescription.

Continuing Dr. Najeeb Al Shorbaji said that implementing bar coding on drugs, blood samples can minimize mishaps. He also laid emphasis on patient support, reporting systems and streamlining the administrative processes. eHealth, he said, can go a long way in improving patient safety. We need to eliminate medical errors, avoid use of high risk medications, reduce drug interactions, legible computer orders can also reduce errors. At present disease coding is inadequate. There are reports of privacy and confidentiality breaches. One should have access to knowledge literature to keep abreast so as to provide useful information to the patient. Talking about the quality of health information on the internet, he said, at times it could be misleading. It can harm patient. However, there are chances of human error, no back up or wrong data, no retention policy, system failure, power cut which  were some of the problems which we have to keep in mind, he added.

Dr. Salma Jaouni CEO HealthCare Accreditation Council from Jordan was the next speaker. She discussed in detail the Accreditation Tool for improving Quality and Patient Safety in a Value Based Approach”. She described her experience in Jordan. She talked at length about waste management, Ethics, Patients’ Rights, Patient Care, Infrastructure Development, and Design of the Hospitals, Infection Control, Patient Safety and Self-Assessment. Speaking about documentation of standards she said, provide quality guidelines on patient care, uphold professional ethics, be mindful of patient rights, follow ethical practices, and ensure patient and his family’s satisfaction. Be mindful of general, surgical, anesthetic care, emergency care and do not forget the safety of healthcare professionals.  Patient safety was also linked to  housekeeping, food services, laundry, linen services, infection control, sterilization, management leadership and we have got to get it all budgeted. She also talked about in-service education, giving accreditation for two years but then re-visit in mid-point for assessment after one year. She also talked about training, preparations and knowledge transfer.  She emphasized that we are not working for accreditation but our aim is continued quality improvement and ensuring patient safety. This works to move things forward.

Continuing Dr.Salma said that work on standard development, surveyor development, and accreditation but make sure it should not be policing. Certified training courses should be made available. Develop consultants, provide consulting service to the Government. Tools, professionals all cost money and accreditation is costly. It not only includes cost of the visit but cost of compliance and all this should be in place. When we implemented all this in Jordan, we were able to save lot of cost of healthcare. One should be visiting frequently these healthcare facilities even after accreditation, make sure it is real truth, team is in place to ensure compliance. Laws by the government ensures that institutions remain in compliance. In Jordan it is both people from private and public who sit on our Board. We have put in place a referral system from primary to secondary to tertiary healthcare facilities. We ensure calibration of machines, employ trained radiologists who can write quality reports and avoid the use of imaging facilities in benign cases of breast cancer. We have put in place a strong regulatory system and certification of professionals. Make people to think of paperless hospitals, provide training to staff and commit yourself, writing on iPads and refer to system, digitalization is really good. Commenting on the presentation Lt.Gen. Azhar Rashid said that we need to take many measures to achieve these objectives.

Mrs. Caroline Bilen made a presentation on Surgical Pathways as part of patient safety. She opined that we need to become voice of the patient and voice of health workers.  She then referred to Hospital Acquired Infections (HAIs) and Surgical Site Infections (SSIs) and said that at least 50% of HAIs can be prevented and we can ensure patient safety. Bacteria is now ready to take revenge with the development of MRSA. SSIs increase morbidity and mortality and it has added a huge burden on healthcare system. We need to find out from where the bacteria comes?. Almost 60% of microorganism comes from the patient and we have to save him from this. We need to take care of procedure factors, microbiological factors, and surgical team and hospital practices. She also laid emphasis on hand hygiene, taking care while removing hairs, surgical site preparations, patient skin preparation, sterilization guidelines and recommendations are there but unfortunately they are not implemented. We need teams to implement these pathways, she stated.

Continuing Mrs. Caroline emphasized that one should not break rules in hospitals, be careful about pre-operative, intra operative and post-operative standards. Patient’s journey starts from home. They need to protect themselves. Speak out if there is a harm. There should be Sign In and Sign Out for every one and make use of surgical check list. Hand Hygiene was most important. It is about you and your family safety. Prevent cross contamination. Despite the fact that hand hygiene is very important but we are not following it. Use of skin antiseptics will kill the bacteria. Use right antiseptics for right procedure. Improve communications and team work. Provide well defined standards but remember if the leadership does not support it, it will not work. SSIs are complex but we can provide safety first by education, go to hospitals and talk about patient safety. Educate the patients, clinical team on preparation, procedures, post-operative care. Best prevention is standardization of policy and procedures. Patient safety is everyone’s responsibility and together we can have it, she concluded.

Dr. Babar Sultan Hassan Associate Prof. of Paediatric Cardiology at AKUH was the next speaker who talked about Quality Based Registries which offers a contextual solution to indigenous problems. He talked about high risk procedures and high risk cases and said that how you made the patient feel while at hospital, they will never forget. He was of the views that change strategy should be a part of the registry in team based practice. Follow safe pre-operative practices, reduction in SSIs and bacterial sepsis and all this will reduce the 30-days mortality. Registry should be an audit report comparison and it should help to improve things. He referred to numerous studies regarding Cath Reports, Medical Records and said that one should start with small things. He also talked about CT Angio radiation protection which they were able to achieve. One should use resources effectively. Now it is our nursing staff which are doing some of the radiation recordings which are not being done even in USA and that is how we can teach them as well how to effectively utilize the available resources. We have reduced radiation. Most of the problems are related to sedation.

Cultural change, he stated, was the most difficult part which takes time to change. MRSAs have now become a community acquired infections. It is no more confined to the ICUs. Compliance of a check list is a problem. There is no focus on teaching in operating rooms. Outcome management, he opined, was linked to the Registry. We know we do have infections but we do not talk about that. When we start talking about it, we will improve patient safety. Sedation is a procedure which should be done by anesthetists and not nurses.

Summing up the presentations the chairman of the session remarked that every one of us must be aware of patient safety, hospital safety. Hospital staff should be infection free to provide infection free treatment.

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