MAKING THE HOSPITALS SAFER FOR OUR PATIENTS 

The World Patient Safety Day is celebrated to bring to the fore the importance of making our healthcare system safe for our patients. The 2023 World Patient Day was commemorated on 17^th September with the theme: Engaging the Patients for Patient safety. 

Safety is the first of the 6 domains of healthcare quality as outlined by the institute of medicine. Below is a brief description of the domains of healthcare: 

• Safe: Care that avoids harm to patients 
• Effective: Evidence based practice that is only offered to those who will benefit
• Patient Centered: Care that is respectful and responsive to individual patient preferences 
• Timely: Care that reduces the waiting times and other harmful delays
• Efficient: Care that avoids wastage of equipment, ideas, supplies, energy, unnecessary investigations or prescriptions
• Equitable: Care that does not vary in quality based on individuals or groups 

The movement towards patient safety gathered momentum after the 2000 seminal publication ‘To Err is Human: Building a Safer Health System’ published by the Institute of Medicine in the United States of America. In this book, data obtained indicated that 98,000 patients were dying every year due to medical errors in hospitals, way more than deaths from road traffic accidents, malaria or AIDS (the top three funded health programs in the US). A follow up equally landmark publication in 2001- ‘Crossing the Quality Chasm: A New Health System for the 21^st Century’ called for a redesigning of the American Healthcare system along quality metrics. 

Since then, different bodies have come up to take the space of healthcare quality standards and accreditation. 

One of the key areas of focus from all these bodies is Patient safety. 

One such body, The Joint Commission International (JCI), has outlined the 6 areas of concern for patient safety. These are dubbed, The International Patient Safety Goals. 

JCI INTERNATIONAL PATIENT SAFETY GOALS (IPSGS)

• IPSG 1: Identify Patients Correctly

The first patient safety focus is to identify patients correctly. Every hospital must have wrist bands for their patients. These wrist bands should contain the patient full name and another unique identifier such as a hospital number. Patients should not be referred by one name or bed location or their disease (e.g. the old man in bed 7 with pneumonia). Using one name has led to serious medication errors as many patients in the same ward can share one name. 

• IPSG 2: Improve Effective Communication

It is important that closed loop communication is used when handling sensitive patient information. JCI recommends that when someone is communicating delicate matter, they should introduce themselves, give clear communication on the matter at hand and the person on the other hand should be able to document this information completely. This second person should then read back the relayed information to the person who gave it to ensure that it has been captured as accurately as was intended. This guide includes communication of investigation results, medication orders etc.

• IPSG 3: Improve the Safety of High-Alert Medications

There are different categories of medicines within a hospital that are dubbed high alert such as concentrated electrolytes like potassium chloride and look-alike sound-alike medications. These are supposed to be controlled in a way that more than one person is involved in their retrieval to be given to the patient. This check will ensure that the likely error from one staff is corrected by the second. It is recommended that these are prescribed in full in words and the dosage is given in words as opposed to figures. This will again minimize errors in dosing.

• IPSG 4: Ensure Safe Surgery 

Ensuring safe surgery is important because the patients are often operated under anesthesia, a situation in which they are not able to confirm or point out any errors. Any errors occurring during surgery are thus only noticed by the patients after they have recovered from anesthesia, many hours since the error. It is expected that the patient must sign a full informed consent and site of surgery must be marked. Just before surgery, the team must have a moment to introduce themselves, confirm the identity of the patient, procedure being done and ensure all equipment and tools are working. The WHO Surgical Safety Checklist is a valuable tool to use for this. Since it was developed, this tool makes it easy for all the team members to be on the same page and known to each other. It also help predict critical steps so that in case they happen, the team is ready to handle them. Any patient going through surgery should have this tool administered to ensure safety. The introduction of this checklist has reduced deaths arising from surgical complications by up to 62% in some units! 

Figure: The WHO Surgical Safety Checklist

• IPSG 5: Reduce the Risk of Healthcare Associated Infections

Hospital acquired infections vary widely. Such include infections at the surgical sites following operation, urinary infections in the wards following catheterisation or pneumonia in the ward after a patient has been connected to a breathing circuit. Hospital acquired infections increase hospital stay and thus the total hospital bill. Sometimes hospital acquired infections are more serious than the disease that brought the patient to the hospital. 

• IPSG 6: Reduce the Risk of Patient Harm Resulting from Falls

It is estimated that up to 1 million falls happen per year among hospitalized patient. This is a major safety concern for every healthcare provider. To reduce the risk of falls, it is important to identify patients who are at high risk of fall. These include patients immediately after surgery as they are still under anesthetic medications, confused patients, patients with broken limbs or those who have had surgery on the legs, elderly patients to name but a few. Patients at high risk of fall should have the side rails of their beds up all the time and should only ambulate under supervision. It is best to tag such patients with a specified wrist band that is known to the entire hospital staff so that it is easy to spot and support these patients. 

As the 2023 theme implies, it is important to engage patients for their safety. Patient engagement entails shared decision making on matters affecting the patient. When we engage the patient, they take on the responsibility of their well-being and this will improve their recovery.