Nations across the world on September 17,2019 commemorated the first-ever World Patient Safety Day, an indication of the growing recognition that this is a critical dimension of Universal Health Coverage (UHC) and a challenge to all health systems as outlined the World Health Assembly’s resolution 55.18 of 2002.
Patient safety is the reduction of risk of unnecessary harm associated with health care, patient harm is any unintended and unnecessary harm resulting from, or contributed to by, health care while an error is the failure to carry out a planned action as intended or application of an incorrect plan. Adverse effects include: delayed diagnosis, untimely follow ups, medication errors, adverse drug events, diagnostic errors, radiation errors, falls, hospital acquired infections, treatments meant for someone else, wrong site surgery, pressure injuries, venous thromboembolism among others.
The most common adverse safety incidents are related to surgical procedures (27 percent), medication errors (18.3percent) and health care-associated infections (12.2percent).
There is a one in one million chance of a traveller being harmed while in an aircraft in comparison with a one in 300 chance of a patient being harmed in a hospital. In deed, 134 million adverse events and 2.6 million deaths occur annually due to unsafe health care in in low and middle-income countries (LMICs); 440,000 people die annually from preventable errors in hospitals. Today alone, more than 1,000 people will die! ; four out of 10 patients are harmed in primary and ambulatory settings; of every 100 hospitalised patients, seven in developed and 10 in developing countries will acquire health care-associated infections; the radiotherapy errors incidence is 15 per 10,000 treatment courses; and more than half of LMICs have no national health technology policies to guide the use of medical devices and equipment for patient safety.
Globally, the annual cost associated with medical errors is $42 billion, representing almost one percent of the global expenditure on health and 15 percent of hospital expenses annually. Reducing the occurrence of adverse event and harm would cut waste, release resources and make the case for more efficient and effective health systems. The economic benefits of improving patient safety are therefore compelling.
In LMICs, a combination of numerous unfavourable factors such as understaffing, fatigue, poor working conditions, inadequate structures and overcrowding, lack of health care commodities and shortage of basic equipment, and poor hygiene and sanitation, contribute to unsafe patient care. Weak safety and quality cultures, flawed processes of care, and disinterested leadership teams further weaken the ability of health care systems to ensure provision of safe services. LMICs must focus on patient safety improvements through provision of leadership, fostering collaboration, development of guidelines, capacity building, empowerment of patients and standardised monitoring protocols. Thus interoperable Electronic Health Record (EHR) systems hold great potential to capture occurrence of harm, enable learning from safety lapses, and ensure flow of clinical information among providers and their patients.
Nationally consistent safety standards linked to accreditation of providers and facilities are invaluable and so is investment in well trained human capital. LMICs can greatly benefit from Letter Grade Scoring Systems which allow consumers to quickly assess the safety of their local hospitals, and choose the safest hospital to seek care which further the facilities to improve quality and safety. At the apex are patients, who must be engaged and empowered as active participants in their care and in systematic reporting on safety lapses including “near misses”. In the United States, focused safety improvements reduced the burden of harm by up to 15 percent hence $28 billion in savings in Medicare hospitals between 2010 and 2015– a very good return on investment!
At an individual level one should do the following: ask questions if you have doubts or concerns; talk to someone immediately; get a second opinion about treatment options; and report to the relevant regulatory bodies. Other measures include: keeping a copy of your own medical history; notifying health care workers of all the medicines you take and dietary supplements including known allergies; taking your medications correctly and; ensuring hand hygiene during your visit to or stay in hospital.
The writer is implementation scientist based in Nairobi.