Hospital Manaement Course Session VIII

1. Hospital Management
Session VIII
Patient Safety Friendly Hospital Initiative (PSFHI)
DR. ASHFAQ AHMED BHUTTO
MBBS, MBA, MAS, DCPS, MRCGP, (PhD)
SUNDAY, FEBRUARY 19, 2012

2. Acknowledgement
2
 The slide depicted here are taken from WHO
resource CD provided by WHO EMRO region with
permission.

3. 3

4. The risk of Dying is:
4
 If some one is admitted to a Hospital in USA for one
day only
It is equal to travel
 8800 hour in an Air plane or 460 trip from Pakistan
to USA

5. Adverse Events in Health Care
5
■ 10% of hospital patients suffer an adverse event
■ 16.6% of hospital patients suffer an adverse event
(Australia)
■ ≈100,000 hospital deaths/year through medical error
(USA)
■ Unsafe Surgery:
o 234m case globally/year: 7 m complications, 1 m death
■ Patient Handovers
o 15% of adverse events or errors (USA study)

6. Common Types of Error
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 A nurse gives a patient a 4 X overdose of
methotrexate; the patient dies
 A physician removes the wrong kidney
 A patient receives a 10 X overdose of insulin,
goes into shock, is resuscitated, but has
persistent brain damage.

7. Case
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 64 year old woman is admitted to hospital with
fevers. Presumed diagnosis of pneumonia, treated
for that with penicillin. On day 2, she develops a
severe rash, felt to be caused by her infection.
Involves entire body. Service is very busy. No senior
doctor available. Penicillin continued. Rash
progresses. On day 4 she is confused, gets out of bed
at night, floor is wet, and she slips and falls,
fracturing hip. Dies on day 7.
 What happened?

8. Causation
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 Individuals made errors
Junior doctor didn’t know what was causing rash
Senior doctor wasn’t available
Nurse wasn’t there when patient got out of bed
 However, the system also allowed errors to slip
through
No good approach for dealing with very busy period
Insufficient nurse staffing at night
Operating room was too full and no surgeon available

9. The Burden of Unsafe Care
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 Adverse events due to medical devices & medications:
 Good data from developed nations
 Very little data from developing / transitional nations
 Surgical errors, health-care associated infections
 Common sources of harm in all nations
 Preliminary data from developing / transitional nations
 Unsafe blood products
 Likely major cause of harm in some developing nations
 Reasonably good data from select nations (WHO)
 Patients safety among pregnant women and newborns
 Better data needed from developing / transitional nations

10. The Burden of Unsafe Care: Developing Countries
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Mothers and newborns
Maternal mortality rates:
North America: 1 in 3700
Asia (some countries): 1 in 65
Africa (some countries): 1 in 16
Afghanistan 1 in 6
% deliveries in developing countries
attended by health professional: 53%

11. The Burden of Unsafe Care: Unsafe Injections
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 16 billion injections a year
in developing countries
 39.6% with syringes and
needles reused non
sterilized (70% in some
countries)
 Unsafe disposal can lead
to re-sale of used
equipment on the black
market.
The extent of harm caused by
unsafe injections is unknown

12. Unsafe Blood, Counterfeit Drugs
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 5–15% of HIV infections in
developing countries are due to
unsafe blood
 Unsafe blood risks
transmission of: hepatitis B & C
syphilis, malaria, Chagas
disease and West Nile fever
 Counterfeit drugs account for
up to 30% of medicines
consumed in developing
countries
The extent of harm caused
by unsafe blood and
medications are unknown

13. Deficit of Qualified Health-care Providers
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 The deficit in 57 countries is
estimated to be 2.4 million doctors,
nurses and midwives
 Fatigue, production pressures cause
high risk of mistakes

14. Medical Record Review Study
Results 14
Study Adverse No. of Permanent Percent Percent AE
event rate records disability deaths preventable
EMR 8.1% 15,548 0.9% 1.86% 83%
(2.5-18%)
Australia 16.6% 14,210 2.2% 0.79% 50%
Canada 7.5% 3,745 0.4% 1.2% 37%
New York 3.7% 30,195 0.24% 0.51% NA
Wilson RM. Unpublished data, Regional Patient Safety Research Meeting, Amman, Jordan, August 2008

15. THE SWISS CHEESE MODEL
SUCCESSIVE LAYERS OF DEFENCES
Physical barriers Procedures
Information
Decisions
Adapted from Professor James Reason
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16. THE SWISS CHEESE MODEL
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DEFENCES
Procedures
Physical barriers
Information THE
Decisions HOLES
Poor protocols
Faulty equipment
Missing information
Patient
harmed Inadequate supervision
Adapted from Professor James Reason

17. Regional Strategy for Patient Safety
5 Axes to enhance the safety of patients
I Awareness
II Assess Scope
EMR
V Organizing & Patient Safety
Strategy III Understanding the
Running
Causes of Error
PS programs
IV Developing &
Testing Methods
For Prevention
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18. Patient Safety Friendly
Hospital Initiative (PSFHI) – (1)
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 Promote safe practices in hospitals by assessing
adherence to PS guidelines developed -
EMRO/WAPS/IIRO
 Develop standards for assessing patient safety and
guidelines for implementation
 Patient safety assessment manual
 7 hospitals identified as pilot sites for PSFHI –
EGY, JOR, MOR, PAK, SUD, TUN, YEM

19. Patient Safety Friendly
Hospital Initiative (PSFHI) – (2)
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 PS Assessment manual developed
 Review of literature
 Internally reviewed
 Externally reviewed
 Pre-piloted
 Piloted
 Baseline Assessment of 7 hospitals completed
between July-October 2009

20. Five Domains for Measurement of
Performance of a PSF Hospital
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21. PSFHI Assessment Manual
Domains Critical Core Developmental
Leadership and 9 20 7
Management
Patient 2 16 10
Centeredness
Evidence based 7 29 8
Practice
Environment 2 19 0
Lifelong learning 0 6 5
Total score 20 90 30
21
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22. Baseline assessment of
pilot hospitals in 7 countries
Standards EGY JOR MOR PAK SUD TUN YEM
Critical (20) 15.5 12 10.5 13 8 11 5
Core (90) 41 34 25.5 34 22 32.5 16.5
Developmen 0.5 4 1 3.5 1 3 1
tal (30)
Total 57.5 50 37.5 50.5 32.5 47.5 22.5
22
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23. Domains Patient Safety Subdomain Critical Core Developmental
Standards Standards Standards
A. Leadership and A.1. The leadership and governance 3 3 2
Management Domain are committed to patient safety
A.2. The hospital has a patient 2 5 2
safety program.
A.3. The hospital uses data to 0 2 2
improve safety performance.
A.4. The hospital has essential 3 3 1
functioning equipment and supplies
to deliver its services.
A.5. The hospital ensures staff 1 5 0
safety for safer patients and
availability of staff round the clock to
deliver safe care.
A.6. Hospital has policies, 0 2 0
guidelines, and standard operating
procedures (SOP) for all
departments and supporting
services.
23 9 20 7

24. Examples of Critical Standards:
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 The hospital has Patient Safety as a strategic priority.
This strategy is being implemented through a
detailed action plan.
 All patients are identified and verified with at least 2
identifiers including full name and date of birth.
 The hospital maintains clear channels of
communication for urgent critical results.
 The hospital conforms to guidelines on management
of sharps waste.

25. Examples of Core Standards :
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 The hospital has a set of process and output
measures that assess performance with a special
focus on patient safety.
 The patient rights statement exists in the hospital
and is visible to patients.
 The hospital ensures that each and every patient has
a single completed medical record with a unique
identifier.

26. LEVELS OF COMPLIANCE WITH PATIENT
SAFETY STANDARDS
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Hospital level Critical Core Developmental
Standards Standards Standards
Level 1 100% Any Any
Level 2 100% 60-89% Any
Level 3 100% ≥ 90% Any
Level 4 100% ≥ 90% ≥ 80%

27. How to Develop a PS Program
in your Hospital?

28. 1-Leadership Commitment
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 Embrace a blame free Culture
 Strategic plan
 Accountability
 Leadership PS walk rounds

29. 2-Establish a PS Organizational Structure
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 Human Resources:
 PS leader
 PS Coordinator
 PS Departmental focal points
 PS Council
 PS Sub committees:
 Infection prevention and control
 Environment safety
 Medication safety
 Research and ethics
 Patient and public involvement

30. 3-Adopt PSFH Standards
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 Start learning about PSFH standards and how to
comply with them
 Self assessment on ongoing basis
 Action plan : develop and monitor its
implementation

31. 4- Train , Train, Train
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Involve as many as possible:
 PS Concepts
 PS assessment
 PS reporting
 PS SOPs , plans
 Risk Management

32. 5- Work to Overcome Resistance
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 What are they going to gain?
 Let them compete and be proud of their
accomplishments
 Communicate to all staff

33. 6- Develop Systems, Procedures that support PS
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 Risk Management
 ADE Reporting
 Clinical Auditing
 PS Performance Management
 Patient Safety Tour

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Thank You