Do No Harm

This article could not have come at a better time as there is currently a vision by the Federal Ministry of Health to revitalize the country’s healthcare system in order to reduce morbidity and mortality due to communicable diseases, meet global targets on the elimination and eradication of disease and increase the life expectancy and …

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This article could not have come at a better time as there is currently a vision by the Federal Ministry of Health to revitalize the country’s healthcare system in order to reduce morbidity and mortality due to communicable diseases, meet global targets on the elimination and eradication of disease and increase the life expectancy and quality of life of Nigerians.

There is a growing recognition, among those concerned with healthcare delivery and management, that the reduction and prevention of medical errors in the system are the main drivers for achieving high quality in the system for the 21st century. The importance of the effective management of such errors and the need to ensure patient safety have been factored into the government’s detailed plans, as key components in achieving the government’s healthcare vision cannot be underestimated.

In the heart of the Hippocratic Oath for doctors lies the key phrase “First, do no harm”. Keeping this Oath, that is delivering safer care to patients at all times, has always been a major challenge not only for doctors, nurses, pharmacists, healthcare technicians and other allied healthcare professionals but also for the management and policy makers in healthcare.

Inspite of the efforts made in developed countries to ensure a high and safe quality of care for patients, the impact of medical errors or incidents revealed in these countries is disturbing: In the United Kingdom, medical errors or patient safety incidents cost the National Health Service (NHS) an estimated £2 billion a year in extra bed days, the cost of Hospital Acquired Infections (HAIs) in the NHS is estimated at £1 billion annually,  around 10% of hospital admissions are associated with unintended harm to patients and an average of 7,300 patients per year per NHS Trust in the UK suffers an adverse event due to medical errors of which approximately 2,180 incidents result in death.

Medical errors are the third-leading cause of death in the United States, closely followed by heart disease and cancer. It is estimated that medical on-related problems alone cost the U.S. healthcare system up to $182 billion a year. The Centre for Disease Control and Prevention reported that HAIs account for an estimated 1.7 million infections and 99,000 associated deaths each year in the United States hospitals.

What is the scale of errors in medical care and their impact on patients, healthcare professionals in Africa and particularly in Nigeria? What are the effects on the Nigeria economy?  Relatively lit le attention has been paid to improving quality of care and managing healthcare risk in this region and there is no research evidence to inform the public and government of the extent of the problem. But considering the level of development in African countries, the situation is very likely to be far more serious when compared to the developed countries. If you are therefore keen on improving quality of care and ensuring patient safety, then you will find the information in this column “DO No Harm” very helpful as it aims to reveal key strategies for ensuring highest standard of quality care.

HISTORICAL HIGHLIGHT OF MEDICAL ERRORS AND PATIENT SAFETY

The key question is, how did medical errors and patient safety evolve to assume its level of importance in the world today? Although the study of medical errors and patient safety started well over a century ago, the scale and complexity of the problems in healthcare was unknown to patients, healthcare professionals, government, media and the public until recently. The publicity witnessed today is triggered by reports from inquiries into high profiles cases such as the Florida, United States case of Willie King, who underwent surgery to have his right foot amputated, awoke to learn his left leg was cut off at university Community hospital in Tampa.

The surgical negligence in Pediatrics’ heart surgery at Bristol Royal Infirmary Hospital between 1984 and 1995 leading to the death of about 30 to 35 children between 1991 and 1995. Another event is the Harold Fredrick Shipman case. Dr. Shipman was convicted (sentenced to life imprisonment) at Preston Crown Court on 31 January 2000 of the murder of 15 of his patients while practicing as a General Practitioner in Hyde near Manchester.

Another trigger for concerns about patient safety according to research is the rising cost of medical negligence.  The reports ‘To Err Is Human’ in the US and ‘An Organization with a Memory’ in the UK revealed the full scale of the problem. Both policy documents prompted a number of research, policies legislation and regulatory initiatives designed to document medical errors and begin an urgent search for solutions in both America and Europe.

Thus a combination of events changed the side of opinion regarding errors in medical care and their potential risk to patients.

Some key patient safety and medical errors prevention initiatives

A great deal of strategies and measures have been formulated at international, national and local levels in recent years by various organizations and individuals aimed at reducing medical error, managing risk and providing safer care. For instance, the World Alliance for Patient Safety launched in 2004 by the World Health Organization (WHO) urges the world to pay the closest possible attention to medical errors and ensure safety of patients.

In the United Kingdom, the National Patient Safety Agency (NPSA) drives improved and safer patient care by informing, supporting and influencing the health sector, for example, the ‘Clean your Hands’ campaign by the NPSA has contributed to a significant reduction in incidents of Hospital Associated Infections (HAI) such as methicillin-resistant Staphylococcus aureus (MRSA). In the United States, the National Patient Safety Foundation (NPSF) worked for the same mission: to improve healthcare safety for patients.

The Agency for Healthcare Research and Quality (AHRQ), also in the United States, leads in improving the quality, safety, efficiency, and effectiveness of care delivery.

In Africa, the first meeting aimed at preventing medical errors and the need for quality and safer care was held in Nairobi, Kenya on the 17th January 2005. A similar meeting was held in Durban, South Africa two days later.  In both meetings participants were encouraged to strengthen common action to address medical error and improve patient safety in the region. The need for African countries to step up actions in managing risk in healthcare posed by medical errors in order to ensure patient safety and healthcare quality was again stressed at the fifty-eighth session of the WHO Regional Committee for Africa which took place in Yaoundé, Cameroon on September 2008.

At this conference African healthcare sectors and institutions were called upon to priorities patient safety by adopting treatment using the safest technology available on health facilities in order provide safe and high quality healthcare and avoid unintentional harm to patients.

At the conference, Ministers of Health from 39 African countries including Nigeria signed on to the WHO’s patient safety global campaign tagged the “First global patient safety campaign” and pledged their countries to certain actions to reduce healthcare associated infection through concrete actions. On 17th November 2008, at the Global Ministerial Forum in Bamako, the African region was again urged to take urgent action in reducing medical errors if we are to overcome the great health challenges of our times, notably the challenges related to improvements set out in the Millennium Development Goals.

A similar progress has been made in Nigeria to promote quality and safer care delivery. For instance, in July 2009, the Society for Quality in Healthcare in Nigeria held its first healthcare quality and patient safety conference followed by its first Quarterly seminar for the members four months later. In both events the major objectives included raising awareness on patient safety and improving healthcare quality of care through medical errors prevention and reduction.  It is now time to translate all the discussions in conferences and meetings into practice.

How can this be achieved?

Practical and sustainable solutions for improving patient safety and quality of care in Nigeria Developing, implementing and maintaining a functional solution to address medical errors, and their risk in healthcare in Nigeria and Africa in general will be extremely dii cult without a clear knowledge and understanding of the cause and the impact on individuals, healthcare organizations and the government. Such knowledge and understanding is useful in seeking and learning lessons from other high risk industries such as aviation, chemical and nuclear power industries. The knowledge and understanding is equally essential in learning from experts in disciplines such as psychology, ergonomics and engineering; learning from the experience and expertise of the patients; and redesigning the healthcare system to prevent or reduce the occurrence of errors.

So what are medical errors and patient safety? Is it possible to eliminate errors in our healthcare system taking into consideration human nature of healthcare professionals, other key players in the industries and patients and their conditions? What is the impact of healthcare activities and technologies in the errors? Do you know that every medicine carries a risk of causing unwanted or harmful sides effects? If so what proactive and reactive measures can healthcare professionals, management and stakeholders put in place to prevent or reduce risk of the side effects? These and other questions and issues regarding errors in medical care, patient safety, healthcare risk management and quality improvement are what this column intends to explore.

The next publication will feature details and succinct answers to the above questions including how best to promote the patient safety and healthcare quality agenda in Nigeria – So keep reading!

By:  Christopher Ente

Photo Credit: Pixabay


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