Safe Healthcare Safe Healthcare Dr J N Srivastava Advisor Quality - PowerPoint PPT Presentation

Safe Healthcare Safe Healthcare Dr J N Srivastava Advisor – Quality Improvement National Health Systems Resource Centre Saf afety i isn’t e expensive, i it’s p priceless.

Patients’ Expectations • Cure • Correct, speedy, low cost, lasting treatment • Emergency care • No new disease It takes too • No harmful procedure/ complication long!! Nobody • Care Cares!! • Psychological well being & courteous behaviour • Clean, inviting atmosphere • Personalised approach

How Safe is Health Care?

Global Burden • Occurrence of adverse events due to unsafe care is likely to be one of the 10 leading causes of death & disability. § 70 Lakhs* surgical patients suffer significant complications each year, resulting into death of 10 Lakh such patients § 1.7 Lakhs* admissions annually in USA due to Patient harm § 15% of hospital expenditure on treatment of safety failure in OECD countries • 50% of such harm is preventable *1 million = 10 lakhs

Indian Scenario q In India around 5.2 million injuries occur due to medical errors, resulting in around 3 million preventable deaths every year. q For every 100 Hospitalization, approx. 12.7 adverse events occur. (Ashsih Jha, BMJ Quality & Safety, Sept 2013) 5

Global age-standardized incidence rates per 100,000 population due to AEMT 460 180 167.26 440 170 420 160 141.02 400 150 Global 380 140 India 128.68 360 130 121.99 340 120 320 110 300 100 1990 2000 2010 2017 Adverse Event of Medical Treatment (AEMT): “unintended injury due to medical care leading to an extended hospital stay, disability at the time of discharge, serious and devastating long-term irreversible consequences or death”.

Patient Safety-Multiple facets Medication Safety • • Reporting and learning Medical Device Safety • • Safety culture Infection Prevention and Control • • Patient engagement Falls • System • Competence based training Patient identification • Issues • Leadership and governance Bed sores • • Human Factors and Venous Thromboembolism • Ergonomics Personal Protection • • Safety Surveillance Injection Safety • • Psychological Safety Environ- Diagnostic safety • • Disaster preparedness mental Clinical Sepsis • Issues Issues Communication during transition • of care Radiation safety • • Fire Safety Safety in mental health care • • Electrical safety Blood safety • • Structural Safety Surgical Safety • Hygiene and Environment • Anaesthesia safety • Seismic Safety • • Illumination • Infectious waste management

Three Common Safety Incidents q Related to Surgical Procedures (27%) q Medication Errors (18.3%) q Healthcare Associated Infections (12.2%) 8

Existing Initiatives supporting Patient Safety • National Quality Assurance Standards • ‘Kayakalp’ Initiative – Infection Control, Needle Stick Injury • National Patient Safety Implementation Framework • Pharmacovigilance Programme of India – Medication Safety • Haemovigilance Programme of India – Blood Safety • Health Management Information System (HMIS) – SSI, Needle Stick Injuries, Performance of Health Facilities (ALS, BOR), Audits, etc. • Facility Level Audits – MDR, CDR, Death Audits, Prescription audits

NATIONAL QUALITY ASSURANCE PROGRAMME National Patient Quality LaQshya Kayakalp Assurance Safety Standards FACILITY LEVEL QUALITY TEAM DISTRICT QUALITY ASSURANCE COMMITTEE STATE QUALITY ASSURANCE COMMITTEE CENTRAL QUALITY SUPERVISORY COMMITTEE

NA TIONAL QUALITY ASSURANCE PROGRAM NQAS (DH/CHC/PHC/UPHC/CLMC/AEFI/HWC) Certification.. KA Y AKALP MERA ASPT AAL An award scheme for improving An IT based application to measure and sanitation, hygiene, infection improve Patient satisfaction.. control and BMW management BIOMEDICAL WASTE MANAGEMENT PA TIENT SAFETY Implementation and monitoring Patient Safety Implementation Framework Monitoring committees. at districts . Patient safety standards ST ANDARD TREA TMENT GUIDELINES LAQSHY A Improve QOC around birth. Formulation and dissemination. Respectful maternity care AEFI Surveillance Standards. Certification

Patient Safety : An Integral Part of NQAS systems Infrastructure Safety, Electrical Safety, Fire Safety, Physical Diester Management, Secure & comfortable Safety Environment for Staff, Visitors & Patients Patient Identification, Identification of high risk & Patient vulnerable patients, Identification & continuity of Identification care of during transition & referral Medication Rationale prescription, Safe drug administration, Safety medication reconciliation, review & optimization Promoting Safe clinical processes, Use of safe surgery Procedure checklist, safe anaesthesia checklist & safe birth Safety checklist, etc.

Patient Safety : An Integral Part of NQAS systems Screening of donated blood, compatibility testing, Blood Safety Adverse reaction associated with blood transfusion. Health Care Reporting of HAI, HAI surveillance, Hand hygiene, Associated Use PPE, Instruments processing, Environmental infections safety, Bio medical waste management Risk management framework & plan, identification of Risk existing & potential risks, risk assessment, reporting, Management evaluation and its mitigation as per plan Staff protection from infections, radiations and other Staff Safety Hazards, provision of medical check ups, immunization, prophylaxis, etc.

Patient Safety components under National Quality Assurance Standards (NQAS) Safety in clinical care Physical safety and Patient Ability at (Medication, Injection, Reporting and Human Factors and environment engagement Surgical, Anesthesia) point of care learning Ergonomics Green marketing is a Green marketing is a Green marketing is a Needs Strongly Moderately strengthening Safety in specific clinical Infection Prevention Safety along Infectious waste concerns (Radiation, Leadership and Safety and Control life cycle management Medical Device, etc.) governance Surveillance

Making Progress - Kayakalp Percentage of health facilities scoring 70% and above in Kayakalp External Assessment 60 49.7 50 DH SDH/CHC 40 PHC 36.4 35.6 Percentage Kayakalp 30 25.8 20.2 18.9 20 15.7 14.5 13.6 13.5 10 10 6.8 5.6 0 0 0 2015-16 2016-17 2017-18 2018-19 2019-20* Financial Years * Result incomplete JMP Report (WHO & UNICEF) 2019 – 97% DHs have some form of waste management facilities. 76% DHs have full system of BMW mgt.

NPSIF Released on 19 th April 2018

NPSIF – Strategic Objectives Competent Establishing Assessment & Healthcare Institutional Reporting of Adverse Workforce Framework Events Safety in Programs Patient Safety Infection and Clinical Research Prevention & Domains Control

Health Worker Safety: A Priority for Patient Safety • Ensuring Availability of PPEs and Masks • Helpline • Insurance for Rs. 50.00 Lakhs • Chemoprophylaxis for Frontline staff • Ordinance to prevent the violence

High Quality system y t Assurance i a l u Q Safety of Standards National Clinical Enabling Policy processes Competence Improvement Framework (Facility level) (National level) Safety Surveillance Human Resource Strengthening Institutional Framework S a f e Antimicrobial c a r e e n v i r o n Resistance m e ` n t Safe point of Standards for patient safety Education and Quality & Safety (NPSIF) Safe System programmes care Training Infection Control Safe High-risk clinical process Use of Indictors for decision Making Reporting & Learning Circle of continuous Monitoring & learning System Supportive Sup. (State level) (District level) Culture of Safety- ‘No blame’

Challenges • Culture Change – shift from punitive to ‘Just’ culture • Creating Enabling Environment • Robust Learning & Reporting System • Health system-based approach in addressing safety issues

Thank you “ To err is human, to cover up is unforgivable and to fail to learn is inexcusable” Sir Liam Donaldson Let’s commit together for building SAFETY across health systems!!