Prevention of Injury and Illness

Key facts

• The occurrence of adverse events due to unsafe care is likely one of the 10 leading causes of death and disability in the world (1).
• In high-income countries, it is estimated that one in every 10 patients is harmed while receiving hospital care (2). The harm can be caused by a range of adverse events, with nearly 50% of them being preventable (3).
• Each year, 134 million adverse events occur in hospitals in low- and middle-income countries (LMICs), due to unsafe care, resulting in 2.6 million deaths (4).
• Another study has estimated that around two-thirds of all adverse events resulting from unsafe care, and the years lost to disability and death (known as disability adjusted life years, or DALYs) occur in LMICs (5).
• Globally, as many as 4 in 10 patients are harmed in primary and outpatient health care. Up to 80% of harm is preventable. The most detrimental errors are related to diagnosis, prescription and the use of medicines (6).
• In OECD countries, 15% of total hospital activity and expenditure is a direct result of adverse events (2).
• Investments in reducing patient harm can lead to significant financial savings, and more importantly better patient outcomes (2). An example of prevention is engaging patients, if done well, it can reduce the burden of harm by up to 15% (6).

 

What is Patient Safety?

Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care. A cornerstone of the discipline is continuous improvement based on learning from errors and adverse events.

Patient safety is fundamental to delivering quality essential health services. Indeed, there is a clear consensus that quality health services across the world should be effective, safe and people-centered. In addition, to realize the benefits of quality health care, health services must be timely, equitable, integrated and efficient.    

To ensure successful implementation of patient safety strategies; clear policies, leadership capacity, data to drive safety improvements, skilled health care professionals and effective involvement of patients in their care, are all needed.

                           

Why does patient harm occur?

A mature health system takes into account the increasing complexity in health care settings that make humans more prone to mistakes.

·         lack of standard procedures for storage of medications that look alike,

·         poor communication between the different providers

·         lack of verification before medication administration

·         lack of involvement of patients in their own care might all be underlying factors that led to the occurrence of errors.

Humans are guarded from making mistakes when placed in an error-proof environment where the systems, tasks and processes they work in are well designed. Therefore, focusing on the system that allows harm to occur is the beginning of improvement, and this can only occur in an open and transparent environment where a safety culture prevails. This is a culture where a high level of importance is placed on safety beliefs, values and attitudes and shared by most people within the workplace 

The burden of harm

Every year, millions of patients suffer injuries or die because of unsafe and poor-quality health care. Many medical practices and risks associated with health care are emerging as major challenges for patient safety and contribute significantly to the burden of harm due to unsafe care. Below are some of the patient safety situations causing most concern.

Medication errors are a leading cause of injury and avoidable harm in health care systems: globally, the cost associated with medication errors has been estimated at US$ 42 billion annually 

Health care-associated infections occur in 7 and 10 out of every 100 hospitalized patients in high-income countries and low- and middle-income countries respectively 

Unsafe surgical care procedures cause complications in up to 25% of patients. Almost 7 million surgical patients suffer significant complications annually, 1 million of whom die during or immediately following surgery 

Unsafe injections practices in health care settings can transmit infections, including HIV and hepatitis B and C, and pose direct danger to patients and health care workers; they account for a burden of harm estimated at 9.2 million years of life lost to disability and death worldwide (known as Disability Adjusted Life Years (DALYs))

Diagnostic errors occur in about 5% of adults in outpatient care settings, more than half of which have the potential to cause severe harm. Most people will suffer a diagnostic error in their lifetime.

Unsafe transfusion practices expose patients to the risk of adverse transfusion reactions and the transmission of infections. Data on adverse transfusion reactions from a group of 21 countries show an average incidence of 8.7 serious reactions per 100 000 distributed blood components.

Radiation errors involve overexposure to radiation and cases of wrong-patient and wrong-site identification. A review of 30 years of published data on safety in radiotherapy estimates that the overall incidence of errors is around 15 per 10 000 treatment courses.

Sepsis is frequently not diagnosed early enough to save a patient’s life. Because these infections are often resistant to antibiotics, they can rapidly lead to deteriorating clinical conditions, affecting an estimated 31 million people worldwide and causing over 5 million deaths per year.

Venous thromboembolism (blood clots) is one of the most common and preventable causes of patient harm, contributing to one third of the complications attributed to hospitalization. Annually, there are an estimated 3.9 million cases in high-income countries and 6 million cases in low- and middle-income countries.

                                                                                                        

Maintaining Patient Safety in the Hospital

Patient safety is the absence of preventable harm to a patient during the process of health care and reduction of risk of unnecessary harm associated with health care to an acceptable minimum. An acceptable minimum refers to the collective notions of given current knowledge, resources available and the context in which care was delivered weighed against the risk of non-treatment or other treatment.

Every point in the process of care-giving contains a certain degree of inherent unsafety.

Clear policies, organizational leadership capacity, data to drive safety improvements, skilled health care professionals and effective involvement of patients in their care, are all needed to ensure sustainable and significant improvements in the safety of health care.

 

Another part of keeping patients safe in hospital is making sure they get the right treatment, do not pick up infections, have falls, take the wrong medication or develop pressure sores. 

 

1. Identification checks

- A patient, should wear an identification (ID) band with name and other important details around the wrist or ankle, or both. Your ID band must be worn during your entire hospital stay. This is to make sure that hospital staff can identify the patient easily and the receive the right treatment and care. Staff should properly identify the patient according to the policies and procedure before giving administration of medication or treatment. 

2. Personal information security

All hospital staff, including administration and medical care team, must take reasonable precautions to protect patient personal health information from:

• unauthorized access
• improper use
• disclosure
• unlawful destruction
• accidental loss.

Staff who come into contact with patient personal health information must maintain the security of that information. 

 

3. Infections

All hospitals have infection control procedures and policies, and staff take every precaution to avoid infections. However, the risk of infection can never be completely eliminated and some people have a higher risk of acquiring an infection than others. 

Lung, wound, urinary tract and bloodstream infections can be picked up during a stay in hospital. These are called ‘healthcare-associated infections’.

Some things that can help reduce the chance of getting an infection while patient are in hospital include:

• Aside from health workers washing their hands, teaching the patient how to wash their hands properly, especially after using the toilet is very important.
• if patient have an IV drip, ensure that the site around the needle is clean and dry.
• Inform the patient to tell the nurse if the wound dressings are not clean, dry and not properly kept or clean.
• Instruct the patient to tell the nurse or relatives if tubes or catheters have moved or feel uncomfortable.
• Instruct the patient to do deep breathing exercises. This is very important because it can help prevent a chest infection
• Instruct relatives or friends of the patient who have colds or are unwell, not to visit.

 

3.Falls

The risk of falling increases with age and the number of times someone has been in hospital. During patient hospital stay, they may be more unsteady feet because of illness or surgery, or because of unfamiliar hospital environment or they are taking new medication.

Falls-related injuries can include:

• minor skin abrasions
• sprains
• joint dislocation
• fractures 
• head injuries. 

These injuries may result in a longer hospital stay. 

 

How to reduce risk of falls:I

• Keep patient personal items and the call button within reach to avoid standing and walking to get them.
• Instruct the patient to ask for help when in need to get out of bed to use the toilet or if they are feeling at all unsteady.
• Ensure that patient, dressing gown and day clothes are the right length so they don’t trip over.
• Check their slippers or other footwear if fit properly and are not slippery.
• Make sure that they have an appropriate walking aid (such as a walking stick) or a relative assisting when walking.

4. Pressure injuries

Pressure injuries are wounds that form due to ongoing pressure on an area of skin. Pressure injuries may cause pain and discomfort, resulting in a slower recovery and longer hospital stay.

 

Care plan to minimize patient risk of developing a pressure injury.

• frequent inspection of skin
• keeping skin clean and dry
• making sure nutrition and fluids are suitable
• change position frequently
• use a pressure-relieving device, such as a special mattress or supportive pad.

 

 5. Electrical appliance checks

For patient safety and to reduce potential fire risks, many hospitals will not allow use of any personal electrical appliances such as a hair dryer, radio, mobile phone charger or docking station, until an electrician tests the item. Nurses should be aware about any appliances that the patient have brought inside the hospital.

 

6. Food safety

Hospitals have food safety regulations in place to prevent food contamination and to keep patients safe from food poisoning. For example, most hospitals will not allow visitors to bring in food from outside the hospital that needs to be heated. 

 

 

 

7.Medication safety

Follow the policies and  procedures to minimize the risk of patients being given the wrong medication or wrong dose
Instruct the patient not to take any other medication while they are in hospital, including herbal supplements or remedies, without the consent of medical team. It could interfere with the medication that the doctor has prescribed or have a negative effect on you.

 

8.Keeping your valuables safe

Advise patients not to bring jewelry, lots of money or valuable personal items in the hospital. Bring only the essential items that needed for their stay. 

If admitted to hospital through the emergency department, ask a friend or relative of the patient to look after the valuables while patient are being treated and to take them home.

Clearly label in all belongings with full name and keep properly according to hospital policies and procedure. If they wear dentures, labelled denture cup for storage. Do not wrap dentures in a tissue because they may get lost or damaged.

 

9. Waste Management

Make sure a policy on waste management is familiar to all staff. This includes ensuring that contaminated waste is disposed of correctly. Gloves must be worn when handling waste and hand washing is a must after touching contaminated waste or waste and fluids generated during surgery. Color coding of different types of waste is used widely and it is important not to mix up waste that is dealt with in different ways. Waste or leftover fluids should not be put down the drain (which could result in splashes to the nurse), but should be handled as contaminated waste, in the prescribed manner. Waste bins and lids should be cleaned regularly.

10. Cleaning

 Remember to wash equipment between patients and again at the end of the day. You need to find out what the standards are for cleaning equipment and you must make sure that you and your colleagues clean everything at the beginning of a shift, in between patients and at the end of the session.

11. Equipment

Equipment should be properly monitor for PPM. Ensure that are all of them are safe to be use to the patient.

 

Practices considered to have sufficient evidence to include in the category of patient safety are as follows:

• Appropriate use of prophylaxis to prevent venous thromboembolism in patients at risk
• Use of perioperative beta-blockers in appropriate patients to prevent perioperative morbidity and mortality
• Use of maximum sterile barriers while placing central intravenous catheters to prevent infections
• Appropriate use of antibiotic prophylaxis in surgical patients to prevent postoperative infections
• Asking that patients recall and restate what they have been told during the informed-consent process to verify their understanding
• Continuous aspiration of subglottic secretions to prevent ventilator-associated pneumonia
• Use of pressure-relieving bedding materials to prevent pressure ulcers
• Use of real-time ultrasound guidance during central line insertion to prevent complications
• Patient self-management for warfarin (Coumadin®) to achieve appropriate outpatient anticoagulation and prevent complications
• Appropriate provision of nutrition, with a particular emphasis on early enteral nutrition in critically ill and surgical patients, to prevent complications
• Use of antibiotic-impregnated central venous catheters to prevent catheter-related infections
• Marking surgical site to ensure surgery is conducted correctly.