Adverse events or serious incidents often result in patient harm, and contribute significantly to poor quality service delivery, disability and death which further amplify the already poor health indices of Sub-Saharan African countries. As the world shone a light on patient safety recently with the commemoration of September 17th as World Patient Safety Day, we pause to take a look at why this issue is important and relevant to healthcare professionals, both clinicians and policymakers alike.
While it is of course impossible to remove all risks associated with health interventions, patient safety as a concept takes root in the ethical principles of non-maleficence and beneficence. In general, when treatment is sought after by a patient, it is largely based on the supposition that the chances of that treatment improving their health outweighs the disability posed by the disease or the injury being managed. Indeed, to “do no harm”, a provider must aim to reduce to an acceptable minimum all unnecessary harm associated with patient care. But what is an “acceptable minimum” and how does one interpret this?
The WHO, in 2004, provided some clarity on how providers may consider this term and defined it as the collective notion of current knowledge taking into consideration the resources available and the context in which care was delivered weighed against the risk of non-treatment or alternative treatment. This definition has however, at points, been criticised for not being sufficiently inclusive and subject to significant contextual bias. As such, in recent years, patient safety has come to be defined as the management of risk over the course of a patient’s life and disease progression to ensure that benefits are maximised and harm is minimised with specific consideration given to the patient’s autonomy and preferences, the provider’s autonomy, the availability or lack thereof of health resources, and preferences of the communities served by the health system. (Vincent & Amalberti 2016).
Globally, patient safety concerns are rife. 4 out of every 10 patients are harmed in primary care settings, and 134 million patients are harmed each year worldwide in hospitals during the process of care, contributing to 2.6 million deaths worldwide annually. Most often, the source of harm lies with diagnostic or medication errors and it could be argued that the former offers an insight into the vulnerability of the health system, after all, approximately 70 percent of diagnostic errors are due to misdiagnosis or delayed diagnosis and underpinning these are factors such as poor access to care, inadequate investigative tools at the place of care, and competency gaps at the level of the clinicians. It therefore stands to reason that policies and interventions addressing some, or all, of these root causes may offer a path to improved patient safety both locally and beyond.
At this point, you may ask, what do we know about patient safety in Nigeria specifically? Unfortunately, the complex and often fragmented process of health service delivery makes it quite difficult to monitor, collect, and investigate cases of patient harm, as such data remains limited.
What we do know however is that a key step towards improving any processor system is hygiene data collection- the process of measuring and reporting patient harm must be accurate and systematic, and performed for the purpose of making an informed decision and implementing informed action. As healthcare professionals across the globe show their increasing recognition of this issue as important, so also is it necessary for them at all levels of their practice to take simple steps to ensure that the necessary data is being collected, analysed, and used to drive the formulation and implementation of processes to reduce the morbidity and mortality associated with poor patient safety practices.
Similarly, effective leadership, clinical governance, quality assurance and improvement practices, and communication (both within and between healthcare actors and between providers and patients and their carers), are all recognised as critical to minimising patient harm and maximising care benefits. Engaging and empowering patients in their care through education and information, empathetic communication, care coordination, and shared decision making are pivotal to improving patient safety. Further, developing health worker capacity through training, and creating routine practices institutionally that foster a culture of continuous learning and improvement are essential in raising patient safety.
Perceptions of poor patient safety fuel distrust in the health system which in turn affects health seeking behaviours, and should we be negligent in our duty to ensure patient safety, we only extend these ramifications beyond the health system to the economy as a whole through sustained losses due to subsequent disability for example.
As a healthcare professional, it is important to ask yourself, what do you do to ensure patient safety? What could you do? The saying goes “little drops of water make a mighty ocean”, so take small initial steps and if you’ve already begun taking these steps, then build on them and make them systemic within your institutions. So, what can you do? Well you could consider some of the following: collect data but don’t stop there, use this data to improve services; perform audits and continue to strive for improvements; standardise processes; optimise communication within and between teams, and also between care providers and patients; contribute to evidence, and build knowledge and understanding, through, for example, the honest reporting of near misses, adverse events, and serious incidents without fear and the regular review of morbidity and mortality data; and empower patients in their care. Improving patient safety is the collective responsibility of health practitioners, researchers, academics, policy makers, policy implementers and of course patients – what are you doing?
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