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Change of mindset crucial for safe care

Making patient safety a priority in hospitals and clinics meant there had to be a change of mindset at the highest level so that even respected surgeons worked through basic safety checklists before they operated, Dr Carmen Audera-Lopez from the WHO's Patient Safety Programme said in Cape Town on March 10, 2011.

Audera-Lopez is in the city for the launch of the SafeCare Initiative, a global quality think tank that will provide healthcare facilities in resource-restricted settings with a means to improve service delivery.

The SafeCare Initiative is a partnership between the locally based Council for Health Service Accreditation of Southern Africa (COHSASA), PharmAccess Foundation of the Netherlands and the Joint Commission International, the United States-based quality standards authority.

"Too often hospital staff, and even patients, are afraid of doctors and fail to speak up when they see a mistake is being made and patient safety compromised," she said.

The WHO has a pre-theatre patient safety checklist and manuals on how to introduce safety in hospitals, which is available to all countries.

"The discipline to follow the checklist means a change of culture is needed in the operating room, which can prove a challenge when a surgeon won't spend even one minute of operating time going through the list." However studies have proved that by following the checklist lives were saved and adverse events prevented.

Dr Antony Linegar, a Cape Town-based cardiothoracic surgeon and COHSASA researcher said patient safety checklists needed to become a pre-operative drill similar to a pilot's cockpit drill.

"If the surgeon or anaesthetist, whoever is in a leadership role in theatre, does not go through a drill and something happens, they need realise their behaviours led to unsafe results" said Linegar.

Audera-Lopez said the WHO was proposing simple solutions to patient safety that could be implemented in developing countries without excessive cost.

"Hand washing is the first place to start," she said. "Are doctors and nurses washing hands and, if there is no running water, what is being used?" In Mali, for instance, an alcohol-based hand steriliser is being used in hospitals and clinics without running water.

Patient safety checklists were expensive to develop but once they had been produced these were available for everyone to use, she added.

Professor Stuart Whittaker, CEO of COHSASA and the first chair of the SafeCare Initiative, appealed to health policy-makers not to "reinvent the wheel", but to work with the WHO and use the resources already available.

"These checklists exist and there is knowledge that is available to all of us," Whittaker stressed.

Audera-Lopez said safety protocols had to be integrated into every aspect of care in a system.
"If the injections you use in a vaccination programme are not hygienic then there is no point vaccinating," she said. These meant there had to be commitment at every level in the health system."

Patient safety also had to form a big part of the curricular in medical schools and other health professional training institutions, she said.

Speaking on behalf of the SafeCare Initiative, Dr Paul vanOstenberg, vice president of Accreditation and Standards for the JCI, said quality in healthcare was a gradual process that needed a meaningful and achievable starting point based on standards.

Mistakes, like those referred to by the WHO, affect many lives, from the patient to their family to the health workers involved in the adverse incident, said vanOstenburg. It was this reality which the patient safety movement had brought to the fore and encouraged everyone working in healthcare to remember.

"All healthcare delivery is based on repetitive systems, even very simple ones, that can be incrementally improved," van Ostenberg said.

He explained that policy-makers working on maintaining the momentum for quality in healthcare facilities needed to focus on developing incentives for facilities and then recognising that improvement.

"The patient safety movement has brought measurement more clearly into the mix so that what we have is data-driven improvement," said vanOstenberg.

He further explained that issues around patient safety were universal and data should be shared among all countries.

A figure often quoted from the well-known "To Err Is Human: Building a Safer Health System" report - one in ten patients in industrialised states are harmed while receiving medical attention in healthcare facilities.

Never forget, he said, that thousands and thousands of patients around the world are harmed by the poor delivery of care each day.

17 Mar 2011 11:04