Patient Safety in the Philippines

Transcription

1 Patient Safety in the Philippines Armando C. Crisostomo, MD, MHPEd Professor of Surgery & Associate Dean College of Medicine, UP Manila Chair, Phil. Alliance for Patient Safety Technical Consultant, DOH & WHO-WPRO Patient Safety Programmes

2 No disclosures

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5 History, facts and figures IOM publishes landmark report To Err is Human

6 History, facts and figures : Institute of Medicine Report: To Err is Human The first public realization of the true extent of patient harm and safety in the healthcare setting Deaths occurring from medical errors (98,000) far outnumber deaths from motor vehicle accidents (43,000), Breast Cancer (42,000) and AIDS (16,000). Deaths from workplace injuries (6,000) are outnumbered by deaths from medication errors (7,000) Costs $17-29Bn annually, half of which are health care costs

7 Adverse Events in Health Care Some examples: 10% of hospital patients suffer an adverse event 16.6% of hospital patients suffer an adverse event (Australia) About 100,000 hospital deaths every year through medical error (USA) HAI: % of hospitalized patients acquire HAI (up to 37% in ICUs) - 5 million HAI estimated to occur in hospitals in Europe/year - 100,000 cases of HAI in UK lead to 5,000 deaths a year Medication Errors: 1.5 million harmed and thousands killed in US/year - 67% of patients' medication histories have errors Unsafe Surgery: (234m case globally/year: 7 m complications, 1 m death) Patient Handovers: 15% of adverse events or errors (USA study) Conc. Injectables, Patient Identification, Catheter/Tubing Misconnections, Injection Safety, etc..

8 PATIENT SAFETY IN DEVELOPING COUNTRIES?

9 Situation in Developing Countries? Probability of adverse event is much higher due to: Poor state of health infrastructure and equipment Unreliable supply and quality of medicines Shortcomings in waste management and infection control Low number and poor performance of health personnel Underfinancing of health services

10 Situation in Developing Countries? At least 50% of all medical equipment in most developing countries is unusable, or only partly usable, at any given time. In the Newly Independent States, about 40% of hospital beds are located in structures originally built for other purposes. As a result the correct infrastructure for radiation protection and infection control is very difficult to install. Approximately 77% of all reported cases of substandard and counterfeit drugs occur in developing countries

11 World Alliance for Patient Safety Launched by WHO in October 2004 Response to WHA resolution urging WHO & member states to pay close attention to problem of patient safety Aims to raise awareness & political commitment to improve safety of care

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13 Philippine initiatives...!2007 WHO-WAPS declares Safe Surgery Saves Lives as theme for 2 nd Global Safety Challenge!Dr. Ted Herbosa of UPCM-PGH participates in expert panel that formulates WHO safe surgery checklist!up-pgh selected as one of 8 pilot sites for WHO safe surgery checklist

14 8 Evaluation Sites PAHO I Toronto, Canada EURO London, UK EMRO Amman, Jordan PAHO II Seattle, USA WPRO I Manila, Philippines AFRO Ifakara, Tanzania SEARO New Delhi, India WPRO II Auckland, NZ

15 Philippine initiatives... December 2007 Dr. Crisostomo elected PCS President and commits to patient safety as PCS flagship program January 2008 PCS creates Committee on Quality Assurance and Patient Safety March 28, 2008 PCS convenes First Philippine Summit on Patient Safety in Surgery. Participant stakeholders commit to promote culture of patient safety

16 1 st Philippine Summit on Patient Safety in Surgery (Mar 28, 2008)

17 Philippine initiatives... April July 2008 pilot testing of WHO safe surgery checklist conducted at UP-PGH June 4, 2008 PCS conducts tri-media forum on Patient Safety in Surgery June 25, 2008 WHO-WAPS launches Safe Surgery Saves Lives program in Washington, DC with PCS as one of international endorsers

18 WHO Checklist in PGH ORs

19 PHILIPPINE INITIATIVES... July 30, 2008 DOH issues AO declaring National Policy on Patient Safety Goal: To ensure that patient safety is institutionalized as a fundamental principle of the health care delivery system in improving health outcomes Objectives: - establish comprehensive patient safety program - develop critical capacity of health care workers - nurture a culture of safety

20 Philippine initiatives... Key elements of patient safety program (DOH AO ) - Leadership - Institutional development - Reporting system ( protected environment) - Feedback and communication - Adverse event prevention and risk management - Disclosure of reported serious events (ensure confidentiality of individual cases) - Professional development - Patient centered care and empowerment of consumers

21 Philippine initiatives... September 12, 2008 (72ndPCS Foundation Day) - Philippine Alliance for Patient Safety in Surgery is launched - MOU between WHO, DOH, PHIC and PCS is signed to collaborate for quality health care and patient safety (WHO- technical support, DOH- lead and supervision, PHIC include patient safety in accreditation, PCS lead implementing organization)

22 Signing of MOU between WHO,DOH,PHIC & PCS Launching of Phil. Alliance for Patient Safety

23 Philippine Alliance for Patient Safety (PAPS) VISION: A collaboration of health care professionals and other stakeholders committed to promote patient safety in RP MISSION: Advocating and ensuring a culture of patient safety CORE VALUES: Quality, Professionalism, Solidarity

24 Philippine initiatives... October 2008 PCS prints and begins distribution of WHO safe surgery checklist posters and guideline manuals to major hospitals thru 11 PCS chapters* December 7-8, 2008 PCS conducts training workshop for implementation of WHO safe surgery checklist with Dr. Alex Haynes as facilitator* (* - funded by WHO)

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26 PHILIPPINE INITIATIVES... May 7, 2009 PCS conducts 2 nd workshop for implementation of safe surgery checklist in 28 pilot hospitals June 25, PCS & PAPS organize First National Patient Safety Day - Presidential Proclamation - First General Assembly of PAPS - Workshop for hospital patient safety officers

27 First National Patient Safety Day June 25

28 Training workshop for hospital patient safety officers

29 WHO Patient Safety Curriculum Developed in 2008 PAPS-PCS workshop (Feb.13,2010) conducted to introduce or strengthen patient safety in undergraduate medical, nursing and residency programs in surgery, Ob-Gyne and anesthesia 2 nd workshop (August 28, 2010) introduced curriculum to dentistry, pharmacy and midwifery

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31 MEDICATION SAFETY SUMMIT

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33 NATIONAL PATIENT SAFETY DAY 2011 Theme: Working Together to Combat Drug Resistance

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36 WHO Multi-professional Patient Safety Curriculum WHO-WPRO Launch (October 19, 2011 Manila)

37 SURGICAL TOXICITY AN ANALYSIS OF WORK HOURS OF SURGERY RESIDENTS IN SELECTED TRAINING HOSPITALS IN THE PHILIPPINES Crisostomo AC, Lim IT, ClaudioKM Phil Jour Surg Spec 2011 Jan-Mar 66(1): 1-8

38 Surgical Toxicity... - MAJOR FINDINGS/CONCERNS Prolonged working hours Sleep deprivation Wide disparity of work hour quantity and quality between seniors and 1 st year High proportion of SCUT WORK Low proportion of time for academics, study and out-patient work

39 PROLONGED WORKING HOURS + SLEEP DEPRIVATION Overall average = work hours/wk ( ) and 4.7 sleep hours/day First year residents = work hours/ wk ( ) and 4.1 sleep hours/day Government residents = work hours/wk ( ) and 3.9 sleep hours/day Way above ACGME limits (80 work hrs/wk) May even be underestimation

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48 UP College of Nursing conduct Master Trainer course in Team STEPPS (Feb. 2017) Team Strategies and Tools to Enhance Performance and Patient Safety

49 PROPOSED HOUSE BILL Seeks to establish the National Center of Healthcare Quality and Patient Safety which shall offer high level expertise.

50 EXECUTIVE SUMMARY Center for Health Care Quality and Patient Safety Our Vision Safer health care for the Filipino Our Mission A center with high-level of expertise and state-of-the-art facilities to develop the clinical competencies of health professionals; promote research and policy formulation through transdiciplinary approach towards safer patient care and better health outcomes Theme SAFE: Safety Strategies and Actions as Forefronts for Engagement and Empowerment Function Units The Center has 5 functional units namely Translation Research, Education and Training, Innovations and Technology, Policy, Network and Linkages

51 Program Trust The 5 units shall be working together to carry program thrusts such as research for patient safety, education for safer care, and patients for patient safety Financial Sustainability The Center will seek its grants from DOST, PCHRD, DOH, CHED and private funding institutions. Meanwhile, while our Incremental Tuition Fee (ITF) is still available, it will also be utilized for the maintenance, upkeep and researches of the Center. Location The Center will be located at the new UPCM Academic Center, University of the Philippines Manila, Pedro Gil St., Ermita Manila

52 PURPOSES AND OBJECTIVES The Patient Safety Center shall have the following purposes and objectives: a. To construct, establish, operate and maintain facilities to house expertise and state of the art facilities to provide teaching and training, data gathering and management, research, policy formulation and public information to promote healthcare quality and patient safety b. To construct and operate facilities for basic and advanced clinical simulation to serve the training needs of health professionals particularly those serving in government and public health facilities c. To construct and operate facilities for training, research and policy development on but not limited to: drug safety, infection control, biomechanics/bioengineering d. To construct and operate facilities for a training center for healthcare professionals on health quality and patient safety systems and programs management e. To promote, encourage and engage in medical and scientific research on healthcare quality and patient safety towards improving healthcare outcomes f. To gather, compile and publish findings of its medical and scientific researches and engage in relevant public information activities g. To conduct studies and teaching programs, in collaboration with universities, hospitals and/or research institutions on promotion of healthcare quality and patient safety; encourage and grant scholarships for advanced training in healthcare quality and patient safety h. To finance, sponsor, hold or participate in congresses, conventions, conferences, seminars, workshops and training programs on promotion of healthcare quality and patient safety

53 Patient (Demographic profile, risky settings) Patient-centered work EDUCATION & TRAINING Healthcare Quality and Patient Safety TRANSLATIONAL RESEARCH/POLICY Health Care Provider (Skills development, Behavior change/ modification) Changing the culture of patient safety through leadership engagement & team training INFORMATION/TECHNOLOGY Environment (Learning facilities/ Stakeholders

54 ORGANIZATIONAL STRUCTURE UP Manila Philippine General Hospital Office of the Dean CENTER Office of the Associate Dean for Planning & Research/Office of the Associate Dean for Academic Development Administrative Support Education & Training Translational Research Innovations & Technology Policy Networking & Linkages TWG Skills Laboratory Stimulationbased curriculum TWG Patient Safety Researches (Phase 2) Basic science researches TWG Telehealth TWG Baseline surveys Performance indicators TWG Legislation

55 SUMMARY Patient safety now an emerging public health problem Initial initiatives by the WHO thru the WAPS Philippine initiatives: - pilot testing and implementation of WHO safe surgery checklist - creation of PAPS and holding of annual Patient Safety Day activities

56 SUMMARY Philippine initiatives: - pilot testing, launching and implementation of the WHO Multi-professional Patient Safety curriculum - First ASEAN Patient Safety Congress - Team STEPPs training - Proposal for National Center for Health Care Quality and Patient Safety in UPCM Faculty members of UPCM and UPM are key figures in Philippine initiatives on patient safety

57 Turúan!..huwag turuán!

58 Let s not assume safety.let s Assure It!

59 Maraming Salamat Po sa Inyong Lahat!