Changing Patient Safety Culture in Neonatal Intensive Care Unit: Egypt

Transcription

1 Changing Patient Safety Culture in Neonatal Intensive Care Unit: Egypt Safaa ELMeneza MD, DTQM, DHPE, DGSHH Professor of Paediatrics Faculty of Medicine for Girls AL Azhar University Geneva 2016

2 Sir Cyril Chantler Medicine used to be simple, ineffective, and relatively safe. Now it is complex, effective, and potentially dangerous.

3 Introduction Patient safety is core of quality of health care. Neonatal patient safety (NICUs) is our interest as has influence on mortality, morbidity and long term quality of life of the newborn infants.

4 Introduction Medical errors are common in NICU due to the complexity of care. Our observations from sporadic case reports, Master theses and media showed evidence of harm. Fear of blame & punishment lead to conceal reporting of adverse events.

5 Introduction What we can do to improve the situation in NICUs? How to change the current patient safety culture? Is establishment of Egyptian Neonatal Safety Training Network, can help for change?

6 The challenges Data Information Actions Current status of patient safety in NICU Gap in knowledge, practice,attitude Steps to achieve safety of care

7 Objectives The wider objective was to develop Egyptian Neonatal Safety Training Network (ENSTN) to promote safe health care practices and prevent inadvertent harm to patients through contribution to learning /training of health care workers (HCWs) on PtS, promotion of a culture for PtS.

8 Step One

9 Methods/ Survey Initially a survey was done to evaluate the current situations among the HCWs of 4 EG Universities. This survey include basic questioners related to :

10 Methods/ Survey Recognition of MOH of Egypt,WHO and international patient safety goals Definition of medical errors Types and frequency of errors in NICUs If discussion about incidents and any corrective actions after incidents Following PTs policy /guidelines

11 Methods/ Survey HCWs : Physicians Neonatologists Pediatricians Pharmacists Nurses Students Other workers

12 Methods/Survey The results of survey showed that : There is deficiency regarding patient safety knowledge lack of guidelines Lack of written policy No incident reporting system

13 Second Step

14 First ENSTN founding Workshop to develop safety standards for NICU,policy and data entry form AL Azhar University May 2014

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16 NAME Institution Tele E mail 1 Safaa El Menezaa Faculty of Medicine for girls Al Azhar University safaa5@hotmail.com 2 Mariem Abu Shady Faculty of Medicine for girls Al Azhar University m_abu_shady@hotmail.com 3 Micael Weindling a.m.weindling@lir.ac.uk 4 Sanaa Tantawy Faculty of Medicine for girls Al Azhar University sanatantawy@hotmail.com 5 Hala Refaat El kolaly Faculty of Medicine for girls Al Azhar University Kolaly_h@hotmail.com 6 Mohamed Reda Bassiony Mansoura University basionmr@hotmail.com 7 Gamal El din Abdel Hamid Al Azhar University gamal572001@hotmail.com 8 Mohamed Nour el Din MCH Ministry of Health mnour_55@yahoo.com 9 Eman Almorsy Ahmed Faculty of Medicine for girls Al Azhar University e_almorsy@gmail.com 10 Soheir Ibrahim Mohamed Faculty of Medicine for girls Al Azhar University elswah.soheir@yahoo.com 11 Mohamed El Kalioby Suez Canal University kalioby@gmail.com 12 Afaf Korraa Faculty of Medicine for girls Al Azhar University afaf_korraa@yahoo.com 13 Naema Ismail Faculty of Medicine for girls Al Azhar University naemaismail@gmail.com 14 Raghda Ali م أحمد ماھر التعليمى Iman El Bagoury Faculty of Medicine for girls Al Azhar University imanelbagoury@hotmail.com 16 Fatma Ali Mamdouh مستشفى النيل بدراوى Ehsan Khaled Mohamed مستشفى النيل بدراوى Shimaa Hamdy Mohamed المعھد القومى للسكر Shoshomedo2007@yahoo.com 19 Iman Yousri Mohamed مستشفى النيل بدراوى imanyousri@gmail.com 20 Nahed Abdel Mordy Kholief مستشفى النيل بدراوى Nahed_mordi@yahoo.com 21 Ehab Abdel Monem Al Bana Al Zagazig University Ehab_banna@yahoo.com 22 Amal Kamal مستشفى األطفال الجامعى بالمنصورة Amalamal98@yahoo.com 23 Mohamed Ahmed Rowisha Tanta University mohamed_rowisha@yahoo.com 24 Mostafa Mohamed Awny Tanta University mostafaawny@gmail.com 25 Neveen Mohamed Abdel Moneam Fayed Helwan University fayed.neveen@yahoo.com 26 Aesha Mohamed Saleh Aswan Hospital aesha.saleh@yahoo.com 27 Shima Mohamed Abdel Salam Helwan Hospital sham @yahoo.com 28 Manal Mohamed Abdel Mageed El Haram Hospital Manal_m_pt@yahoo.com

17 NAME Institution Tele E mail 30 Eman Khaled 31 Zeinab Farag Aseiba Wesam Abdelmonem Ashraf Mohamed Ibrahim Mosallam Omhamed Mervat Mohamed Ahmed Gamalel Din Abeer Ahmed Abdel Hady Amera Ali Abdel Rahman Awatef Abdul Hameed Al Eefaey Amal Gaber Mohamed Amira Ali Tahaa Assem Faculty of Medicine for girls Al Azhar University Faculty of Medicine for girls Al Azhar University Al Zagazig University Tanta University dremankhaled@yahoo.com dr_2.farag@yahoo.com dr_wesammokhtar@yahoo.co m Superstar @yahoo.co m Al Azhar University mosallamnasser@gmail.com private hospital Helwan abeeraaaaa2002@yahoo.com Al Fswa General Hospital alnagaa98@yahoo.com Al Zahraa Hospital awatefalrefaly@yahoo.com Al Zahraa Hospital amalgaber33@hotmail.com Alexandria amiraassem55@yahoo.com

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21 Aims of Patient Safety Standards for NICU

22 Aims of NICU Standards To improve the quality and safety of medical care for newborn infants. To embrace all health care disciplines and actors in NICU. To endorse a comprehensive multifaceted approach to prevent and manage the actual and potential risks to patient safety in NICU.

23 NICU Safety Standards There are divided into 19 General standards 16 Specific standards

24 Specific Standards Can You Remind Me Just What We re Looking For?

25 Specific Standards Standard 1 : Provide patient pathways for neonatal illness Standard 2: Ensure safe transfer for newborn infants Standards 3: Care of the newborn immediately after birth

26 Specific Standards Standard 4: Newborn infants with low Apgar score at 5 minutes should not go home till checked by senior neonatologist. Standard 5: Oxygen must be considered as serious drug when treating newborn infants.

27 Specific standards Standard 6: Ensure safe invasive maneuvers when indicated for care of newborn infants. Standard 7: Resuscitation of newborn infants by expert staff. Standard 8: Encourage noninvasive ventilation in DR and in NICU.

28 Specific standards Standard 9: Proper use of surfactant. Standards 10: Judicious use of medications that have effect on quality of life.

29 Specific standards Standards 11: All newborn infants who have been admitted to NICU must subject to eye ; fundus examination, hearing evaluation and skull ultrasound before discharge.

30 Specific standards Standard 12: Initiation of breastfeeding Standard 13: Scheduling the optimum timing of discharge from NICU or nursery or other health care facilities.

31 Specific Standards Standard 14: Prevent total parenteral nutrition errors. Standard 15: Improve the accurateness of respiratory care, resuscitationrelated, and ventilator care related errors.

32 Specific Standards Standard 16: Prevent diagnostic errors among neonatal population.

33 Third Step

34 Methods/Training Modernization of the participating NICUs workforce through development of cohesive shared education & training workshops in the scope of PtS.

35 Methods/NICU Patient Safety Courses We developed NICU patient safety course for medical staff, nurses and nonmedical as well as leadership and scientific research courses. Up till now we conducted 14 workshops for physicians and 2 for nurses and other health care workers. 8 leadership and researches workshops

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39 Nurses

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42 Fourth Step

43 Methods/Webpage and Incident Reporting To implement anonymous event reporting and learning system database, to allow continuous learning from errors and disseminate patient safety culture in Egypt. We developed manual for events report and policy agreement.

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49 Methods/Alerts and Indicators We are working on establishment of electronic alert and indicators.

50 Fifth Step

51 NICU Patient Safety Researches Iatrogenic hazards in neonatal intensive care unit Study the medical errors due to use of medical devices in NICU NICU Medication Errors: Identifying a Risk Profile for Medication Errors in the NICU Audit and debriefing delivery room resuscitation process

52 NICU Patient Safety Researches Incidence of errors in medical practice in NICU of ITAY ELBAROUD hospital An audit study on aseptic techniques used in NICU in EL RAML pediatric hospital The impact of preformatted medical order sheet on decreasing the incidence of medication errors in NICU

53 Six Step

54 Methods/Guidelines We are now developing 10 Guidelines& clinical pathway for NICU. 8 guidelines are ready for publications

55 Seventh Step

56 Methods/Parents Education On going preparation for parents educational booklet.

57 Conclusions

58 Conclusions Change is hard We still have resistance for events reporting. Still facing problems to get staff to attend the workshops.

59 Conclusions The majority of progresses in patient safety do not necessitate innovation, but reasonably demand improvement of the current practices to make it safer. Building a safety culture is not only related to health care system,but also need a societal change.

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