Safety: A Key Component of Quality Improvement

Transcription

1 Patient Safety : A Key Issue for Health Systems First, do no harm Dr. Jinpeng Xu, Health Services Development World Health Organization Western Pacific Regional Office (WPRO) 20 July 2009 Training of Trainers Workshop on Quality Assurance/Quality Improvement Kuala Lumpur, Malaysia Safety: A Key Component of Quality Improvement Quality is evolving Many different models but all with similar components and methods The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (IOM, 2001).

2 Why Patient Safety? And why now? To Err is Human (2000) Institute of Medicine USA Estimated 98,000 deaths in USA per year from medical errors Similar studies from multiple countries Adverse events in hospitals - 3% - 15 % - Studies from Australia, UK, New Zealand, Denmark, Canada Similar problems throughout the world Gradually evidence is being collected WHO Patient Safety: Set up as a Special Programme following WHA Resolution 55.18, May 2002 Urged Member States to pay close attention to the problem of patient safety and establish science-based systems for improving patient safety and the quality of health care

3 Putting safety on the world's agenda World Alliance for Patient Safety (WAPS) launched in October 2004 Patient safety and health systems Permanent part of a health system Not a one-off effort A whole of system approach Multidisciplinary Relates to over-all quality

4 WHO/WPRO health systems framework: Universal access to quality services for improved health outcomes for all System building blocks Service Delivery Health Workforce Information Access Coverage Goals/outcomes Improved health (level and equity) Responsiveness Medical products, Technologies Health Financing Leadership / Governance - Priorities in each - Multiple, dynamic interactions Quality Safety Social & financial risk protection Improved efficiency Patient safety and Primary Health Care Practically & Scientifically sound/appropriate & Effective Universal accessible/convenient Universal coverage/bottom to Top Affordable/Least cost or no cost to patient (directly) Full participation/health workers, Patients, Grass-root/Village level (most needed) No safety or quality of basic health service = no PHC PHC/Basic care to the poor/not poor care in quality!

5 Elements of Quality Effectiveness Efficiency Accessibility Acceptability Equity Safety Patient safety Effectiveness Patient centredness Timeliness Efficiency Equity WHO IOM Quality Assurance Process Planning Quality Improvement Monitoring

6 How do we do our work: Strategizing patient safety Raise awareness & understand problem Strengthen capacity Creating Safer Health Care Develop solutions Build sustainable partnerships Scale up & evaluate impact World Alliance for Patient Safety Programmes 2008/09 Action Areas 1. Global Patient Safety Challenges 2. Patients for Patient Safety 3. Research for Patient Safety 4. Taxonomy International Classification for Patient Safety 5. Reporting and Learning for Patient Safety 6. Safety Solutions

7 World Alliance for Patient Safety Programmes 2008/09 Action Areas 7. Disseminating best practice 8. Technology for Patient Safety 9. Knowledge Management 10. Duplicate Michigan experience central line infection 11. Education for safer care 12. Safety prize First Global Patient Safety Challenge Clean Care is Safer Care WHO Guidelines for Hand Hygiene in Health Care

8 Western Pacific Region Clean Care is Safe Care - 6 countries have signed the statement (Australia, China, Malaysia, Mongolia, Philippines, Singapore) - Campaigns have been held in other countries as well, e.g. Vietnam, Australia, etc - Active pilot site in Hong Kong - Over 352 hospitals in the WPR (10 in Philippines; National Campaigns in Vietnam, etc) registered to Save Lives, Clean Your Hands campaigns to move action to the point of care and to reduce health care-associated infection (HCAI). - Toolkit requests have increased recently for preventing influenza A(H1N1) virus spread. Second Global Patient Safety Challenge Safe Surgery Saves Lives WHO Guideline for Safe Surgery

9 WHO Surgical Safety Checklist WPRO Safe Surgery Saves Lives - Philippines and New Zealand have participated in a pilot test. - WAPS presentation and training workshop at PCS meeting in December Roll-out and monitoring of checklists in 2009 in PHL - Hong Kong discussing national roll-out - Regional launch planned in 2010

10 The Global Pulse Oximetry Project Integral Part of Safe Surgery Saves Lives to improve the quality of anaesthesia care by affordable, robust pulse oximetry for every OR/OT in the world Global pulse oximetry pilot study Hospitals in the WPR applied Third Global Patient Safety Challenge Tackling antimicrobial resistance Urgent issue - a pandemic of resistance Building a coalition Launch in 2010 Action areas: Rational drug use and regulation: Animal husbandry Research & Development Surveillance Infection Prevention

11 New Checklist on Safe Childbirth Based on the experience of Safe Surgery Checklist (Study published in NEJM) Expert meeting to be held in July 2009 to discuss most effective practices to reduce newborn and maternal mortality Need close collaboration with MCH and other programmes Future dissemination depending on the results of field-test Stimulating research to make care safer Several Institutions in Region have Applied

12 WHO Patient Safety Small Research Grants Research priorities: Counterfeit and substandard drugs. Maternal and newborn care. Safe injection practices. Improving competencies, training and skills. Communication and coordination across care pathways. Latent organizational failures. Deadline : 30 September WPRO QI/A Small Implementation Grants Priorities: Training & workshop Development of Protocol Promotion activities Application: DFC No.1 and 2 Applying before end of August Implementing before end of December

13 WPRO Health Systems Work Capacity Building for Quality/Safety in Countries : Awareness Raising workshop on QA/QI : Training of Trainers (ToT) for 6 countries (Laos, Vietnam, Cambodia, Mongolia, China, Philippines) with follow-up activities : 2 ToTs, 1 for the 6 countries and 1 for Pacific Island Countries, with focus on Patient Safety Key Regional Health Systems, Quality/ Safety Work 2009, Cont d Infection Control Toolkit Formulation, including: Assessment tool Evidence-based information and tools IEC templates WHO Nursing/Midwifery Collaborating Centers Training with Communities in Acute Respiratory Disease Prevention and Management

14 Resources Websites PS and QA 1. Quality assurance project of URC/USAID International society for quality in health care 3. Institute of Medicine To err is human, Quality chasm and other publications Cochrane Collaboration National Library of Medicine 6. Institute for Health Systems Research Malaysia 7. WHO - MAKER Managers taking Action based on Knowledge and Effective use of resources to achieve Results WPRO Health Systems Website WHO/World Alliance for Patient Safety - Parting thoughts and thank you for your attention It is the quality of our work which will please God and not the quantity. - Mahatma Gandhi Quality is never an accident; it is always the result of intelligent effort. - John Ruskin, English critic, essayist, & reformer ( ) First, do no harm. - Hippocrates, 500 B.C.E.

15 谢谢 11 THANK YOU Participant Action Planning 2009 Action plans developed by country teams or sub-teams, including: Identify a quality/safety need or problem of national or institutional significance Rationale for selection Objectives Expected outcomes, achievements Action steps, resources needed, timeline Report and presentation: insert date

16 Action Plan Template Problem Statement/Statement of Purpose of Action Plan Rationale Objectives Expected outcomes, achievements Action Steps/Methods Resources needed Report Writing, Presentation and Dissemination of Results, Conclusions