Why Patient Safety is so Important for Every Hospital and Healthcare professional

Patient safety is the absence of preventable harm to a patient during the process of health care and reduction of risk of unnecessary harm associated with health care to an acceptable minimum. An acceptable minimum refers to the collective notions of given current knowledge, resources available and the context in which care was delivered weighed against the risk of non-treatment or other treatment.

Every point in the process of care-giving contains a certain degree of inherent unsafety.

Clear policies, organizational leadership capacity, data to drive safety improvements, skilled health care professionals and effective involvement of patients in their care, are all needed to ensure sustainable and significant improvements in the safety of health care.

Meaning of Patient Safety:

Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care. A cornerstone of the discipline is continuous improvement based on learning from errors and adverse events. 

Elements of patient safety:

• Medication Error
• Adverse drug events
• Nosocomial infections / Hospital Acquired Infection
• Surgical mishaps / Unsafe surgical care procedures
• Unsafe injections practices
• Pressure ulcers
• Diagnostic errors
• Unsafe transfusion practices /Blood product safety and its administration
• Radiation errors
• Sepsis
• Venous thromboembolism (blood clots)
• Antimicrobial resistance
• Blood stream - vascular catheter care
• Systematic review, follow-up, and reporting of patient/visitor incident reports
• Falls
• Restraint use
• Vulnerable patients

The types of errors and harm are further classified regarding domain, or where they occurred across the spectrum of health care providers and settings. The root causes of harm are identified in the following terms:

Latent failure: Removed from the practitioner and involving decisions that affect the organizational policies, procedures, allocation of resources

Active failure: Direct contact with the patient

Organizational system failure: Indirect failures involving management, organizational culture, protocols/processes, transfer of knowledge, and external factors

Technical failure: Indirect failure of facilities or external resources

Finally, a small component of the taxonomy is devoted to prevention or mitigation activities. These mitigation activities can be universal (implemented throughout the organization or health care settings), selective (within certain high-risk areas), or indicated (specific to a clinical or organizational process that has failed or has high potential to fail).

Status of India:

Non-Accredited Hospitals:

• Very poor
• Structured programme for patient safety non-existent in majority of hospitals

Accredited Hospitals:

• Adhere to International patient safety goals
• Collecting data on safety related issues
• Monitoring adverse / sentinel events
• Risk assessment – Admission

Patient Safety Organization in India:

National accreditation board for hospitals and healthcare providers (NABH) 

NABH Standards related to safety:

• AAC.9 - Lab safety
• AAC 12 - Radiation Safety
• CQI  5 - Audit of patient care services.
• CQI  6 - Sentinel events are analysed.
• ROM 4 - Patient safety integral part of patient care and hosp management.
• FMS 9 - Safe and secure environment
• HRM 4 - Training in patient safety.

Implementation in Hospital:

Patient Safety Committee:

• Administrator
• Patient Safety Officer
• Medical Officer
• Quality Manager
• Quality Coordinator
• Nursing Head
• Infection Control Nurse

Patient Safety Teams - Each department

• Ward In charge
• Ward / Unit Manager 

Nursing as the Key to Improving Quality Through Patient Safety:

Nursing has clearly been concerned with defining and measuring quality long before the current national and State-level emphasis on quality improvement.

In the past, we have often viewed nursing’s responsibility in patient safety in narrow aspects of patient care, for example, avoiding medication errors and preventing patient falls. While these dimensions of safety remain important within the nursing purview, the breadth and depth of patient safety and quality improvement are far greater.

The most critical contribution of nursing to patient safety, in any setting, is the ability to coordinate and integrate the multiple aspects of quality within the care directly provided by nursing, and across the care delivered by others in the setting.

This integrative function is probably a component of the oft-repeated finding that richer staffing (greater percentage of registered nurses to other nursing staff) is associated with fewer complications and lower mortality. While the mechanism of this association is not evident in these correlational studies, many speculate it is related to the roles of professional nurses in integrating care (which includes interception of errors by others—near misses), as well as the monitoring and surveillance that identifies hazards and patient deterioration before they become errors and adverse events.

Relatively few studies have had the wealth of process data evident in the RAND study of Medicare mortality before and after implementation of diagnosis-related groups. The RAND study demonstrated lower severity-adjusted mortality related to better nurse and physician cognitive diagnostic and treatment decisions, more effective diagnostic and therapeutic processes, and better nursing surveillance.

Further, when we consider the key role of communication or communication lapses in the commission of error, the role of nursing as a prime communication link in all health care settings becomes evident.

The definition of “error chain” at PSNet clearly indicates the role of leadership and communication in the series of events that leads to patient harm.

Root-cause analyses of errors provide categories of linked causes, including:

• Failure to follow standard operating procedures,
• Poor leadership,
• Breakdowns in communication or teamwork,
• Overlooking or ignoring individual fallibility,
• Losing track of objectives.

Conclusion of the Topic:

Patient safety is the cornerstone of high-quality health care. Much of the work defining patient safety and practices that prevent harm have focused on negative outcomes of care, such as mortality and morbidity. Nurses are critical to the surveillance and coordination that reduce such adverse outcomes. Much work remains to be done in evaluating the impact of nursing care on positive quality indicators, such as appropriate self-care and other meas

Written by:

Dr. Praveen Bajpai

Director of Ingenious Healthcare Consultants Pvt. Ltd.
Founder of Skill Sathi

MBA in Hospital administration, PG Diploma in Quality Accreditation, PG Diploma in Medico Legal System, M. Phil in Hospital Mgmt. from BITS Pilani, P.hD in Management, Certified NABH Auditor, Certified NABL Auditor, Certified Auditor for Clinical Audits, Green Belt in Six Sigma, Certified in Hospital Infection Control Practices, Certified trainer for International Patient Safety Goals, Certified Auditor for JCI 7th Edition Standards 

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