The statistics are alarming: worldwide, 10% hospital patients see adverse events occur attributed to hospital-related mistakes and unsafe care. Individual studies have reported adverse events from 4–17% of hospital admissions. Of these, 5–21% result in death. In low- and middle-income countries, the risk of acquiring Hospital Acquired Infections (HAIs) goes up by 2-20 times. At any given time, the prevalence of HAI varies between 3.5% and 12% in the developed countries, while in the developing countries, the prevalence of HAI varies between 5.7% and 19.1%.
Why this happens: Medical literature reports the incidence of hospital acquired infections which the patient may not have when s/he walks in the hospital. However evidence also suggests that half of these can be prevented by just investing a minor fraction of the budget while planning the hospital systems, pathways, and processes. This is where public-private partnerships come in, as government set-ups usually have insufficient resources to take care of people. The non-allocation of all types of resources in proportion to the workload has also been documented. Often, it isn’t individuals who inadvertently make mistakes, but systems and processes that may not be efficient enough to prevent infections slipping through.
Why we need to act now: The issue is coming into the news with the soon-to-be-launched National Health Assurance Mission aimed at universal health coverage for the entire population in India. In August and September this year, there have been two discussions on patient safety at the national stage and at the World Health Organization. The latter has also released a patient safety policy framework for South-East Asian countries, including India. Many countries in the developed world have “Speak Up for Patient Safety” campaigns. Improving patient safety requires a system-wide effort involving a wide range of actions in performance improvement, environmental safety and risk management, including infection control, safe use of medicines, equipment safety, and safe clinical practice and providing a safe environment of care.
What we need to do: We must implement the culture of safety such as is observed in the airline industry. Efforts have been made by the National Accreditation Board of Hospitals and Health care providers (NABH) and its different programs, the MoHFW’s National Quality Assurance Mission (NQAS), Joint Commission International (JCI). They have instilled a sense of confidence among patients and service providers alike that a set of minimum standards is maintained in an accredited hospital. The accredited hospitals undertake clinical audits and apply quality assurance processes by design and thus avoid numerous medical errors well in time. The healthcare insurance industry has also played a catalytic role, at least in major cities across India, to indirectly force their clients to improve and standardize the quality of service.
How we can do this: Like many other issues, the challenge of patient safety also needs to be addressed through a multi-dimensional approach. India has robust mechanisms to roll out blood bank safety, organ transplantation safety and basic maternal and newborn health services across, but needs a booster shot for safe surgical practices, safe medications, stricter control on spurious drugs, safe injections, and safe disposal of bio medical waste. We propose the following 4-point program for all stakeholders to take up patient safety issues on fast track.
- Consider a national Patient Safety week. It should be relevant to all public and private sector health sector institutes and standalone clinics.
- The MoHFW should continue their efforts to adopt the WHO regional strategy which include nationwide patient safety assessments and capacity development besides behavioral change initiatives.
- Bureaucrats and technocrats at state and district level should spend just about 15-20 minutes every week on the issue. A ‘dip stick’ at various health institutes would give them a flavor and they could use their administrative skills to fix the gaps at local level to enhance patient safety.
- Professional and Industry bodies should also develop innovative thoughts and supplement government efforts while providing patient care.
Let us all speak up for Patient Safety in India.
Inputs by Dr Om Prakash Kansal, Technical Advisor, Injection Safety