Building Safe Healthcare Systems: Fighting the War against Medical Errors

and Improving Patient Safety in Developing Countries

Isabel Kazanga, PhD Student, Center for Global Health, Trinity College Dublin

29th November 2010

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IntroductionIntroduction

Healthcare is not usually safe as it is intended to be.

In 1999, the IOM published a landmark report on medical errors: “To Err is Human”

Everyday many people get injured and die in hospitals silently as a result of preventable medical errors (MEs)

In USA, 44,000–98,000 people die every year due to MEs

Source: Institute of Medicine (IOM), 1999

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Introduction cont.Introduction cont.

10%

20%

30%

40%

% of patients affected with medical errors

• The epidemic of MEs is a global problem.

• MEs affect 1 in 10 patients worldwide.

• The incidence of MEs is however more serious and challenging in developing countries than developed countries.

Source: World Health Organisation, 2005

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Research ObjectivesResearch Objectives

Broad Objective

To identify priorities and strategies that can help reduce MEs and improve patient safety in developing countries, in order to draw suggestions for public health policy improvement.

Specific Objectives

1. To investigate the epidemiology of MEs

2. To identify factors which contribute to MEs

3. To explain the effects of MEs

4.To identify priorities and strategies to reduce MEs and improve patient safety in developing countries

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Significance of this StudySignificance of this Study

The findings of this study will:

- give insight into the epidemiology of MEs in

developing countries

- provide suggestions for policy improvement

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Methodology

• Desk research

• Masters research project

• Extensive literature review

• Sources of data

✓ PubMed

✓ MEDLINE

✓ ScienceDirect

✓ Other sources

• Keywords- Healthcare systems, medical errors, patient safety, developing countries

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Review & FindingsReview & Findings

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What are medical errors?What are medical errors?

Definition

“A commission or an omission with potentially negative consequences”a

(Wu et al, 1997)

Examples

• Wrong diagnosis or treatment

• Object left inside patient during surgery

• Mix-up in patient identities

• Delay in treatment

• Injury, infections etc

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What causes medical errors?What causes medical errors?

Healthcare systems complexity issues

Personal factors

Professional issues

e.g:

• Poor organizational culture

• Inadequate technology

• Poor communication channels

• Poor leadership

• Lack of incident reporting systems

• Lack of skilled healthcare staff

e.g:

• High workload and busy schedules (with many pressures and high level of stress)

• Illegible hand writing & inaccurate prescription

e.g:

• Lack of knowledge & incompetency

• Failure to acknowledge and understand how errors occur and their consequences

“Beyond honest errors are mistakes caused by negligence - haste, carelessness.”

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The epidemiology of medical errorsThe epidemiology of medical errors

It is difficult to get a full and complete picture of

medical errors in developing countries

Why?

Due to inadequacy of research studies and limited publications

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The Incidence of MEs in developing countriesThe Incidence of MEs in developing countries

Countries Studies on MEs

Durban, South Africa(King Edward VIII Hospital)

MEs occurred in 11.7% of gynaecology admissions & 52% of the errors were avoidable. MEs accounted for 17.7% of mortality & 2.1% of all admissions (Matsaseng & Moodley, 2005)

Bangladesh 73.5% of U/5 children with acute diarrhea received inappropriate treatment (Alam et el, 1998)

Malawi 29.2% of children with uncomplicated malaria were subject to medication error (Osterholt et al, 2006).

Nigeria Out patient prescription common errors- over dosage (38%) and under dosage (18.8%) (Oshikoya & Ojo, 2007).

Pakistan Anaesthetic medication errors- under dosage & side effects/ drug reaction. A total of 76% of the medication errors were classified as preventable; 56% resulted from human error, whilst 19% was as a result of system error (Khan & Hoda, 2005).

Malaysia Common types of drug administration errors - incorrect time (34%), followed by incorrect technique of administration (22%)Intravenouse routes (21.3%) ( Chua et al, 2009).

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1118 observations

127 errors

11.4% error rate

Chua et al, 2009

Types & Frequency of MAEs- A study in Malaysia

Hospital (2009)

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Effects of medical errors

“Honest error is to be pitied, not ridiculed.” ~ Lord Chesterfield

“Admit your errors before someone else exaggerates them.” 

~ Andrew Mason

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“To prescribe treatment To prescribe treatment regimens for the good of regimens for the good of my patients according to my patients according to my ability and my my ability and my judgment and never do judgment and never do harm to anyoneharm to anyone".

Ethical and Legal Issues in Patient SafetyEthical and Legal Issues in Patient Safety

Hippocrates 400BC

HIPPOCRATIC OATH HIPPOCRATIC OATH

✓ Patients have a right to safe & effective care at all times (JCI, 2007)

✓ Healthcare professionals & Institutions owe a legal duty and responsibility to providing safe care to their patients.

✓ Medical malpractice or negligent errors are acts of crime.

“Failure to disclose MEs compromise patients and societal trust”

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Strategies & Priorities to reduce MEs & promote Strategies & Priorities to reduce MEs & promote Patient Safety in Developing CountriesPatient Safety in Developing Countries

1. Laws, Policies and Guidelines to promote patient safety

e.g Patient Safety Act- Denmark (2004),

USA (2005).

2. Stakeholders InvolvementIt helps to improve safety & quality

(McFadden et al, 2006)

3. Creating Patient Safety CultureSafety as a commitment & priority

4. Promotion of safe clinical practices

e.g “ Five Rights Principle” (5Rs), double

checking, correct diagnosis & prescriptions,

proper patient handovers

5. Incident Reporting Systems Should be “ blame free”, confidential/ anonymous &

non punitive

6. Accreditation of Hospital“ Accredited hospitals reported improvements in;

reduction of medication errors, professional credentialing…” (JCI, 2007)

7. Staffing, Education & Training of Healthcare workers

Including training of pharmacists & drug vendors e.g Kenya, Phillipines, Indonesia & Nepal

8. Improving Communication & Teamwork

9. Promoting research on patient safety

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ConclusionConclusion

✓ MEs will continue to claim many lives silently in developing countries, unless immediate attention and effort is made to prevent this problem.

✓ In order to successfully win the war against MEs, strong commitment and application of a comprehensive approach are essential.

✓ Patient safety can only be achieved through a “bundle” strategies.

“Learn from the mistakes of others. You can't live long enough to make them all yourself”~ Eleanor Roosevelt

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Thank Thank You!You!