PATIENT SAFETY

PFPS – Patient for Patient safety; WHO PSP

1. WHAT & WHY?

2. STAKE HOLDERS?

3. HOW?

AGENDA

1. Patient & Patient safety

2. Patient & Sickness

3. Patient & RUM

1. PATIENT SAFETY 200 BC … 2005 …. 2013

PRIMUM NON NO CERE (Above all, DO NOT harm)

WHY IS IT A SERIOUS

GLOBAL HEALTH ISSUE?

SAFETY COST, RESOURCES

Patient safety is the absence of

preventable harm to a patient during

the process of health care.

WHAT & WHY

WHAT CAN BE WRONG?

• Diagnosis

• Treatment, Dosage (pediatric)

• Laboratory errors

• Patient identification

• Adverse event

• Infection control

• Surgery

Every point in the process of care-giving

contains inherent unsafety.

Today’s health-care context is highly complex.

Care is often delivered in a pressurized and fast-moving

environment, involving a vast array of technology and,

daily, many individual decisions and judgements by

health-care professional staff.

In such circumstances things can and do go wrong.

1. 1. SAFETY issues

To err is human… Institute of Medicine

If you think going to a hospital is safer than

travelling by plane … THINK again!!

Industries with a perceived higher risk (aviation,

nuclear plants) - much better safety record than

health care.

Aircraft accident 1: 10.000.000 chance

Patient harmed 1 : 300 chance

1.4 million people worldwide suffer from

infections acquired in hospitals.

Developed countries:

50% medical equipment

unusable/partly usable -

leads to substandard or

hazardous D/ or T/

health care-associated

infection: 20 x. Injections

given without sterilization is

70% causes 1.3 million

deaths

1 : 10 patients harmed.

Surgical safety: half of

the avoidable adverse

events results in

death or disability.

Developing countries:

1. 2. COST & RESOURCES

Additional hospitalization, litigation

costs, infections acquired in hospitals,

lost income, disability and medical

expenses have cost some countries

between US$ 6 - 29 billion a year.

The economic benefits of improving

patient safety are compelling.

HEALTH INDUSTRY 50% of Rx/ - unnecessary, ineffective

• Indonesia: increases

10-13% per year

• % causes e.g:

– Sophisticated exam

increased 65%

– Overtreatment - 56%

(50% Rx/ - ineffective)

MEDICAL ERROR - US:

Cause of death no 4-5

> $ 177.4 Billion (2000)

$847 million/yr - UK (2006)

2/3 pts – Rx/

10 drugs/pt, yr 2000, US

HARM?

0

50,000,000

100,000,000

150,000,000

200,000,000

250,000,000

300,000,000

350,000,000

Outpatient

Inpatient 31/1

340/6

109/8

SUPERBUGS (resistant to antibiotics)

HARM?

RESISTANT MICROBA

IN THE HOSPITAL

• CDC: ± 2 million/yr - USA additional infection 90,000 death

• Nosocomial infection = infection during hospitalization (“BONUS”)

Antibiotics =

societal

medicines HARM?

2. PATIENT as

STAKEHOLDER

• Symptoms and Signs

• DIAGNOSIS

• Management (Treatment)

RUM

SIGNS & SYMPTOMS

• PIECES OF PUZZLES that will lead doctors

to the DIAGNOSIS

• Be smart!

• Focus on:

– What is the problem?

Instead of on:

– how to suppress the

symptoms

EVIDENCE BASED MEDICINE (EBM)

↓

GUIDELINES

SICK

• Signs &

Symptoms

Fever, head-

ache, coughs,

mucous, etc

DIAGNOSIS

• URI/ISPA:

– Cold

– Influenza

GUIDELINE

Treatment

Advice

Non drug

Drug

2nd opinion

Combination

WHY DO WE NEED EBM? Save LIVES!

WHEN given a Rx/

• Do I really need medication?

• How many (count the lines)?

• 5 drug information – patient’s right

– Active ingredients?

– Indication?

– Risk of ADR?

– Contraindication?

– Dosage, duration, etc?

• The generics please?

• Support group

• Ambassador

Empower parents/consumers - HEPP

A thinking

community

Shared

responsibility

Promoting

Rational Use of Medicine

to the Community

• Client, Partner

• Learn

• Ask questions

Empower parents/consumers - HEPP • Courses

• (PESAT) – 6/12;

• Companies; Institutions

• Others: grandmother, baby sitters

• Mailing List sehat@yahoogroups.com

• Breastfeeding support group (KLASI)

• Media

• Radio(s) ; Published materials

• Consultation corner (CBN (web server), Magazine

• Website: www.sehatgroup.web.id

• Model clinic

• Studies

SUA

Say NO to antibiotics for:

1.Common colds (coughs, coryza)

2.Acute diarrhea (non bloody diarrhea)

3. RATIONAL USE OF MEDICINE

(RUM)

Patients receive medications APPROPRIATE to their

clinical needs,

• in DOSES meet their individual requirements for

an

• ADEQUATE PERIOD of time,

• accurate INFORMATION, and

• at the LOWEST COST.

WHO conference of experts Nairobi 1985

Why

RUM?

• Better therapeutics

• Less side effects

• Saves money:

– Patient,

– Hospital,

– Country

• Ethics and Equity

Overtreatment

Undertreatment

Mistreatment

WHO:

1. Avoid mixing drugs

2. As few drugs as

possible

Irrational Use of Medicines:

Wasteful & Harmful

• Side effects of drugs → increased morbidity & mortality (and cost)

• Irrational use of antibiotics → resistant bugs → stronger & expensive antibiotics → prolong hospitalization, yet death rate increased

1. Polypharmacy

2. Overuse of Antibiotic, steroid

3. Non generics

4. High rate of injections

5. Supplement; off label use

”... Perlu segera dikoreks. Jika praktek-praktek

primitive itu tetap dipertahankan, keselamatan

pasien (patient safety) ... jadi taruhannya"

Prof Iwan Dwiprahasto

• "Menggeruskan tablet untuk dijadikan puyer, kapsul, bahkan sirup untuk sediaan anak, atau menggeruskan tablet atau kaplet untuk dijadikan saleb dan krim adalah bentuk off label use yang jamak ditemukan. Hal itu terjadi secara turun menurun, berlangsung puluhan tahun tanpa ada yang sanggup menghentikannya.”

• ”Melestarikan penyimpangan, menikmati kekeliruan, dan mengulang-ulang kesalahan tampaknya sudah menjadi hedonisme peresepan. Yang satu mengajarkan dan yang lain mengamini sambil menirukan. Itulah cara termudah untuk mendiseminasikan informasi yang tidak berbasis bukti."

Prof Rianto Setiabudi …

Permasalahan seputar puyer

• Kemungkinan kesalahan manusia

• Stabilitas obat tertentu dapat menurun

• Toksisitas obat dapat meningkat

• Waktu penyediaan obat lebih lama

• Efektivitas obat dapat berkurang

• pencemaran lingkungan

• tingkat higienis

• biaya lebih mahal

• Dokter tidak tahu obat mana …

• Potensial IRUM

Going to the Doctor?

1. Consultation 2. Second opinion

AIMS?

4. 1. Medical consultation

perundingan antara dokter dan pasien

untuk mencari sebab terjadinya penyakit

& untuk menentukan cara pengobatannya

AIMS?

Ask: the DIAGNOSIS in

medical term

4. 2. SECOND OPINION

• 20% second opinion

• 1 out of 3 : a new diagnosis

• Search in the credible web : appraise medical information

• Steps

– Choose the right doctor

– Prepare all the records

– Doctor-2 may agree or disagree

Some “don’ts” (for

agreed opinion):

• Don't assume that the doctor

who gives you better news is

the correct one. Just because

you like the answers better

doesn't mean she is right.

• Don't assume that Doctor-2 is

correct. If the second doctor's

opinion is always the correct

one, why did you go to a first?

• Don't assume that the "nicer"

doctor is right either. A doctor

with better bedside manner isn't

necessarily a better practitioner.

• If the doctors'

opinions are very

different, you'll want

to consider getting a

third opinion. The

third opinion will likely

be similar to either

Doctor-1 or Doctor-2,

and that will help you

make your treatment

decisions, too.

Some “do’s” (for

differing opinion):

Ask Doctor 3Qs:

What should

Be done?

Problems?

Cause?

Physical exam When - worry?

Diagnosis Treatment Plan

Emergency signs

Nowadays, most patient-physician interactions

end with a prescription

Tidak semua

obat

bermanfaat

Jika bermanfaat,

tidak untuk semua

Tidak semua

obat aman

Jika aman, tidak

untuk semua

Physicians should adopt the best guidelines

because they represent the best practice and

are best for the patient

Evidence

ACTION Factors influencing

the use of research

evidence

”TRANSLATING”

COMPLY to GUIDELINES

E2 = Evidence x Experience

GUIDELINES (CPG)

are systematically developed

statements that aim to help

physicians and patients reach

the best health care decisions.

A doctor will be able to

cure some of the time,

relieve most of the time

but should

comfort all the time.

• preventing medical error

• http://www.ahrq.gov/consumer/safety.html

The World Alliance for Patient Safety is working with

40 champions – who have in the past suffered

due to lack of patient safety measures –

to help make health care safer worldwide.