Quality Assurance in Healthcare Delivery;

A MUST for Safety of End Users

Dr Olufemi AinaMaster TeamSTEPPS TrainerAesculapius Healthcare Consultants (AHC)

Our Goals- Aesculapius Healthcare Consultants (AHC)

• Broaden Patient Safety Knowledge in Nigerian Hospitals

• Develop Patient Safety Culture in our Hospitals by deploying TeamSTEPPS Patient Safety Strategies

Healthcare Quality Assurance

Developments in Quality Assurance

Need for Safety Assessment in Hospitals

Entrenching Patient Safety in our Healthcare System

TeamSTEPPS Patient Safety Strategies

Quality Assurance ensures Safety

Components of Quality Care

Thus Safety is the foundation upon which all other aspects of Quality Care are built.

Institute of Medicine (IOM) considers patient safety “indistinguishable from the delivery of quality health care.”

Safe

Effective

Patient Centred

Efficient

Equitable

Timely

End Users of Healthcare Service

• Patients and Family Members

• Healthcare Provider and its Professionals

Quality Assurance is that set of activities that are carried out to previously Set Standards to

monitor and improve Performance so that the care provided is as Effective and as Safe as

possible.

Quality Assurance in Healthcare

Component of Quality Management that ensures the Right things are being done- based on Standards and Established Goals.

Systematic Process of checking if a Healthcare Service is meeting Specified Requirements

Helps reduce waste and unnecessary activities and improve Service Delivery

Quality Assessment Methods

System Performance Health Priorities, System

Planning, Financing And Resource Allocation done at National Level & Global Level.

General Environment Of The Country, Legislation & Other Regulatory Mechanisms, Professional Recognition and Overall Quality Management.

Institutional and Clinical Performance

External Assessment ISO, Accreditation,

Licensing, EFQM, Peer Review

Internal Self-assessment Patients Rights, Risk

Management, Clinical Governance, Clinical Audit, Performance Indicators & Benchmarking

Healthcare Quality Assurance Strategies

Process Issuing OrganizationObject of Evaluation

Standards Components

Licensure Mandatory GovernmentIndividual and Organization

Minimum Standards to ensure a Minimum Risk Environment to Health and Safety

Regulations to ensure Minimum Standards, Competence and On-site Inspection

Certification Voluntary Authorized BodyOrganization or Component

ISO 9001 Standards to ensure Conformance to Industry Standards

Organization to demonstrate Services, Technology or Capacity

Accreditation VoluntaryUsually Non Governmental-Recognized Tools

Organization Maximum Achievable Level to stimulate Improvement over time

Compliance with Published Standards and Onsite Evaluation

Comparing Healthcare Quality Improvement Strategies

4 Tenets of Quality Assurance

• Oriented toward meeting the needs and expectations of the Patients and other Users.

• Focused on systems and processes.

• Use data to analyse service delivery processes.

• Encourage a team approach to Problem Solving and Quality Improvement.

Developments in Quality Assurance

1859- Florence Nightingale introduced the first standards in nursing care during the Crimean War

1913-American College of Surgeons(ACS)- Minimum Standards for Hospitals

1951-Joint Commission- ACS , American College of Physicians, American Hospital Association, Canadian Medical Association, American Medical Association

1966-Avedis Donabedian- ‘Evaluating the Quality of Medical Care’

Structure| Process | Outcome

1998- International Society for Quality in Healthcare (ISQUA) ALPHA Program

2004-WHO- World Alliance for Patient Safety

Comparing Quality and Safety

Quality Safety

Degree of the realisation of the reasons that the Patient has come to the care hospital e.g. patient comes to Hospital for an Operation

Results which are not the reasons for the Patient coming e.g. ‘not catching an infection’ and he is implicitly confident he will not run the risk of this happening.

Need for Safety Assessment Institute of Medicine Report

Impact of Error: 44,000–98,000 annual deaths occur

as a result of errors

Medical errors are the leading cause, followed by surgical mistakes and complications

More Americans die from medical errors than from breast cancer, AIDS, or car accidents

7% of hospital patients experience a serious medication error

Cost associated with medical errors is $8–29 billion annually.

Federal Action:

By 5 years;

medical errors by 50%,

nosocomial by 90%; and

eliminate “never-events” (such as wrong-site surgery)

Medical Errors Still Claiming Many Lives 20/01/2005By Elizabeth Weise, USA TODAY

As many as 98,000 Americans still die each year because of medical errors.

The researchers blame the:

Reluctance to admit Errors

Billing System that Reward Errors

Lack of Leadership

Complexity of Health Care Systems

14

05/18/2005

…little progress towards the goalLeape and Berwick,

JAMA May 2005

Hospitals have taken steps to reduce medical errors and injuries.

Examples:

Computerized prescriptions: 81% decrease in errors.

Including pharmacist in medical team: 78% decrease in preventable drug reactions.

Team training in delivery of babies: 50% decrease in harmful outcomes — such as brain damage — in premature deliveries.

Source: Journal of the American Medical Association

Improvements

WHO- African RegionWHO- African Region

Adverse events 4% to 16% of all hospitalized patients

Developing Countries estimated 5% to 10% of patients acquire one or more infections

Risk 2 to 20 times higher than in developed countries.

Sentinel Events Surgical Care- > 50% of Adverse Events, Unsafe injections, blood and medicines

African Countries Mali 18.9%, Tanzania 14.8%, Algeria 9.8%

Drugs 25% of medicines are counterfeit, poly-pharmacy, inappropriate use of antimicrobials; overuse of injections, lack of prescription guidelines, inappropriate self-medication, non-adherence to dosing regimes.

WHO- Patient Safety Practice

• Processes or structures which, when applied, reduce the probability of adverse events resulting from exposure to the health-care system across a range of diseases and procedures.

• Healthcare-associated infection is a global problem with over 1.4 million people suffering at any given time.

• Medical errors result in numerous preventable injuries and deaths.

• Inadequate Patient Safety Data in African Region

Need for Safety-Personal Experience

• Young NYSC dr. in a GH, many years ago: ordered IM drugs, nurse uncomfortable, even though gave lower dose- respiratory arrest, called and answered promptly.

• Young Father in a PH, Lagos: 2 years ago: overworked nurse (esp. with reports), set up IV line, suction didn’t work, sucked manually

Entrenching Patient Safety in Our Healthcare System

Focus on Patient Safety Performance Goals in Hospitals

Reward Patient Safety Achievement by Hospitals

Government to support Patient Safety Advocacy Groups

Patient Safety Forum between Health Professionals & Patient Groups

Accreditation: ensure Sector-wide Quality Assurance System in Healthcare.

Forward thinking AGPMPN is embarking on Patient Safety and Quality Management Program

Accreditation standards will include Patient Safety Standards and Patient Safety Performance Goals

The Components of a Patient Safety Program

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Classification of Medical Errors- Near Miss

Near Miss is defined as an act could have harmed the patient but did not do so as a result of:

• Chance e.g. patient received a contraindicated drug but did not experience an adverse drug reaction

• Prevention e.g. a potentially lethal over-dose was prescribed, but a nurse identified the error before administering the medication

• Mitigation e.g., a lethal drug overdose was administered but discovered early and countered with an antidote.

Classification of Medical Errors- Adverse Events

Adverse Events cause harm to patients—causing a large number of injury, disability, and death.

Errors of Commission • Prescribing a medication that has a potentially fatal

interaction with another drug the patient is taking.

Errors of Omission • Failing to prescribe a medication from which the

patient would likely have benefited, which may pose an even greater threat to health.

Why Do Errors Occur—Some Obstacles

Workload fluctuations

Interruptions

Fatigue

Multi-tasking

Failure to follow up

Poor handoffs

Not following protocol & standard operating procedures

Poor Leadership

Breakdown in Communication

Breakdown in Teamwork Losing track of Objectives Excessive professional

courtesy Complacency High-risk phase Task (target) fixation

Healthcare System focused on Patient Safety

• Prevents Errors

• Learns From The Errors That Do Occur

• Is Built On A Culture Of Safety that Involves Health Care Professionals, Organizations, And Patients.

“Initiative based on evidence derived

from team performance…

leveraging more than 25 years

of research in military, aviation,

nuclear power, business and

industry…to acquire team competencies”

Team Strategies & Tools to Enhance Performance & Patient Safety

Quality Assurance ensures Safety by assessing:

Adverse Event Reporting

Patient Safety Culture

Leadership Support of Patient Safety

Adverse Event Analysis

Adverse Event Prevention

Communication and Feedback

Patient Involvement in Care

Environment of Care

Accreditation Standards

Hospital has a Patient Safety Program

Hospital Risk Management Program

Specific Prevention Programs

Transfusion Safety Program

Procedures for identifying Patients Correctly

Conducts Periodic Patient Safety Training

Effective Communication Techniques

Ensures Safety of High-Alert Medications

Accreditation Standards

Ensures Correct-Site, Correct-Procedure, Correct-Patient Surgery

Procedures for reducing Health Care–Associated Infections

Hand Hygiene Standards

Reduce Patient Harm Resulting from Falls

Conducts Risk Management & Infection Prevention for Healthcare Professionals

Hospital has Procedures for handling, storage, preparation & distribution of foodstuffs

Ensures Radiation Safety

Ensures Injection Safety

The AGPMPN Quality Program

Components of the AGPMPN Quality Program are :

• Patient Safety

• Staff Safety

• Quality Management

• Performance Excellence

Goals of The AGPMPN Quality Program

• First Professional Group to deploy an intensive Quality Management and Patient Safety Program across board

• Influence all Healthcare Professionals and Service Delivery in Nigeria.

• Build capacity for transformation across the entire AGPMPN Membership with Peer Monitoring and Performance Management.

• Become Point of reference in Health in Nigeria and Africa as a whole.

• Activate Paradigm Change in Nigerian Healthcare

Thank You