A global challenge to reduce harm and save lives

Implementation and Scale Up of Patient Safety Progr ams

Dr Itziar Larizgoitia

WHO Patient Safety ProgrammeSymposium Einstein- IHI 2013

The burden of unsafe care is widespread and higher than expected

Patient Safety: A global challenge

• 42.7 million adverse events. These adverse events result in 23 million DALYs lost per year.

• Approximately two-thirds of all adverse events, and the DALYs lost from them, occurred in low income and middle-income countries

• Given the magnitude of these effects, findings suggest that to improve the health of the world’s citizens, we will need to improve access to care and also to invest substantial focus on improving the safety of the healthcare systems that people access worldwide

Jha AK, et al. BMJ Qual Saf 2013;22:809–815.

Global resources devoted to patient safety should be concentrated in LMICs, where the burden is greatest

Jha AK, et al. BMJ Qual Saf 2013;22:809–815.

Deaths associated to preventable harm…………………………..210 000

John T. James, J Patient Saf 2013;9: 122Y128

Healthcare can not be dissociated from interventions to improve its safety

** Incidence

Average in Europe: 7.1% patients ECDC, Comm Dis Report 2008

Prevalence of HAI in developed countries

Prevalence of Healthcare Associated Infections in transitional & developing countries

Pooled prevalence 15.5% patients Lancet, 2011; 377: 228–41

Unsafe injection practices: A plague of many health systems

■ Over-prescription of injections• In some situations, 9 out of 10 patients presenting to a primary healthcare provider receive an injection, over 70% of which are unnecessary or could be substituted by oral medications

■ Reuse of syringes and needles in the absence of sterilization exposes millions of people to infections

■ Each year unsafe injections cause an

estimated 1.3 million early deaths , a loss of 26 million years of

life, and an annual burden of USD 535 million in direct medical costs.

IBEAS: A study on 5 Latin-American Countries.

And, 2 out 10 suffered an incident during their hospital

stay

On average, on the day of the survey, 1 in 10 inpat ients showed the consequences of a patient safety inciden t

Death

Permanent Disability

Low Disability Moderate Disability

Argentina

PerúColombia

Costa Rica

México

Universal health coverage is our new priority

“I regard universal health coverage as the single most powerful concept that public health has to offer. It is inclusive. It unifies services and delivers them in a comprehensive and integrated way, based on primary health care"

Dr Margaret Chan, WHO Director-General

WHO's call for Universal Health Coverage

"To free the world from extreme poverty by 2030, countries must ensure that all their citizens have access to quality,

affordable health services"Margaret Chan, WHO Director General

Expanding access to healthcare should be accompanied by activities in quality and patient safety improvement.

Areas of intervention

Putting safety on the world's agenda

First Global Patient Safety Challenge Clean Care is Safer Care

WHO Guidelines for Hand Hygiene in Health Care

WHO Surgical Safety Checklist

Safe Surgery Saves Lives

Fostering a global patient-led movement to encourage partnership, promote empowerment and inspire action on patient safety around the world.

Effective solutions imply tackling the latent organizational weaknesses and failures

The burden of unsafe care: Global Priority areas

■ Counterfeit and substandard drugs

■ Problems with communication and coordination

■ Latent organizational failures

■ Inadequate competence, training and skills

■ Maternal and New Born Care

■ Unsafe Injection and Blood Practices

■ Poor Safety Culture

■ Lack of Human Factors design

■ Misdiagnosis

■ Insufficient cost-effective risk-reduction strategies

Improving patient safety through effective interventions

■ By Creating and Sustaining a Culture of Safety

■ Through Informed Consent, Life-Sustaining Treatment, Disclosure, and Care of the Caregiver

■ By Matching Healthcare Needs with Service Delivery Capability

■ By Facilitating Information Transfer and Clear Communication

■ Through Medication Management

■ Through the Prevention of Healthcare-Associated Infections

■ Through Condition- and Site-Specific Practices

■ Opportunities for Patient and Family Involvement

Safe Practices for Better Healthcare–2010 Update: A Consensus Report - National Quality Forum

Expand Education of the workforce

WHO Patient Safety Curriculum GuideMulti-professional edition

Curso online: Introdução à investigação sobre segur ança do paciente/doente – The sessions

� Sessão 1 : Segurança do Paciente/Doente, o que é? , Claudia Travassos, 1°de março de 2012

� Sessão 2 : Princípios da investigação em segurança do paciente/doente , Mônica Martins , 8 de março de 2012

� Sessão 3 : Medir o dano , Walter Mendes, 15 de março de 2012

� Sessão 4 : Compreender as causas , Walter Mendes,22 de março de 2012

� Sessão 5 : Identificar as soluções / Implementação , Maria João Lage, 19 de abril de 2012

� Sessão 6 : Avaliar o impacto , Paulo Sousa , 26 de abril de 2012

� Sessão 7 : Transpor a evidência em cuidados mais seguros , José Fragata, 3 de maio de 2012

� Sessão 8 : Aprofundar o conhecimento em segurança do paciente ,Paulo Sousa, 10 de maio 2012

Engaging professionals and engineering systems for safety

Launch of a Global Campaign on Medication Safety

The 3rd Global Challenge on Patient Safety

2014-2015

Safe Injections Campaign� Behaviour change strategies to reduce overuse of injections

� Implementation of a sound sharps waste management option to prevent scavenging and reuse of syringes

� Continuous availability of safety engineered injection devices to prevent reuse and stick injuries

Addressing the challenges of implementation

Challenges to implementation: no magic bullet

■ Consistent use, of interventions are not straightforward in any setting. It may be more difficult in low-income countries

■ Resources and changes to clinical systems may be needed to secure compliance

■ Wrong implementation may cause additional unintended risks in low-income settings

Emma-Louise Aveling, Peter McCulloch, Mary Dixon-Woods. BMJOpen 2013;3:e003039.

Eliminating Bacteremia in ICU's

• Educate

• Engage

• Execute

• Evaluate

1. Adequate Hand Hygiene2. Skin disinfection with clorhexidine

3. Extreme hygiene barriers in insertion 4. Removal of unnecessary lines5. Hygienic maintenance of lines

1. Assess patient safety culture2. Training in patient safety principles

3. Identify falleres in standard practice4. Set up alliances with management

5. Learn from mistakes

STOP-BACTERAEMIA

Comprehensive Safety ICU programme

32

Palomar et al Critical Care Medicine DOI: 10.1097/CCM.0b013e3182923622

Major discriminant factor:understanding of patient safety principles and tool s

Those who shared the principles of patient safety, were sensitive to their leadership, team work and e ngagement

Patient safety culture is the single most relevant condition for successful implementation

Implementation

■ Culture

■ Leadership at all levels, including authorities for successful scale up

■ Educate

■ Engage professionals and teams: foster team building and integration

■ Execute: Fixing the system, engineering processes for safety

■ Evaluate and provide feedback

WHO invites Member States, healthcare professionals, academics, patients and citizens to:

- Foster the patient safety culture

- Adopt effective solutions

- Roll out commitment & engagement

To achieve Universal Health Coverage of

safe and quality care

Thank you

www.who.int/patientsafety/en