Enhancing Patient Safety in

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Enhancing Patient Safety in The Eastern
Mediterranean Region of Making Health Care Safer
Ahmed A. Abdullatif, Coordinator,
Health Systems Regional Adviser, Health Care
Delivery WHO/EMRO
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Introducing the big picture of PS
Magnitude EMRO/WHO Initiatives with Member
States World Alliance for Patient
Safety Regional Organizations
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Patient Safety How care should be
properly delivered.
Patient Safety FREEDOM from
Unintended Health Care Errors / Injuries due to
Medical Management.
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Some Examples of Harm ( Adverse Events) .
Hospital incurred patient injury . Adverse drug
reaction . Development of neurological
deficit not present on admission . Unexpected
death (not an outcome of this disease) .
Cardiac/respiratory arrest, low Apgar score .
Injury related to abortion or delivery .
Hospital acquired infection/sepsis Lack of
CommunicationWrong / Delayed Procedure
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• What ERRORS are Users/ Patients exposed to ?
• I. Products/ Technology
• Drugs Reactions. Failures
• Devices Injections (75 of 2 Billions
  Unsterilised ) Machines ( Dialysis)
• Biological Blood
• II. Services Health/medical practices
• Inpatient HAI,, MM, wrong surgery
• Inpatient Outpatient... (HH lt40 )
• non- personal services Communication Longer
  stay
• III. Environment of care
• waste management (50)

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Health Care Errors cause Harm

• Patient harm 10 admissions
• Ranges from Serious. ..Minor
• Death and serious disability in 20
• Costly 5-10 of health expenditure (ReR,
  ALOS.)
• Good News!
• Potentially preventable in 50-80 of cases

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Range of health care errors

Sentinel event Serious incident
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Harm
Minor incident
Near miss Could have caused harm but it did not
this time
1 29 300
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Patient Safety A Public
Health Problem EVERYWHERE
10 of Admissions in Developed
Systems With variable degree of harm
gtgtMillions
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The message

• 10
• of 22.2 Millions of Inpatients
• In 11 of our countries!

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16 thousand million injections misuse and
overuse of injections worldwide
Example of Devices
95 Curative injections 3-10 Immunizations 1
Injectable contraceptives 1 Blood and blood
products
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Proportion of New HCV Infections Attributable to
Unsafe Injections Worldwide, 2000
Attrib. Fraction
0-4 5-9 10-19 20-29 30-49 50-74 75-100

Note estimates represent averages for each
region, not specific estimates for individual
countries
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Patient Safety as a Public Health RiskA problem
Everywhere
The Relative RISK Deaths Per 100 Million
Hours Being pregnant
1 Traveling by train
5 Working at home
8 Being in traffic
50 Flying on a commercial airplane 100
Being hospitalized
2000
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Why H C Errors happen SYSTEM Barriers Failures
When we should worry about Safe Practice? Always
But More where
In Developing Countries

• Organizational skill mix, time, outdated
  training
• EBP standards ,protocols
• poor technical design of medical equipment and
  packaging.
• Weak safety culture Denial BLAME
• Ineffective Communication

• The poor state of INFRASTRUCTURE (including HRH)
• Severe Under Financing
• WHO figures suggest that developing countries
  account for
• Around 77 of all reported cases of counterfeit
  and substandard drugs.
• At least 50 of all medical equipment in most of
  these countries is unusable, or only partly
  usable,
• In a quick survey Alarming results
• post operative infection among cardiac surgery
  reached 60
• 50 of deaths in Emergency Cases are due to
  Improper Case Management

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What we in WHO/EMRO Did?A long way to go.. But
started with

• Integrating PS Hospital Accreditation
  Guidelines 02
• QUESTIONNAIRE MOH FACILITY
• STANDARDS Joint WHO/AL Facility Accreditation 04
• CONSENSUS FRAMEWORK Regional Patient Safety
• GUIDELINES / SOPs of major health problems
• CAPACITY BUILDING Training Packages (2005)
• Patient Safety Friendly Hospital Initiative (
  PSFHI)
• PARTNERSHIP
• World Alliance for Patient Safety
• Patient Safety Centre (2004)
• Joint WHO/AL Facility Accreditation 04
• GCC Glossary for PS
• Countries Joint Programming 07-08
• On going safe injections, safe blood, safe
  motherhood,

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5 Axes to enhance the safety of patients
EMR Strategy
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Open account from 4 perspectives
Populations
Organization
Profession
Patient

• Structure

• Process

• Result

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Twenty Seven Hospitals in EMR are undertaking a
research on PS following these steps Nurses
Physicians are working together to assess
Frequency Type of AE
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The message

• 10
• of 22.2 Millions of Inpatients
• In 11 of our countries!
• NOT FIGURES
• BUT PEOPLE