Preventable adverse events in healthcare: Issues and solutions
According to the World Health Organization (WHO), the risk of being harmed during healthcare is much greater than the risk of being harmed by air travel or nuclear plants, sources usually perceived as being of much greater risk. The chance of being harmed in an aircraft is 1 in 1,000,000, whereas in healthcare it is 1 in 300. This number is an average based on the incidence of adverse events worldwide. It is important to stress that there are differences between developed and developing countries; in fact, the risk can be 20 times higher in developing countries.
Patients can be harmed by, for example, transfusion errors, adverse drug events, wrong-site surgery, surgical injuries, preventable suicides, treatment-related infections, falls, burns or even mistaken identity. While adverse events are relatively rare, the majority of them are preventable. Does this mean that our healthcare systems are unsafe? Where do adverse events occur: is it only in hospitals? What is being done about this problem, and what can we do to improve the situation?
In order to make patient safety a public health priority for governments, the WHO launched a patient safety program in 2004 with the objective of improving safety and quality of care. To achieve high quality in healthcare systems, a patient must receive the treatment that gives the best health results based on the current state of scientific knowledge. While each healthcare professional has a different perception of what constitutes quality care, they all agree that responding to the patient’s needs by taking care of him or her in the “perfect” way is essential. Reaching this level of quality requires optimized procedures and processes to avoid preventable adverse events.
Solutions presented in this topic of the month
One possible approach to decreasing the number of preventable adverse events is to improve technology so that healthcare professionals can better carry out their daily activities. Recent advances include the use of bar codes in administering medications, software to help in decision making and radio-frequency tags on sponges to ensure they are not left inside the patient during surgery. The disadvantage with this approach is that when a new technology is introduced, users have to go through a learning process and may find it difficult to adapt to the new technology. Furthermore, the availability of such technologies does not mean that vigilance can be lowered. In the case of the bar code system for administering medications, the nurse is still responsible for what medication is ultimately administered to the patient. And if an error was made at the beginning of the process, the bar code system will not prevent an adverse event.
Can technology resolve all of the problems that cause high rates of adverse events? In fact, different solutions may be needed depending on the origin of the problem. Some institutions have implemented programs that address the problem at the organizational level. The WHO, in collaboration with experts, has created the Surgical Safety Checklist for use in the operating room. This checklist is a useful tool for confirming the identity of the patient, the procedure to be performed and the issues to be considered during the surgery. In this case, changing attitudes and communication procedures can reduce the number of preventable adverse events. And this raises the important question: Which is more efficient – using costly high technology that may require a difficult adaptation process for its users, or using low-cost innovations such as checklists?
Patients are concerned about adverse events for they are the ones directly affected. When they have been harmed, they often feel entitled to some form of compensation. Some will even take legal action against the healthcare professional and/or institution involved. However, healthcare professionals and institutions are usually protected by law under such circumstances. It is a long, hard battle for a patient to receive compensation, and a decision in their favour is far from certain. So when the adverse event is the result of an institutional problem, where should a patient turn for compensation or reparation? Would a government no-fault compensation system be helpful? Another issue of concern is what patients say is a lack of recognition and apology from the healthcare institution when they suffer an adverse event, and the lack of information they receive when an unexpected event happens. Why are institutions so reluctant to inform patients and their families? Would this not be the best first step to improving the situation?
This month, Hinnovic presents various issues related to adverse events, from the importance of improving quality in healthcare to the development of technologies and strategies aimed at limiting the number of preventable accidents. We also touch on the legal side with the presentation of an outline for a government no-fault compensation system.
|Author :||Pauline Boinot, M.Sc.|
Institute of Medicine (2000) To Err Is Human: Building a Safer Health System. Washington D.C., National Academy Press.
Runciman W., Hibbert P., Thomson R., Van Der Schaaf T., Sherman H., Lewalle P. (2009) Towards an international classification for patient safety: Key concepts and terms. International Journal for Quality in Health Care, 21(1): 18-26.