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Patient safety in a time of COVID-19

infant deaths. Image credit: Yuriy Klochan / 123rf
Image credit: Yuriy Klochan / 123rf

Patient safety is critical. When we are admitted to a medical facility, we expected to be cared for – not endangered. Yet it is an area where too often we fall short.

Today marks World Patient Safety Day – an observance which, to quote the World Health Organization (WHO), serves “to enhance global understanding of patient safety, increase public engagement in the safety of “health care” and promote global actions to enhance patient safety and reduce patient harm. The origin of the Day is firmly grounded in the fundamental principle of medicine – First, do no harm.” 

‘First, do no harm’ is enshrined into the Hippocratic Oath – one which medical practitioners have adopted for millennia and that acts as the foundation for medical ethics. In the contemporary context, the WHO defines patient safety as “a discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care. 

“A cornerstone of the discipline is continuous improvement based on learning from errors and adverse events. Patient safety is fundamental to delivering quality essential health services. Indeed, there is a clear consensus that quality health services across the world should be effective, safe and people-centred. 

“In addition, to realize the benefits of quality health care, health services must be timely, equitable, integrated and efficient. To ensure successful implementation of patient safety strategies; clear policies, leadership capacity, data to drive safety improvements, skilled health care professionals and effective involvement of patients in their care, are all needed.” 

The COVID-19 pandemic underscores the importance of patient safety. The transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or simply coronavirus – which causes COVID-19 – is a risk for all in any healthcare facility. As authors in The International Journal of Quality in Health Care outlined earlier this year, “the COVID-19 pandemic has suddenly challenged many healthcare systems. To respond to the crisis, these systems have had to reorganize instantly, with little time to reflect on the roles to assign to their patient safety (PS) and quality improvement (QI) experts. 

“In many cases, staff who had a background in clinical care was [sic] called to support wards and critical care. Others were deemed “non-essential” and sent back to work from home, while their programmes were placed in hibernation mode. This has meant that many QI and PS experts with skills to offer in their field have ended up carrying out tasks unrelated to the current crisis.” 

Those authors outlined “a five-step strategy and actions through which PS and QI staff can meaningfully contribute during a pandemic by employing their core skills to support patients, staff and [organisations]: [1] strengthen the system by assessing readiness, gathering evidence, setting up training, promoting staff safety and bolstering peer support. [2] Engage with citizens, patients and their families so that the solutions are jointly achieved and owned by both the healthcare providers and the people who receive care and in particular the citizens who are required to undertake preventive interventions. 

“[3] Work to improve care, through actions such as the separation of flows, flash workshops on teamwork and the development of clinical decision support. [4] Reduce harm by proactively managing risk to both COVID-19 and non-COVID-19 patients. [5] Boost and expand the learning system, to capture improvement opportunities, adjust very rapidly and develop resilience. 

“This is crucial as little is known about COVID-19 and its impacts on patients, staff and institutions.” 

In the Indian context, patient safety is a significant issue – one which the Union Ministry of Health and Family Welfare has sought to address through the National Patient Safety Implementation Framework (NPSIF). This Framework seeks to, as the Ministry describes, “[position] patient safety as [a] fundamental element of healthcare. NPSIF is intended to be adopted by both, public and private, sectors to address the various issues arising while providing qualitative healthcare services.”

In 2018, a survey found that 66 percent of respondents felt that “their safety was a priority during healthcare professional visits in India.” Of the remainder, 26 percent neither agreed nor disagreed. Eight percent disagreed. 

However, India’s healthcare system does carry some worrying ramifications for patients. Take hospital-acquired infections for example. As my colleague Nicholas Parry noted for Health Issues India last year, “hospitals, by nature of their function, are hotbeds of infectious disease. It is no wonder then that hospital-acquired infections (HAIs) are such a common phenomenon.” He cited Dr Victor D Rosenthal, founder and chairman of the International Nosocomial Infection Control Consortium (INICC), who told Express Healthcare journalist Prathiba Raju that such infections “infections are further leading to morbidity, mortality and increased financial burden among patients.” 

It is imperative that steps are taken to fortify patient safety, both in India and globally. This is especially true of the developing world. The WHO estimates that “134 million adverse events occur in hospitals in low- and middle-income countries (LMICs), due to unsafe care, resulting in 2.6 million deaths.” World Patient Safety Day this year functions as a reminder of the need for medical attention and healthcare practitioners to be the remedy of human suffering – not the cause.

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