First do no harm: Patient safety needs to be a public health issue

  • Wellness
  • Monday, 16 Apr 2018

WHO has reported a poor safety record for healthcare, with a one-in-300 chance of a patient being harmed during healthcare, compared to a one-in-a-million chance of being harmed while in an aircraft. - AFP

Public Health is a discipline in Medicine, like Obstetrics and Gynaecology, Surgery and Internal Medicine.

There is more than one definition of Public Health. A commonly used one is “the art and science of preventing disease, prolonging life and promoting health through the organised efforts of society” (Acheson, 1988; World Health Organization [WHO]).

Public health focuses on the entire spectrum of health and wellbeing, and not only the eradication of particular diseases.

Whilst healthcare facilities are crucial in helping and supporting the sick, Public Health contributes to the reduction of the causes of ill-health and improvement of the population’s health and wellbeing.

Many communicable diseases have been eradicated or controlled globally through Public Health measures, which include health protection from environmental threats like mosquito-borne diseases or food poisoning; health improvement such as smoking cessation; and ensuring healthcare services are effective, efficient and accessible.

Hazards of healthcare

Three landmark studies in the United States, United Kingdom and Australia in the 1990s alerted the healthcare professions to the hazards of healthcare.

This was summed up by Cyril Chantler’s statement in 1998: “Medicine used to be simple, ineffective, and relatively safe. It is now complex, effective, and potentially dangerous.”

Medical error has been defined as an act of omission or commission in planning or execution that contributes or could contribute to an unintended outcome; the failure of a planned action to be completed as intended (error of execution); the use of a wrong plan to achieve an aim (error of planning); or a deviation from the process of care that may or may not cause harm to the patient.

The role of error in healthcare is complex. Many errors are non-consequential, but some lead to harm to the patient.

The WHO’s facts on patient safety are:

  • One in 10 patients may be harmed while in hospital.
  • Hospital infections affect 14 out of every 100 patients admitted.
  • Most people lack access to appropriate medical devices.
  • Unsafe injections decreased by 88% from 2000 to 2010.
  • Delivery of safe surgery requires a teamwork approach.
  • About 20%-40% of all health spending is wasted due to poor-quality care.
  • A poor safety record for healthcare, with a one-in-a-million chance of being harmed while in an aircraft compared to a one-in-300 chance of a patient being harmed during healthcare.
  • Patient and community engagement and empowerment are key.
  • Hospital partnerships can play a critical role.

Medical errors have been estimated to be the third leading cause of death in the US.

The data in developed economies is not very different.

There is no data of medical errors in Malaysia. However, the voluntary incident reporting by 120 hospitals of the Health Ministry in 2017, provides some clues.

The top five incidents that resulted in severe harm were patient falls (191 incidents); medication error (86 incidents); adverse outcome of clinical procedure (62 incidents); dislodgement of catheter (46 incidents); and injury to neonate (39 incidents). (Source: Accessed Apr 3.)

Deaths do not tell the whole story about medical errors.

Preventable adverse events in hospitals have also resulted in serious harm, such as requirement for additional procedures and/or resuscitation; extended hospitalisation; and permanent disability.

Whilst the data from clinics and pharmacies is sparse, it would be very brave for anyone to claim that they do not have any preventable adverse events.

That there is a serious problem is reflected in the number of medical negligence claims, settlements, court awards, and complaints to healthcare facilities, regulators and media.

It is clear that the current data about the harm from healthcare is just the tip of a large iceberg.

Going forward

Healthcare-associated harm impacts on the affected individual and family. That it is a public heath issue has been recognised by the WHO, which launched its Patient Safety Programme back in 2004.

Currently, adverse events due to medical errors are not measured in an organised manner.

Discussions about its causes and prevention are limited and confidential, involving management and selected clinicians.

The lessons learnt are usually not disseminated beyond the department or healthcare facility.

Regardless of its exact toll, harm to patients is inarguably among the most pressing of public health issues, and it must be treated as such.

The question is, what actions are being taken by policymakers and healthcare providers.

Human error is a fact of life as no one is perfect. Although human error cannot be eliminated altogether, there is much scope for improvement in the design of healthcare systems to reduce the frequency, visibility and consequences of medical error.

The strategies taken by an increasing number of countries are by making medical errors more visible when they occur so that early intervention(s) can prevent or mitigate their effects; and by reducing the frequency of errors through adherence to principles that take into account human limitations.

The Public Health discipline has contributed much to one aspect of patient harm prevention – infection control.

The tools and techniques of Public Health, such as epidemiology and application of social and behavioural science to healthcare have much to offer to Patient Safety. Would policymakers consider applying Public Health tools to Patient Safety?

What can patients and their families do? For a start, they can ask questions of the healthcare facilities, particularly hospitals, doctors and nurses.

For example, what are the existing patient safety measures in the healthcare facility? Are surgical and maternity check lists used?

What measures are in place to reduce medication errors and healthcare-acquired infections?

They can also ask doctors and nurses if and why they do not wash their hands before and after examining a patient.

Medical errors cannot be totally eliminated, but they can be reduced considerably.

It requires effort from policymakers, healthcare providers, patients and their families. The role of policymakers in this public issue is particularly crucial.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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