Building, promoting, and institutionalizing patient safety from theory to practice was the core theme of the 2nd Patient Safety Congress held on March 28-29, 2019 that tackled the framework, principles, elements, implications, problems, and other issues.
A collaboration among the UP Manila College of Medicine (CM), College of Nursing and College of Pharmacy, the conference’s theme reflected the complexity and challenging nature of patient safety as a system and culture.
The conference included expert inputs and case studies with interactive discussions and research presentations, including best practices and innovative strategies in different settings on different sub-themes. It followed the first congress that gave an overview on patient safety and posed a challenge to actively start safety initiatives in healthcare institutions and across healthcare professionals and advocates.
“This partnership reflects the nature of patient safety that is preventable harm in health care that requires a coordinated team approach among doctors, nurses, pharmacists, administrators, relevant stakeholders, and even officials,” stressed CM Dean Charlotte Chiong.
Dean Chiong pointed out that the Tokyo Declaration on Patient Safety dated 14 April 2018 strengthens the 2002 World Health Assembly Resolution reaffirming the commitment to improving patient safety globally in order to reduce all avoidable harm and risk of harm to all patients during their interaction with the healthcare systems by 2030. The declaration recognizes among others that patient safety is one of the most important components of healthcare delivery which is essential to achieve universal health coverage.
“The theme of this event is timely as we have recently made significant strides in passing landmark health laws that seek to improve access of our countrymen to quality health care services. The challenge for all of us now in the health sector is to translate these laws into more tangible reforms and programs that can positively impact our citizens,” stated Senator Risa Hontiveros in her message delivered by Dr. Joseph Anthony Lachica, Consultant for Health Policy and Public Health.
Principles and elements
“Patient safety is the cornerstone of high quality health care,” Philippine Academy of Family Physicians National Director Dr. Limuel Abrogena quoted Mitchell in an article entitled “Defining Patient Safety and Quality Care” in Patient Safety and Quality: An Evidence-Based Handbook for Nurses: Vol 1. The fundamental principles for patient safety, according to Dr. Abrogena, are patient engagement at all levels of health care provision; a just and trusting culture; respectful, transparent relationships between and among those who deliver and those who receive healthcare; recognition that health care providers work in a complex system; appropriate responsibility and accountability at all levels of the healthcare system; and continuous learning and improvement.
In her lecture entitled “Building a Strong Team: Teamwork and Communication Strategies for Patient Safety,” Dr. Lynn Panganiban, professor at the UPCM, mentioned the following driving factors toward establishing a patient safety culture: leadership, evidence-based practice, teamwork, communication, learning culture, just culture, and patientcentered culture. Citing a study by Dingley C, et al in 2008, she mentioned that in the acute care setting, communication failures lead to increases in patient harm, length of stay, and resource use, as well as more intense caregiver dissatisfaction and more rapid turnover in multi-site studies of intensive care units, poor collaborative communication among nurses and physicians, among other specific factors contributed to as much as a 1.8% fold increase in patient risk-adjusted mortality and length of stay.
Ensuring patient safety, for UPCN nursing professor Jenniffer Paguio, entails examining the professional practice and work environments of health professionals, of which 60-80% are nurses, under a context-specific lens that covers the structures and processes vis-à-vis patient, provider, and health care organization outcomes. It also demands developing long-term solutions and strategies to address health human resource limitations and growing healthcare demands and exploring innovations at the hospital and unit levels.
“Temporary measures will increase burnout and push professionals away. We need to work things in a complementary way. We need to focus not only on the physical problems but also on how workloads are being addressed. Task shifting is common in the Philippines. We have an existing nurse patient ratio of 1:22 patients in general wards and 1:8 in Intensive Care Units and a ratio of 1 physician for every 3 wards and of one pharmacist for every 1 hospital. We need opportunities for professional training, development and career advancement,” the patient safety advocate urged.
Affirming Cook, Gaynor, Stephens and Taylor’s findings in 2012 that “staffing improvements alone was found to be inadequate in improving patient safety but needs to be complemented with other approaches,” Paguio found in her study of tertiary and referral hospitals that in one government hospital, 15% of nurses are on job order and contractual status, 1 in 3 frontline nurses earns less than 15,000 a month, nurses engaged in an average of 3 continuing professional development activities per year, 30% of nurses plan to leave their units, hospitals and the country in the next six months, and that leadership and management support is the lowest rated dimension of the nurse work environment.
Meanwhile, UP Manila Vice Chancellor for Research Dr. Armand Crisostomo explained that patient safety is a complex, multifaceted goal that demands a multipronged approach. These approaches emphasize the importance of healthcare provider education to reduce inadvertent errors, as well as the importance of patients’ expectations, perceptions and engagement.
“For many reasons, concern about the quality and safety of patient care is reaching new heights both locally and globally,” said Dr. Crisostomo. He urged that patient safety education be done as early as the undergraduate level as what some countries do in conducting patient safety education while students are still in medical school.
In her lecture on Innovations in Patient Safety Education: Best Practices, Dr. Marishiel MejiaSamonte emphasized the importance of teamwork and bedside rounds activities such as skills development for learners; observation and feedback; role modelling; team building among trainees, attending physicians and patients; improved patient care delivery through combined clinical decision-making and team consensus; and culture of medicine as a patient-centered care.
She also stressed the importance of optimizing digital technology and use of simulators to create a learning environment with a culture of patient safety and of care actors to provide opportunities to learn specific skills prior to actual patient contact.
Issues and problems
Dr. Abrogena cited the following as top patient safety issues in 2018: disparate electronic health records, hand hygiene, nurse-patient ratio, drug and medical supply shortages, quality reporting, resurgent diseases, mergers and acquisitions, physician burnout, antibiotic resistance, and opioid epidemic.
In addition, he identified the items below as the common contributing factors to patient harm which are categorized into medical/ clinical complexity that includes multiple medications, complex medical conditions, and frailties; systems failures and processes that cover poor communication, lack of coordination, unclear lines of authority, drug names that look or sound alike, environment and design factors, infrastructure failure, reliance on automated systems, and fragmented reporting; and human factors such as variations in the training and experience of health professionals, inadequate training, fatigue, depression and burnout, and failure to acknowledge harm.
Cynthia M. Villamor and Charmaine Lingdas
Published in UP Manila Healthscape No. 373 (March – Apil 2019)
