Patient safety

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Patient safety is a discipline that emphasizes safety in health care through prevention, reduction, reporting, and analysis of medical errors that often cause adverse effects. The frequency and magnitude of the patient's avoidable side effects were not well known until the 1990s, when some countries reported a surprising number of patients who had been harmed and killed by medical errors. Recognizing that health mistakes affect 1 in every 10 patients worldwide, the World Health Organization calls patient safety an endemic concern. Indeed, patient safety has emerged as a different health discipline supported by an underdeveloped yet undeveloped scientific framework. There is a significant transdisciplinary body of theoretical and research literature that informs patient safety science. The resulting patient safety knowledge continuously informs improvement efforts such as: applying lessons learned from business and industry, adopting innovative technology, educating providers and consumers, improving error reporting systems, and developing new economic incentives.

Video Patient safety

Prevalence of side effects

Millennia then, Hippocrates acknowledged the potential injury that arose from the actions of a well-meaning healer. The Greek physician of the 4th century BC composed the Hippocratic Oath and promised to "prescribe the regimen for the good of my patients according to my abilities and my judgment and never hurt anyone." Since then, the direction of primum non nocere ("first no harm") has been a central principle for contemporary medicine, but despite the increasing emphasis on the scientific basis of medical practice in Europe and the United States at the end of the century 19, data on adverse outcomes is difficult to obtain and the various studies assigned to collect most of the anecdotal events.

In the United States, the public and medical anesthetist specialists were shocked in April 1982 by the ABC 20/20 television program entitled "The Deep Sleep". Presenting an anesthesia accident account, the producers stated that, every year, 6,000 Americans die or suffer brain damage associated with this accident. In 1983, the British Royal Society of Medicine and Harvard Medical School jointly sponsored the symposium on death and anesthetic injuries, resulting in an agreement to share statistics and to conduct research. In 1984, the American Society of Anesthesiologists (ASA) established the Anesthesia Patient Safety Foundation (APSF). The APSF marks the first use of the term "patient safety" on behalf of a professional review organization. Although an anesthesiologist consists of only about 5% of doctors in the United States, anesthesiology becomes a leading medical specialist dealing with patient safety issues. Similarly in Australia, the Australian Patient Safety Foundation was established in 1989 for monitoring anesthesia errors. Both organizations were soon expanded due to the magnitude of the medical error crisis known.

For Err is Human

In the United States, the full magnitude and impact of errors in health care were not appreciated until the 1990s, when some reports brought attention to this issue. In 1999, the Institute of Medicine (IOM) of the National Academy of Sciences released a report, For Err is Human: Building a Safer Health System . IOM is calling for broad national efforts to include the establishment of a Patient Safety Center, expanding the reporting of adverse events, the development of safety programs in health care organizations, and the attention of regulators, health care buyers, and professional societies. Most media attention, however, focuses on staggering statistics: from 44,000 to 98,000 preventable deaths annually due to medical errors in the hospital, 7,000 preventable deaths are associated with medication errors alone. Within two weeks of the release of the report, Congress initiated hearings and President Clinton ordered a broad government study on the feasibility of implementing the report's recommendations. The initial criticism of the methodology in IOM's estimates focuses on statistical methods to reinforce low incidence rates in pilot studies for the general population. However, subsequent reports emphasize the prevalence of conspicuous and consequent medical errors.

His experience is similar in other countries.

• Ten years after innovative Australian research reveals 18,000 annual deaths from medical errors, Professor Bill Runciman, co-author of the research and president of the Australian Patient Safety Foundation since its inception in 1989, reported himself as a victim of a medical dose.
• The Health Department's Expert Group in June 2000 estimated that more than 850,000 incidents endanger the patients of the National Health Service hospital in the UK each year. An average of forty incidents each year contributes to the death of patients in every NHS institution.
• In 2004, the Canadian Adverse Events Study found that adverse events occurred in more than 7% of hospitalized admissions, and estimated that 9,000 to 24,000 Canadians die each year after avoidable medical errors.
• These and other reports from New Zealand, Denmark and developing countries have led the World Health Organization to estimate that one in ten people receiving health care will suffer preventable hazards.

Maps Patient safety

Communications

Effective communication is essential to ensure patient safety. Communicating begins with the provision of information available on any operational site, especially in mobile professional services. Communicate continuously with reduced administrative burden, release operating staff and reduce operational demand by model-based orders, enabling compliance with well executed procedures with minimum eligible feedback.

Effective and ineffective communication

The use of effective communication between patients and health care professionals is essential to achieve optimal patient health outcomes. However, according to the Canadian Patient Safety Institute, ineffective communication has the opposite effect because it can cause harm to the patient. Communication related to patient safety can be classified into two categories: prevention of side effects and response to adverse events. The use of effective communication can help in the prevention of adverse events, whereas ineffective communication may contribute to this incident. If ineffective communication contributes to adverse events, better and more effective communication skills should be applied in response to achieve optimal results for patient safety. There are various modes in which health professionals can work to optimize patient safety covering verbal and nonverbal communication, as well as effective use of appropriate communication technology.

Effective verbal and nonverbal communication methods include caring for patients with respect and empathy showing, clearly communicating with patients in ways that best suit their needs, practicing active listening skills, being sensitive to cultural diversity and respecting privacy and secrecy rights from patient. To use appropriate communication technology, health care professionals should choose which communication channel is best suited to benefit patients. Some channels are more likely to generate communication errors than others, such as communicating by phone or email (missing nonverbal messages that are important elements in understanding the situation). It is also the provider's responsibility to know the advantages and limitations of using electronic health records, as they do not convey all the information needed to understand the patient's needs. If a health care professional does not practice these skills, they do not become effective communicators that can affect patient outcomes.

The goal of a healthcare professional is to assist patients in achieving their optimal health outcomes, which means that patient safety is not at risk. Effective communication practice plays a major role in promoting and protecting patient safety.

Teamwork and communication

During complex situations, communication between healthcare professionals should be at its best. There are several techniques, tools, and strategies used to improve communication. Each team must have clear goals and each member should be aware of their role and be involved accordingly. To improve the quality of communication between the people involved, regular feedback should be provided. Strategies such as briefings allow teams to set their goals and ensure that members share not only the goals but also the processes they will follow to achieve them. Briefing reduces interruptions, prevents delays and builds stronger relationships, resulting in a strong patient safety environment.

Debriefing is another useful strategy. Healthcare providers meet to discuss the situation, record what they learn and discuss how it is handled better. Closed-loop communication is another important technique used to ensure that messages sent are received and interpreted by the recipient. SBAR is a structured system designed to help team members communicate about patients in the most convenient form. Communication between healthcare professionals not only helps achieve the best outcome for patients but also prevents any unseen incidents.

Safety culture

As in other industries, when errors or mistakes make people search for someone to blame. It may seem natural, but it creates a blame culture where anyone is more important than why or how . A just culture , also sometimes known as not blaming or incorrect , attempts to understand the root cause of the incident rather than just the involved..

In health care, there is a movement towards a patient safety culture. It applies lessons learned from other industries, such as aviation, marine, and industry, to health care settings.

When assessing and analyzing an incident, the individuals involved are much more likely to come up with their own mistakes if they know that their work is not at risk. This allows a much more complete and clear picture to be formed from the facts of an event. From there, root cause analysis of the problem can occur. There are often several causative factors involved in adverse events or near miss. Only after all contributing factors have been identified that effective change can be made that will prevent similar incidents from occurring.

Incident disclosure

After a bad event occurs, each country has its own way of handling the incident. In Canada, quality improvement reviews are mainly used. A review of quality improvement is a completed evaluation after a bad incident occurred in order to fix the problem, and prevent it from happening again. Each province and region have laws on whether to disclose quality improvement reviews to patients. Health care providers have an obligation to disclose any adverse events to their patients due to ethical and professional guidelines. If more providers participate in quality improvement reviews, it can improve interdisciplinary collaboration and can maintain relationships between departments and staff. In the US, clinical college reviews are used: medical staff not involved in reviewing events and trying to prevent further incidents.

Disclosure of side effects is important in maintaining trust in the relationship between health care providers and patients. It is also important in learning how to avoid these mistakes in the future by conducting quality improvement reviews, or peer-reviewed reviews. If the provider accurately handles the event, and discloses it to the patient and his family, he can avoid punishment, including lawsuits, fines, and suspensions.

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Causes of a health service error

The simplest definition of health care errors is the preventable side effects of treatment, whether or not it is clear or harmful to the patient. Errors are partly due to:

Human Factors

• Variations in training of health & amp; experience, fatigue, depression, and fatigue.
• Various patients, unknown settings, time pressure.
• Failure to acknowledge the prevalence and seriousness of medical errors.
• Increase nurse work hours

Medical complexity

• Complex technology, powerful medicine.
• Intensive care, hospitalization of the old hospital.

System failure

• Poor communication, unclear lines of authority from doctors, nurses, and other care providers.
Increased complications as the patient improves the ratio of nursing staff.
• The hospital's disconnected reporting system: a fragmented system in which so many patients result in lack of coordination and error.
• Similar or similar drug names.
• The impression that action is taken by another group within the institution.
• Automatic system dependency to prevent errors.
• Insufficient systems for sharing information about errors prevent concomitant causes analysis and improvement strategies.
• Cost-cutting measures by the hospital in response to cost-cutting costs.
• Environmental and design factors. In an emergency, patient care may be provided in areas not suitable for safe monitoring. The American Institute of Architects has identified concerns for the safe design and construction of health care facilities.
• Failure of infrastructure. According to WHO, 50% of medical equipment in developing countries can only be used in part due to lack of operators or skilled parts. As a result, diagnostic procedures or treatments can not be performed, leading to sub-standard care.

The 2007 Joint Commission's Annual Report on Quality and Security found that inadequate communication between healthcare providers, or between service providers and patients and family members, is the root cause of more than half of serious adverse events in accredited hospitals. Other major causes include inadequate assessment of the patient's condition, and poor leadership or training.

According to a study by RAND Health, the US health care system can save more than $ 81 billion annually, reduce adverse health activities, and improve the quality of care if HIT technology is widely adopted. The most rapid barrier to widespread adoption of technology is cost even though patients benefit from better health, and payers benefit from lower costs. However, hospitals pay higher fees for implementation and lower income potential (depending on replacement schemes) due to reduced length of stay. The benefits provided by technological innovation also pose serious problems with the introduction of new and invisible types of errors.

Type of health care technology

Handwritten reports or notes, manual order entries, non-standard abbreviations, and poor readability result in substantial errors and injuries, according to IOM (2000). The IOM follow-up report, Crossing the Quality Gap: The New Health System for the 21st Century , advises the rapid adoption of electronic patient records, electronic drug reservations, with computer-based information systems and the Internet to support clinical decisions. This section only contains aspects related to patient safety from HIT.

Electronic Health Record (EHR)

Electronic health records (EHR), formerly known as electronic medical records (EMR), reduce some types of errors, including those related to prescription drugs, for emergency and preventive care, and for tests and procedures. Key features of modern EHR include automatic drug-drug/drug-drug interaction checks and allergy checks, standard drug doses and patient education information. Drug information at the point of care and drug delivery points help to reduce errors. Example: India, MedCLIK. Also, the system provides recurring warnings to alert doctors of intervals for preventative care and to track references and test results. Clinical guidelines for disease management have demonstrated benefits when accessible in electronic records during the patient care process. Advances in health informatics and the widespread adoption of operable electronic health records promise access to patient records in every health care setting. However, there may be a weak relationship because of a lack of doctors in understanding patient safety features eg. government-approved software. Errors related to patient identification errors can be exacerbated by the use of EHR, but the inclusion of patient photos clearly displayed in the EHR can reduce errors and is almost false.

Portable offline emergency medical records have been developed to provide access to health records during widespread or extended infrastructure failures, such as in natural disasters or regional conflicts.

Active RFID Platform

The basic security measures of this system are based on sound voice tag identification, so that patient details provided in different situations are always reliable. The system offers three different eligible options:

• Identify at the request of health-care personnel, using a scanner (similar to a reader for passive RFID tags or scanners for barcode labels) to identify patients semi-automatically when presenting patients with tags to staff
• Automatic identification when the patient logs in. Automatic identification checks are performed on everyone with tags (especially patients) entering the area to determine which patients are presented differently from other patients who previously entered the range of readers used.
• Automatic identification and approximate coverage on approaches for the majority of nearby patients, excluding reading from further labels from other patients in the same area

Each of these options can be applied whenever and wherever the patient details are required in electronic form. Identification is very important when the information concerned is very important. There are more and more hospitals that have RFID systems to identify patients, for example: La Fe Hospital in Valencia (Spain); Wayne Memorial Hospital (USA); Royal Alexandria Hospital (UK).

Command Provider Entry Computer (CPOE)

Error writing is the largest identified source for preventable errors in hospitals (IOM, 2000, 2007). The IOM (2006) estimates that each hospitalized patient is, on average, exposed to one treatment error every day. The computerized order commission (CPOE) entry, previously called computerized physician order entries, can reduce treatment errors by as much as 80% overall, but more importantly reduce patients' danger by 55%. A Leapfrog (2004) survey found that 16% of US clinics, hospitals, and medical practices are expected to use CPOE within 2 years.

Complete Safety System

Standard barcode system for drug administration can prevent 25% of drug errors. Despite considerable evidence to reduce treatment errors, competing drug delivery systems (barcoding and electronic prescriptions) have slow adoption by doctors and hospitals in the United States, due to concerns with interoperability and compliance with future national standards. Such concerns are not unimportant; standards for electronic prescribing for Medicare Part D conflict with regulations in many US states.

Patient Safety Software Specific

A standard modular technology system that enables hospitals, clinics, or health systems to record their Incidents that include falls, medication errors, pressure ulcers, near-close, etc. This system can be configured for a particular workflow and the analytics behind it will allow reporting and dashboards to help learn from the things that are wrong (and true). Some vendors include Datix, RL Solutions, Verge, Midas, and Quantros.

Iatrogenesis Technology

Technology caused by errors is significant and increasingly evident in the maintenance delivery system. The strange and potentially serious issues associated with this HIT implementation have recently become a real concern for health and information technology professionals. Thus, the term iatrogenesis technology describes this new category of side effects which are the property that arises as a result of creating technological innovation systems and microsystem interference. Health systems are complex and adaptive, meaning that there are many networks and connections that work simultaneously to produce certain results. When these systems are under increasing pressure caused by the diffusion of new technologies, unusual and new process errors are common. If not recognized, over time, these new errors can collectively lead to catastrophic system failures. The term "e-iatrogenesis" may be used to describe the manifestation of local error. Sources for this error include:

• Prescriber and inexperienced staff can cause the wrong security; that when technology suggests action, mistakes are avoided.
• The shortcut or default option may replace non-standard treatment regimens for elderly or underweight patients, resulting in toxic doses.
• CPOE and automatic drug expenditure were identified as the cause of errors by 84% of the over 500 health care facilities participating in the surveillance system by the United States Pharmacopoeia.
• Warnings are irrelevant or can often interfere with the workflow.

Solutions include ongoing changes in design to address unique medical settings, oversee the waivers of automated systems, and the training (and retraining) of all users.

Evidence-based drugs

Evidence-based medicine integrates individual physician examinations and diagnostic skills for specific patients, with the best available evidence of medical research. Doctors 'skills include diagnostic skills and consideration of individual patients' preferences and preferences in making decisions about their care. Clinicians use relevant clinical studies on the accuracy of diagnostic and efficacy tests and therapeutic, rehabilitation, and preventive safety to develop individual care plans. The development of evidence-based recommendations for specific medical conditions, termed clinical practice guidelines or "best practices", has accelerated in recent years. In the United States, more than 1,700 guidelines (see examples of images, right) have been developed as a resource for physicians to apply to specific patient presentations. The National Institute for Clinical Health and Excellence (NICE) in the UK provides detailed "clinical guidance" for healthcare professionals and the public about certain medical conditions. The National Guides Agency of all continents collaborates in the International Networking Guide, which entertains the largest guide library around the world.

Advantages:

1. Evidence-based drugs can reduce side effects, especially those involving false diagnoses, tests or procedures that are expired or at risk, or overuse of drugs.
2. The clinical guidelines provide a common framework for improving communication among physicians, patients, and non-medical health care buyers.
3. Errors related to shift changes or some specialists are reduced by a consistent maintenance plan.
4. Information about clinical effectiveness of care and services can help health care providers, consumers and buyers better utilize limited resources.
5. As medical advancement becomes available, doctors and nurses can take new tests and treatments as the guidelines are upgraded.

Weakness:

1. Managed care plans may try to limit "unnecessary" services to cut health care costs, despite evidence that the guidelines are not designed for general inspection, but rather as a decision-making tool when an individual practitioner evaluates a particular patient.
2. Medical literature develops and is often controversial; the development of guidelines requires consensus.
3. Apply the guidelines and educate the entire health care team in time and facility cost resources (which can be recovered by efficiency and future error reduction).
4. Doctors can refuse evidence-based medicine as a threat to traditional relationships between patients, doctors, and other health professionals, as each participant can influence the decision.
5. Failure to follow the guidelines may increase the risk of liability or disciplinary action by regulators.

Quality and safety initiatives in community pharmacy practice

Community pharmacy practices make important progress in the quality and security movement despite existing federal and state regulations and in the absence of national accreditation organizations such as the Joint Commission - the driving force for improved performance in health care systems. Community pharmacies use automated drug delivery devices (robots), computerized drug use review tools, and most recently, the ability to receive electronic prescriptions from prescriptions to reduce the risk of errors and increase the likelihood of providing high-quality care.

Quality Assurance (QA) in community practice is a relatively new concept. In 2006, only 16 countries had some form of law regulating QA in the pharmaceutical practice of society. While most of the country's QA regulations focus on error reduction, North Carolina recently approved a law that requires a pharmaceutical QA program to incorporate fault reduction strategies and quality assessment of their pharmaceutical and pharmaceutical care outcomes.

New technology facilitates patient tracking and medication tools. This is highly relevant for drugs that are considered high risk and cost.

Pediatric Quality and Security Improvement Initiative

Improving the quality and safety of patients is a major concern in the world of child health care. The next section will focus on improving the quality and patient safety initiatives in inpatient settings.

Over the past few years, groups of children have partnered to improve common understanding, reporting, process improvement methodologies, and quality of inpatient care. This collaboration has created powerful project programs, benchmarking efforts, and research. Much of the research and focus on side effects has been on medication errors - the most frequently reported adverse effects for adult patients and children. It is also interesting to note that treatment error is also the most preventable type of disorder that can occur in pediatric populations. It has been reported that when pediatric treatment errors occur, these patients have higher mortality rates associated with errors than adult patients. A more recent review of potential pediatric security issues by Miller, Elixhauser, and Zhan found that hospitalized children who experienced a patient's safety incident, compared with those who did not, had

• 1) Long stay 2- to 6 times longer
• 2) Hospital mortality 2- to 18 times greater
• 3) Hospitals charge 2- to 20 times higher

To reduce this error, the attention to safety needs to revolve around designing systems and secure processes. Slonim and Pollack show that security is very important to reduce medical errors and side effects. These problems can range from diagnostic and treatment errors to hospital-acquired infections, procedural complications, and failure to prevent problems such as ulcer pressure. In addition to addressing the quality and safety issues found in adult patients there are some characteristics unique to the pediatric population.

• Development: As children mature cognitively and physically, their needs as consumer goods and health care services change. Therefore, the planning of an integrated approach to pediatric safety and quality is influenced by the fluid nature of childhood development.
• Addiction: Children who are hospitalized, especially those who are very young and/or nonverbal, rely on caregivers, parents, or other substitutes to convey important information related to patient meetings. Even when children can accurately express their needs, they are unlikely to receive the same recognition given to adult patients. In addition, since children rely on their caregivers, their care must be approved by parents or substitutes during all meetings.
• Epidemiology is different: Most hospitalized children require acute episodic treatment, regardless of chronic conditions as in adult patients. Planning of safety and quality initiatives within the framework of "health, disturbed by acute conditions or exacerbations," presents different challenges and requires new ways of thinking.
• Demographics: Children are more likely than other groups to live in poverty and experience racial and ethnic differences in health care. Children are more dependent on public insurance, such as the State Children's Health Insurance Program (SCHIP) and Medicaid.

One of the main challenges faced by pediatric safety and quality efforts is that much of the work on patient safety is currently focused on adult patients. In addition, no standard nomenclature for the safety of pediatric patients is widely used. However, a standard framework for classifying pediatric side effects that offers flexibility has been introduced. Standardization provides consistency between interdisciplinary teams and can facilitate multisite research. If this large-scale study is conducted, findings can result in large-scale intervention studies conducted with a faster life cycle.

Leader in Pediatric Security and Quality

The Agency for Research and Quality of Health (AHRQ) is the Federal authority for patient safety and quality care and has been a leader in pediatric quality and safety. AHRQ has developed Pediatric Quality Indicators (PedQIs) with the aim of highlighting areas of quality concern and targeting areas for further analysis. Eighteen pediatric quality indicators are included in the AHRQ quality measurement module; based on expert input, risk adjustments, and other considerations. Thirteen inpatient indicators are recommended for use at the hospital level, and five are indicators of designated areas. An inpatient indicator is the treatment or condition with the greatest potential of side effects for hospitalized children.

The likelihood of adding datasets will address the patient's condition at admission and increase understanding of how laboratory and pharmaceutical utilization impact on patient outcomes. The AHRQ objective is to improve the area-level indicators to improve outcomes for children receiving outpatient care and to reduce the incidence of hospitalization for the prescribed conditions.

Collaboration for Pediatric Security and Quality

Many groups are involved in improving pediatric care, quality and safety. Each of these groups has unique mission and membership. The following table details the mission and website of this group.

Nurses and Pediatric Results Satisfaction

While the number of nurses providing patient care is recognized as an inadequate measure of inadequate care quality, there is strong evidence that nursing staff are directly related to patient outcomes. Studies by Aiken and Needleman have shown that patient deaths, nosocomial infections, cardiac arrest, and pressure ulcers are associated with inadequate nurse-to-patient ratios. The presence or absence of registered nurses (RN) affects outcomes for pediatric patients requiring pain management and/or peripheral administration of fluids and/or intravenous drugs. The two indicators of quality of pediatric nursing care are sensitive treatment measures. Professional nurses play a key role in successful pain management, especially among pediatric patients who can not describe verbal pain. Smart scoring skills are required to intervene successfully and eliminate discomfort.33 Maintenance of patient intravenous access is a clear nursing responsibility. Pediatric patients are at high risk for intravenous infiltration and for significant infiltration complications, if they occur.

The characteristics of an effective indicator of the quality of pediatric nursing care are as follows:

• Scalable: Indicators apply to pediatric patients in various units and hospitals, both in intensive care and general care settings.
• Eligible: Data collection does not incur an unnecessary burden on participating unit staff because data is available from existing sources, such as medical records or quality improvement databases, and can be collected in real-time.
• Valid and reliable: Indicator measurements within and across participating sites are accurate and consistent over time.

Conclusion

Childcare is complex because of developmental problems and dependencies associated with children. How these factors impact on a special care process is a field of science where little is known. Throughout health care providing safe and high quality patient care continues to provide significant challenges. Efforts to improve the safety and quality of care are an intensive resource and take ongoing commitments not only by those who provide care, but also by institutions and foundations that fund this work. Advocates for the health care of children should be on the table when major policies and regulatory issues are addressed. Only then will the voice of our most vulnerable consumer health care group be heard.

Nurse and Patient Safety Hours

Recent increases in working hours and nurse overtime shifts have been used to compensate for the reduction of registered nurses (RNs). A notebook equipped with nearly 400 RN has revealed that about "40 percent of the 5,317 work shifts they record exceeded twelve hours." Errors by hospital staff nurses are more likely to occur when work shifts exceed 12 hours, or they work more than 40 hours in a week. Studies have shown that overtime shift has a harmful effect on the quality of care given to patients, but some researchers "who evaluated the safety of 12-hour shifts found no improvement in treatment errors." The mistakes the researchers found were "distorted attention to detail, negligence errors, problem solving compromised, reduced motivation" due to fatigue and "errors in grammatical reasoning and chart review." Overworked nurses are a serious safety issue for their healthy patients. Working back to the rear shift, or night shift, is a common cause of fatigue in hospital staff nurses. "Lack of sleep, or fatigue, can lead to an increase in the likelihood of making mistakes, or even less likely to catch other people's mistakes." Restricting working hours and shift rotation can "reduce the harmful effects of fatigue" and improve the quality of patient care.

Health literacy

Health literacy is a common and serious security problem. A study of 2,600 patients at two hospitals determined that between 26-60% of patients were unable to understand the treatment instructions, standardized informed consent, or basic health care ingredients. The incompatibility between the doctor's communication level and the patient's ability to understand can lead to medication errors and adverse outcomes.

The Institute of Medicine (2004) reported finding low levels of health literacy negatively impacted health care outcomes. In particular, these patients have a higher risk of hospitalization and longer hospital admissions, tend to adhere to treatment, are more likely to make mistakes with drugs, and more painful when they seek medical care.

Pay for performance (P4P)

Pay for a performance compensation link system for a measure of quality of work or purpose. In 2005, 75 percent of all US companies linked at least part of their salaries to performance measures, and in health care, more than 100 private and federal pilot programs are underway. Current health payment methods may actually reward less secure care, as some insurance companies will not pay for new practices to reduce errors, while doctors and hospitals may bill for additional services needed when patients are hurt by mistakes. However, preliminary research shows little gain in quality for money spent, as well as evidence that demonstrates unintended consequences, such as high risk patient avoidance, when payments are associated with improved outcomes. The 2006 Institute of Medicine Prevent Drug Errors recommends "incentives... so that the profitability of hospitals, clinics, pharmacies, insurance companies, and producers (aligned) with patient safety goals... (for) business case for quality and security. "

There is broad international interest in health care pay programs in many countries, including the United Kingdom, the United States, Australia, Canada, Germany, the Netherlands and New Zealand.

United Kingdom

In the United Kingdom, the National Health Service (NHS) initiated an ambitious payment for performance initiatives in 2004, known as the Quality and Outcome Framework (QOF). The general practitioner agreed to increase the existing income in accordance with performance with respect to 146 quality indicators covering clinical care for 10 chronic diseases, care organizations, and patient experiences. Unlike the proposed quality incentive program in the United States, funding for primary care increased 20% from the previous level. This allows the practice of investing in extra staff and technology; 90% of GPs use the NHS Electronic Recipes Service, and up to 50% use electronic health records for most clinical treatments. Preliminary analyzes indicate that substantially increasing physician salaries based on their success in meeting successful quality performance measures. The 8,000 family practitioners included in the study earned an average of $ 40,000 more by collecting nearly 97% of the available points.

The components of this program, known as exception reporting , allow physicians to use criteria to exclude individual patients from quality calculations that determine the replacement of a physician. There are initial concerns that exception reporting will allow an inappropriate exception in patients whose targets are missed ("game"). However, a 2008 study has shown little evidence of widespread game.

United States

In the United States, Medicare has various pay-for-performance ("P4P") initiatives in offices, clinics and hospitals, which seek to improve quality and avoid unnecessary health care costs. The Medicare and Medicaid Service Centers (CMS) have several ongoing pilot projects offering compensation for improvement:

• Payment for better care coordination between home, hospital and office for patients with chronic illness. In April 2005, CMS launched its first pilot-based pilot or "demonstration" project - a three-year Doctoral Practice Demonstration (PGP). The project involves ten practices of specialist multi-specialty doctors who care for more than 200,000 Medicare cost-for-service beneficiaries. Participating practices will be phases in quality standards for the prevention and management of common chronic diseases such as diabetes. Practices that meet this standard will be eligible for rewards from savings due to improvements resulting in patient management. The First Evaluation Report to Congress in 2006 showed that the model rewarded the provision of high quality and efficient health care, but the lack of prepayment for investment in the new case management system "has been made for the future which is uncertain with respect to each payment under demonstration. "
• A set of 10 hospital quality measurements which, if reported to the CMS, will increase the payment the hospital receives for each debit. In the third year of demonstrations, hospitals that do not meet the quality threshold will be subject to reduced payments. Preliminary data from the second year of the study showed that payments for performance were associated with about 2.5% to 4.0% improvement according to quality measures, compared to control hospitals. Dr. Arnold Epstein of the Harvard School of Public Health commented in an accompanying editorial on performance-paying "essentially a social experiment that tends to have only modest additional value." The undesirable consequences of some of the publicly reported hospital quality measures have affected patient care. The requirement to provide the first antibiotic dose in the emergency department within 4 hours, if the patient has pneumonia, has led to an increase in misdiagnosis of pneumonia.
• Rewards for doctors to improve health outcomes using health information technology in the care of chronically ill Medicare patients.
• Disincentives : Tax Relief & amp; The Health Care Act of 2006 requires the HHS Inspector General to study Medicare's remuneration ways to the hospital to be recovered for "never happened," as defined by the National Quality Forum, including hospital infections. In August 2007, CMS announced that it would stop payments to the hospital for some of the negative consequences of treatment resulting in injury, illness or death. This rule, effective October 2008, will reduce hospital payments for eight serious types of preventable incidents: objects left to patients during surgery, blood transfusion reactions, air embolism, fall, mediastinitis, urinary tract infections from catheters, pressure ulcers, and sepsis of the catheter. Reporting "never happened" and the creation of performance benchmarks for hospitals is also mandated. Other private health payers are considering similar actions; in 2005, HealthPartners, a Minnesota health insurer, chose not to include 27 "never" types. Leapfrog Group has announced that it will work with hospitals, health plans, and consumer groups to advocate for "never-ending" payment reductions, and will recognize hospitals that agree on certain steps when adverse events can be avoided seriously in facilities including informing patient and patient safety organizations, and waiving fees. The group of doctors involved in the management of complications, such as the Infectious Diseases Society of America, have voiced an objection to this proposal, observing that "some patients develop infections despite application of all known evidence-based practices to avoid infection", and that response penalties may inhibit studies further and slow the dramatic improvements that have been made.

Complicated illness

For health care institutions, revealing unexpected events should be done as soon as possible. Some health care organizations may have policies on unexpected disclosure of events. The amount of information presented to those affected will depend on family preparedness and organizational culture. Employees who disclose events to families need support from risk management, patient safety officers and senior leadership. The disclosure is objectively documented in the medical record.

Voluntary disclosure

In a public survey, a significant majority of those surveyed believed that healthcare providers should be required to report all serious medical errors openly. However, medical literature reviews show little effect from publicly reported performance data on patient safety or quality of care. Public reporting on the quality of individual providers or hospitals does not seem to affect the selection of hospitals and individual providers. Several studies have shown that reporting on performance data stimulates quality improvement activities in hospitals.

United States

Medical error

Ethical standards The Joint Commission on Accreditation of Health Organization (JCAHO), the American Medical Association (AMA) Council on Ethical and Judicial Affairs, and the American College of Physicians Ethics Manual require the most serious disclosure of side effects. However, many doctors and hospitals do not report errors under the current system due to concerns about malpractice lawsuits; this prevents the collection of information necessary to find and correct the conditions that cause the error. In 2008, 35 US states have laws that allow doctors and healthcare providers to apologize and offer expressions of regret without their words used against them in court, and 7 states have also passed laws requiring disclosure written for bad events and bad results for patients and families. In September 2005, US Senators Clinton and Obama introduced the National Medical Eradication and Compensation Bill (MEDiC), providing physicians protection from responsibilities and a safe environment for disclosure, as part of a program to inform and compensate patients harmed by medical error. Now is the policy of several academic medical centers, including Johns Hopkins, University of Illinois and Stanford, to promptly reveal medical errors, offer apologies and compensation. This national initiative, hoping to restore integrity to dealing with patients, makes it easier to learn from mistakes and avoid angry lawsuits, modeled after the University of Michigan Hospital System program that has reduced the number of lawsuits against hospitals by 75% and has lowered average litigation costs. The Veterans Health Administration requires disclosure of all adverse events in patients, even those that are not clear. However, in 2008 this initiative covered only self-insured hospitals and employed their staff, thus limiting the number of parties involved. Medical errors are the third leading cause of death in the US, after heart disease and cancer, according to a study by Johns Hopkins University. Their study published in May 2016 concluded that more than 250,000 people die each year due to medical mixing. Other countries report similar results.

Performance

In April 2008, consumer organizations, employers and workers announced an agreement with the organization of major physicians and health insurance companies about the principles for measuring and reporting physician performance on quality and cost.

United Kingdom

In Britain, whistleblowing is well known and sanctioned by governments, as a way to protect patients by encouraging employees to call attention to poor service. Health authorities are encouraged to put local policies in place to protect the complainants.

Study on patient safety

Many organizations, government offices, and private companies conduct research to investigate the overall health of patient safety in America and around the world. Despite widespread and widely publicized statistics on preventable deaths due to medical errors in American hospitals, the 2006 National Healthcare Quality Report compiled by the Agency for Health Research and Quality (AHRQ) has the following reassuring appraisals:

• Most Quality measures improve, but the rate of change remains simple.
• Quality improvements vary based on maintenance settings and phases.
• The rate of increase is accelerated for some sizes while some continue to show a decline.
• Variations in the quality of health care remain high.

A 2011 study of more than 1,000 patients with advanced-stage colon cancer found that one in eight patients were treated with at least one drug regimen with specific recommendations for its use in the National Comprehensive Cancer Network guidelines. This study focuses on three chemotherapy regimens not supported by evidence from previous clinical studies or clinical practice guidelines. One treatment assessed "the data is insufficient to support," one has "proven to be ineffective," and one is supported by "no data, nor is there a good reason." Many patients receive multiple non-beneficial chemotherapy cycles and some receive two or more unproven treatments. Potential side effects for treatment include hypertension, high risk of bleeding and bowel perforation. Organizations

src: www.beckershospitalreview.com

recommend patient safety

Several authors of the 1999 Institute of Medicine report reviewed their recommended status and patient safety status, five years after "To Err is Human". Finding that patient safety has become a frequent topic for journalists, health care professionals, and the public, it is more difficult to see overall improvement at the national level. What is noteworthy is its impact on attitudes and organizations. Some health care professionals now doubt that a preventable medical injury is a serious problem. The central concept of the report - that the bad system and not the bad guys cause the majority of mistakes - becomes solid in the patient's safety effort. Organizations are now advancing the cause of patient safety. For example, in 2010 the main organization of European anesthesiology launched the Helsinki Declaration for Patient Safety in Anaesthesiology, which incorporated many of the principles described above.

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See also

src: media.npr.org

References

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External links

• CIMIT Center for the Integration of Medical and Innovative Technologies - Nonprofit organizations jointly advocate for patient safety
• Security Institution in Surgical-Based Office
• EU-Health Portal Security in the EU
• Academic Center for Evidence-Based Practice (ACE)
• Improvement Science Research Network (ISRN)
• Beyond The Checklist: What Other Health Can Learn From The Working Team and Aviation Security

Source of the article : Wikipedia