Patient Safety in Slovakia
Assoc Prof Viera Rusnáková, MD, PhD, MBA
Slovak Medical University Bratislava
Novi Sad, November 2, 2010
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Overview
Patient Safety Global Context
Local Research SK
– „Patients´ safety culture“ pilot hospital survey
Implication to
– Education and Training
Patient Safety in Health Professionals Curricula
– Management
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Monitoring of Patient Safety
in European Union
Report on the open consultation on Patient Safety in the European Union. Commission of the European Communities,
Brussels, 10.12.2008
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Patient Safety and Quality
of Healthcare (Euro barometer 327, 2010)
SK 65%
Respondents in Greece (83%), Cyprus (81%) and Latvia (75%) feel that the risk of being harmed
is much higher than respondents in Austria (19%), Finland (27%) and Germany (31%).
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Citizens´ Assessment
of Adverse Events Type
SK
how
likely
53%
68%
45%
47%
40%
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Avoidable confusion is everywhere…
Normal Vision Viewpoint and Impaired Vision Viewpoint
LASA E-PETITION TO ELIMINATE OPHTHALMIC LOOK ALIKE SOUND ALIKE MEDICATION ERRORS. 2010.
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EU-Council Recommendation
on Patient Safety, 2009
1. Support establishment and 5. Classify and measure patient
development of national safety at Community level, by
policies and programs working with each other and
with the Commission –
2. Empower and inform indicators
citizens and patients
6. Share knowledge, experience
3. Support establishment or and best practice by working
strengthen blame-free
reporting and learning with each other and with the
systems on adverse events Commission and relevant
European and international
4. Promote, at the appropriate bodies
level, education and
training of healthcare 7. Develop and promote
workers
research on patient safety
http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:C:2009:151:0001:0006:EN:PDF
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Problems to respond
The lack of a safety culture, individual and
institutional
The lack of communication
– between professionals /patients
The weak pro-active risk assessment
The education and training
The limitation of funds and sometimes also
limited access to technologies
Research Program: WHO World Alliance for Patient Safety, 2008
http://www.who.int/patientsafety/research/en/
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Patient Safety Culture Tool
sponsored by AHRQ,USA
http://www.ahrq.gov/qual/patientsafetyculture
Assessment tool for hospitals to:
Raise staff awareness about patient safety
Diagnose and assess the current status of patient
safety culture
Identify strengths and areas for patient safety culture
improvement
Examine change in patient safety culture over time
Evaluate the cultural impact of patient safety initiatives
and interventions
Conduct internal and external comparisons
Recommended also by European Network for Patient Safety (EUNetPaS)
http://90plan.ovh.net/~extranetn/
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Pilot Hospital Survey on
„Patient Safety Culture - PSC“
Slovakia, 2010
Setting
AHRQ tool translated to Slovak
Voluntary participating respondents
from 4 hospitals ( 6 addressed)
Questionnaires – 110/150 RR 73% Respondens Experience in Profession - in years
30%
Field work completed by PH student 26%
25% 25%
Characteristics of the sample 20%
18% 18%
Surgery 24,6 % 15%
Medicine 23% 10% 9%
ICU 13%
NS 37 % 5%
4%
0%
Less than 1 1-5 6-10 11-15 16-20 21-
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n=110
SK Pilot Hospital Survey PSC
80 % respondents were not reporting adverse events last year
Number of Reports Reported Last 12 months
100%
90%
80%
80%
70%
60%
50%
40%
30%
20%
11%
10%
8%
1% 0%
0%
No 1-2 reports 3-5 reports 6-10 reports 11 and more
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AHRQ Data USA, 2009
n=160 176
52 % respondents were not reporting adverse events (signif.diff to SK)
Sorra J, Famolaro T, Dyer N, et al. Hospital Survey on Patient Safety Culture 2009 comparative
database report. 2009. AHRQ Publication No. 09-0030
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Safety Culture Dimensions - Average Positive Score
Benchmarking SK- USA
Hospital Handoffs & Transitions ***
100 USA
Nonpunitive Response To Error *** 90 Overall Perceptions of Safety
80
SK
70
60
Organizational Learning—Continuous
Staffing *** 50
improvement
40
30
20
10
Frequency of Event Reporting ** 0 Teamwork Within Hospital Units***
Supervisor actions for safety *** Teamwork Across Hospital Units
Hospital Management Support for Patient
Feedback and Communication About Error
Safety***
Communication Openness
Stat Significant Differences **,*** (z test for proportion)
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Analysis of Comments
Problems in staffing
Limited time for a patient
Lack of safety devices
Poor Safety environment (floors, lifts,
patient beds, ...)
Questionnaire – clarity of some questions,
complexity
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Conclusions
Relative good acceptance of the tool
– high response rate and interest was presented
– no significant barriers for the broader implementation
of AHRQ questionnaire
Remarkable problems observed in dimensions
– non punitive response to error,
– staffing,
– supportive managerial competencies,
– open communication,
– frequency of event reporting,
– team work
Under reporting of adverse events notable/
hidden agenda
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Broader Consequences
Patient Safety in Medical Education is an
challenge
– WHO, EUNetPaS, IHI, AAMA recommendation –
curricula available
– Integration into recent curricula for medical students,
PH and nursing
– e-Learning /e-Health technology implementation
– Space for Collaboration
Prominent reserves are in managerial
mechanism and organizational behavior
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Berwick DM, Finkelstein J
in Academic Medicine, 2010
WHO curricula 2009
PART A: TEACHER’S GUIDE
PART B: CURRICULUM GUIDE
TOPICS
http://www.who.int/patientsafety/activities/technical/medical_curriculum /en/index.html
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Innovation in Health Service
Organization (GREENHALGH, T. et al , 2004)
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Thank You
viera.rusnakova@szu.sk
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