Research and resources for perinatal professionals.
September 17, 2019
By: Sharon Muza, BS, CD/BDT(DONA), LCCE, FACCE, CLE | 0 Comments
Today, September 17th, 2019 is the inaugural World Patient Safety Day. This is designated by the World Health Organization (WHO). Patients in hospitals in both highly resourced countries and under-resourced countries are both impacted. Since childbirth is the most common reason for hospitalization, many new families are impacted by adverse events. Systemic change comes slowly, and unfortunately, the responsibility often falls to the patient (and their family) to remain diligent and watchful in order to avoid complications caused by errors of health care staff.
The WHO has prepared 10 facts that every health care consumer should be aware of.
Estimates show that in high-income countries, as many as one in 10 patients is harmed while receiving hospital care (2–5). The harm can be caused by a range of adverse events, with nearly 50% of them considered preventable (6).
A study on the frequency and preventability of adverse events across 26 hospitals in eight low- and middle-income countries, showed the adverse event rate to be around 8%. Of these events, 83% were preventable, while about 30% were associated with death of the patient (7,8).
The occurrence of adverse events, resulting from unsafe care, is likely to be one of the 10 leading causes of death and disability worldwide (9). Recent evidence suggests that 134 million adverse events occur each year due to unsafe care in hospitals in low- and middle-income countries (LMICs), resulting in 2.6 million deaths annually (10).
Another study has estimated that around two-thirds of all adverse events resulting from unsafe care, and the years lost to disability and death (known as disability-adjusted life years, or DALYs), occur in LMICs (11).
The provision of safe services is extremely important across all levels of health care, including in primary and outpatient (ambulatory) care, where the bulk of services are offered. Globally, as many as four out of 10 patients are harmed while receiving health care in these settings, with up to 80% of the harm considered to have been preventable. The most detrimental errors are related to diagnosis, prescription and the use of medicines.
Harm in primary and ambulatory care often results in hospitalization. It has been found, that across Organisation for Economic Co-operation and Development (OECD) countries, patient harm may account for more than 6% of hospital bed days and more than 7 million admissions (12).
A minimum of 1 out of every 7 Canadian dollars is spent treating the effects of patient harm in-hospital care (13). Recent evidence shows that 15% of total hospital expenditure and activities in Organisation of Economic Co-operation and Development (OECD) countries is a direct result of adverse events, with the most burdensome events being blood clots (venous thromboembolism), bedsores (pressure ulcers) and infections.
It is estimated that the total cost of harm in these countries alone amounts to trillions of US dollars every year (4).
Investment in improving patient safety can lead to significant financial savings and more importantly better patient outcomes. This is because the cost of prevention is typically much lower than the cost of treatment due to harm (4). As an example, in the United States alone, focused safety improvements led to an estimated US$ 28 billion in savings in Medicare hospitals between 2010 and 2015 (14).
Greater patient involvement is the key to safer care. Engaging patients is not expensive and represents a good value. If done well, it can reduce the burden of harm by up to 15%, saving billions of dollars each year– a very good return on investment (12).
Unsafe medication practices and errors – such as incorrect dosages or infusions, unclear instructions, use of abbreviations and inappropriate prescriptions – are a leading cause of avoidable harm in health care around the world. Globally, the cost associated with medication errors has been estimated at US$ 42 billion annually, not counting lost wages, productivity, or health care costs. This represents almost 1% of global expenditure on health (15).
Medication errors may occur when weak medication systems and/or human factors such as fatigue, poor working conditions, or staff shortages affect prescribing, storage, preparation, dispensing, administration and monitoring practices. Any one or a combination of these can result in severe patient harm, disability and even death (16).
Diagnostic error, that is the failure to identify the nature of an illness in an accurate and timely manner, occurs in about 5% of adults in the United States outpatient care settings. About half of these errors have the potential to cause severe harm (5,17). A study of primary care clinics in Malaysia established the occurrence of diagnostic errors at 3.6% (18).
In the United States, extensive autopsy research performed in the past decades has shown that diagnostic errors contribute to approximately 10% of patient deaths. Furthermore, medical record reviews demonstrate that diagnostic errors account for 6–17% of all harmful events in hospitals (19).
Evidence from low- and middle-income countries is limited, however, it is estimated that the rate is higher than in high-income countries as the diagnostic process is negatively impacted by factors such as limited access to care and diagnostic testing resources (20).
Out of every 100 hospitalized patients, at any given time, seven in high-income countries and 10 in low- and middle-income countries will acquire one or more health care-associated infections (HAIs) (5,21,22). Hundreds of millions of patients worldwide are affected by HAIs each year. People with methicillin-resistant Staphylococcus aureus (MRSA), a bacterium increasingly found in hospital settings that is resistant to most antibiotics, are estimated to be 64% more likely to die than people with a non-resistant form of the infection (23).
Regardless of a country’s income level, different types of interventions, including appropriate hand hygiene, can reduce HAI rates by up to 55% (24).
Findings by WHO suggest that, globally, surgery still results in high rates of illness, disease and death. Unsafe surgical care procedures cause complications in up to 25% of patients. Almost 7 million surgical patients suffer significant complications annually, 1 million of whom die during or immediately following surgery (25).
As a result of improved patient safety measures, deaths related to complications from surgery have decreased in the past 50 years. Nevertheless, they remain two to three times higher in low- and middle-income countries than in high-income countries (26).
Worldwide, there are more than 3.6 billion x-ray examinations performed every year, with around 10% of them occurring in children. Additionally, there are over 37 million nuclear medicine and 7.5 million radiotherapy procedures annually. Inappropriate or unskilled use of medical radiation can lead to health hazards, both for patients and staff (27).
Radiation errors involve overexposure to radiation and cases of wrong-patient or wrong-site identification. A review of 30 years of published data on safety in radiotherapy estimates that the overall incidence of errors is around 15 per 10 000 treatment courses (28).
Treating pregnancy and childbirth as normal and supporting community birth and midwifery care for heathly low-risk individuals can go a long way to reduce the likelihood of a family being impacted by a medical error. Childbirth educators and other perinatal professionals can normalize the experience of birth. We can also help families to learn how to be an active participant in the care they receive and develop skills that will help them to engage in shared decision making with their health care providers. For many healthy individuals, pregnancy and birth may be the first time they are engaged in making major health care decisions. Helping families to learn how to avoid an unnecessary cesarean, and the potential s surgery complications and hemorrhage and infection risks that may result in the immediate postpartum period are also useful. Join the World Health Organization in promoting this first World Patient Safety Day by making sure you are sharing information with the families you work with so they can have a safe and healthy experience. You can find information and tools on World Patient Safety Day here.
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