Isabel Kazanga, PhD Student, Center for Global Health, Trinity College Dublin

1. Building Safe Healthcare Systems: Fighting the War against Medical Errors and Improving Patient Safety in Developing Countries Isabel Kazanga, PhD Student, Center for Global Health, Trinity College Dublin 29thNovember 2010

2. Introduction • Healthcare is not usually safe as it is intended to be. • In 1999, the IOM published a landmark report on medical errors: “To Err is Human” • Everyday many people get injured and die in hospitals silently as a result of preventable medical errors (MEs) • In USA, 44,000–98,000 people die every year due to MEs Source: Institute of Medicine (IOM), 1999

3. 40% 30% 20% 10% % of patients affected with medical errors Introduction cont. • The epidemic of MEs is a global problem. • MEs affect 1 in 10 patients worldwide. • The incidence of MEs is however more serious and challenging in developing countries than developed countries. Source: World Health Organisation, 2005

4. Research Objectives • Broad Objective • To identify priorities and strategies that can help reduce MEs and improve patient safety in developing countries, in order to draw suggestions for public health policy improvement. • Specific Objectives • 1. To investigate the epidemiology of MEs • 2. To identify factors which contribute to MEs • 3. To explain the effects of MEs • 4.To identify priorities and strategies to reduce MEs and improve patient safety in developing countries

5. Significance of this Study The findings of this study will: - give insight into the epidemiology of MEs in developing countries - provide suggestions for policy improvement

6. Desk research Masters research project Extensive literature review Sources of data ✓ PubMed ✓ MEDLINE ✓ ScienceDirect ✓ Other sources Keywords- Healthcare systems, medical errors, patient safety, developing countries Methodology

7. Review & Findings

8. What are medical errors? • Examples • Wrong diagnosis or treatment • Object left inside patient during surgery • Mix-up in patient identities • Delay in treatment • Injury, infections etc • Definition • “A commission or an omission with potentially negative consequences”a (Wu et al, 1997)

9. Healthcare systems complexity issues Professional issues Personal factors What causes medical errors? • e.g: • Poor organizational culture • Inadequate technology • Poor communication channels • Poor leadership • Lack of incident reporting systems • Lack of skilled healthcare staff • e.g: • Lack of knowledge & incompetency • Failure to acknowledge and understand how errors occur and their consequences • e.g: • High workload and busy schedules (with many pressures and high level of stress) • Illegible hand writing & inaccurate prescription “Beyond honest errors are mistakes caused by negligence - haste, carelessness.”

10. The epidemiology of medical errors It is difficult to get a full and complete picture of medical errors in developing countries Why? Due to inadequacy of research studies and limited publications

11. The Incidence of MEs in developing countries

12. Types & Frequency of MAEs- A study in Malaysia Hospital (2009) 1118 observations 127 errors 11.4% error rate Chua et al, 2009

13. Effects of medical errors “Honest error is to be pitied, not ridiculed.” ~ Lord Chesterfield “Admit your errors before someone else exaggerates them.”  ~ Andrew Mason

14. “To prescribe treatment regimens for the good of my patients according to my ability and my judgment and never do harm to anyone". Ethical and Legal Issues in Patient Safety HIPPOCRATIC OATH Hippocrates 400BC ✓ Patients have a right to safe & effective care at all times (JCI, 2007) ✓ Healthcare professionals & Institutions owe a legal duty and responsibility to providing safe care to their patients. ✓ Medical malpractice or negligent errors are acts of crime. “Failure to disclose MEs compromise patients and societal trust”

15. Strategies & Priorities to reduce MEs & promote Patient Safety in Developing Countries • 1. Laws, Policies and Guidelines to promote patient safety • e.g Patient Safety Act- Denmark (2004), • USA (2005). • 2.Stakeholders Involvement • It helps to improve safety & quality • (McFadden et al, 2006) • 3. Creating Patient Safety Culture • Safety as a commitment & priority • 4. Promotion of safe clinical practices • e.g “ Five Rights Principle” (5Rs), double • checking, correct diagnosis & prescriptions, • proper patient handovers • 5. Incident Reporting Systems • Should be “ blame free”, confidential/ anonymous & non punitive • 6. Accreditation of Hospital • “ Accredited hospitals reported improvements in; reduction of medication errors, professional credentialing…” (JCI, 2007) • 7. Staffing, Education & Training of Healthcare workers • Including training of pharmacists & drug vendors e.g Kenya, Phillipines, Indonesia & Nepal • 8. Improving Communication & Teamwork • 9. Promoting research on patient safety

16. Conclusion ✓ MEs will continue to claim many lives silently in developing countries, unless immediate attention and effort is made to prevent this problem. ✓ In order to successfully win the war against MEs, strong commitment and application of a comprehensive approach are essential. ✓ Patient safety can only be achieved through a “bundle” strategies. “Learn from the mistakes of others. You can't live long enough to make them all yourself”~ Eleanor Roosevelt

17. Thank You!