ADVANCES oN PATIENT SAFETY IN MEXICO

1. ADVANCES oN PATIENT SAFETY IN MEXICO Dra. Odet Sarabia González Advisor of the Under Secretary of Quality and Innovation, Ministry of Health Mexico, Mexico City, Mexico August/2008

2. Location of the program on the national agenda Progress in training Signing the joint statement in favour of the first challenge of the World Alliance for Patient Safety of WHO National Campaign for Hand Hygiene Research Bulletins Patient Safety Quality Committee Indicators of good practice in patient safety Lessons learned CONTENT

3. The program in the national healthcare agenda Progress on training Signing the joint statement in favour of the first challenge of the World Alliance for Patient Safety of WHO National Campaign for Hand Hygiene Research Bulletins on Patient Safety Quality Committee Indicators of good practice in patient safety Lessons learned CONTENT

4. National Development Plan (PRONASA 2007-2012) • Five objectives • “To provide efficient health services, quality, warmth, and patient safety”

5. PRONASA 2007-2012 • Chapter III- Objectives and strategies. • Strategy 3 • Action Line 3.1 • To link public hospitals of middle and high complexity with the programme of patient safety, including measures to ensure a clean care and prevent the occurrence of adverse events, medication errors and insecure surgery.

6. PRONASA 2007-2012 • Chapter III - Objectives and strategies • Strategy 3 • Action Line 3.1 • To contribute to reduce the morbidity and mortality from hospital-acquired infections. The goal is that 60% of public hospitals have a risk management model for nosocomial infections.

7. The program in the national healthcare agenda Progress on training Signing the joint statement in favour of the first challenge of the World Alliance for Patient Safety of WHO National Campaign for Hand Hygiene Research Bulletins on Patient Safety Quality Committee Indicators of good practice in patient safety Lessons learned CONTENT

8. PROGRESS IN TRAINING • At present, progress on training hospital personel of the Secretary of Health is around 40%.

9. PROGRESS IN TRAINING • This is throughout many hospitals of the Health System.

10. The program in the national healthcare agenda Progress on training Signing the joint statement in favour of the first challenge of the World Alliance for Patient Safety of WHO National Campaign for Hand Hygiene Research Bulletins on Patient Safety Quality Committee Indicators of good practice in patient safety Lessons learned CONTENT

11. Signature On September 21, 2007, Mexico, along with 6 other countries of Central America and the Caribbean, signed the joint declaration in favour of the first challenge of the World Alliance for Patient Safety of the World Health Organization.

12. Signature Clean care is a safer care

13. Signature

14. The program in the national healthcare agenda Progress on training Signing the joint statement in favour of the first challenge of the World Alliance for Patient Safety of WHO National Campaign for Hand Hygiene Research Bulletins on Patient Safety Quality Committee Indicators of good practice in patient safety Lessons learned CONTENT

15. Poster

16. Stickers

17. Flyer (forward)

18. National Campaign for Hand Hygiene • The National Campaign for Hand Hygiene will be launched in October. • The campaign represents a commitment from the whole health system.

19. Flyer (back)

20. Flyer for the patient (Outside)

21. Flyer for the patient (Inside)

22. The program in the national healthcare agenda Progress on training Signing the joint statement in favour of the first challenge of the World Alliance for Patient Safety of WHO National Campaign for Hand Hygiene Research Bulletins on Patient Safety Quality Committee Indicators of good practice in patient safety Lessons learned CONTENT

23. Research • Considered a potentially serious and preventable problem, with great economic and social impact. • A study of the Under Secretary of Quality and Innovation, through the Directorate of Performance Evaluation has documented prevalence of adverse events of 11.8% on two general public hospitals. 4 Observatorio del desempeño hospitalario 2006. Secretaria de Salud. México DF.

24. Research • At this stuydy the main adverse events in hospitals are: • a) Acquired pneumonia (33.3%) • b) Surgical wound infection(25%) • c) Infection with medical procedures(20%) • e) Others (21.7%)

25. Research • Patients who experienced any adverse events had an ALOS of 23-day. • This represented 10 days more regarding the comparison group.

26. Research • Most of adverse events occurred in women unrelated to obstetric conditions (53.7%) and in children under 5 years (33%).

27. Research • Mexico participated in the study “Iberoamerican Advers Events” (IBEAS, by its Spanish initials). • This study measures the prevalence of adverse events in 5 countries in the region of Central and South America. • 28 mexican hospitals participated in this study, involving approximately 500 professionals.

28. Research • The databases have already been send to Spain and we are awaiting feedback. • We are confident that their findings result in valuable information regarding Patient Safety in the Region and in Mexico.

29. The program in the national healthcare agenda Progress on training Signing the joint statement in favour of the first challenge of the World Alliance for Patient Safety of WHO National Campaign for Hand Hygiene Research Bulletins Patient on Safety Quality Committee Indicators of good practice in patient safety Lessons learned CONTENT

30. Bulletins • In order to disseminate knowledge in the field of patient safety, a threemonthy newsletter has been published from September of 2005 until now.

31. Bulletins • Currently, we have 9 volumes of this newsletter. • In the last issue, Tomas Flores and his wife Rosa Garcia, shared their experience when their children suffered Kernicterus undetected timely.

32. Bulletins • These parents demonstrate their strength to work in workshops and conferences which provide preventive information on this disease. • With this work the health system have an opportunity for improvement. http://dgces.salud.gob.mx/seguridaddelpaciente/

33. The program in the national healthcare agenda Progress on training Signing the joint statement in favour of the first challenge of the World Alliance for Patient Safety of WHO National Campaign for Hand Hygiene Research Bulletins on Patient Safety Quality Committee Indicators of good practice in patient safety Lessons learned CONTENT

34. Commissions National Quality Committee 5 commissions 10 actions in Patient Safety Nosocomial infections Taxonomy Implementing the programme in hospital units Analysis of cases of SINRAECE for issuing recommendations

35. The program in the national healthcare agenda Progress on training Signing the joint statement in favour of the first challenge of the World Alliance for Patient Safety of WHO National Campaign for Hand Hygiene Research Bulletins on Patient Safety Quality Committee Indicators of good practice in patient safety Lessons learned CONTENT

36. Indicators of good practice in patient safety 1. Use limited and regulated abbreviation of dose and annotations 2. To implement protocols to prevent wrong surgical site and wrong patient 3. Assessment and prevention of decubitus ulcers

37. Indicators of good practice in patient safety 4. Assessment and prevention of deep vein thrombosis 5. Appropiate management of anticoagulants 6. Prevention of infections associated with the use of central catheter

38. Indicators of good practice in patient safety 7. Prevention of surgical infections 8. Washing or disinfecting hands before and after direct contact with patients or objects around

39. Indicators of good practice in patient safety 9. Identification of high alert medications 10. Method for standardized labelling and storage of medicines 11. Assessment of climate for patient safety

40. The program in the national healthcare agenda Progress on training Signing the joint statement in favour of the first challenge of the World Alliance for Patient Safety of WHO National Campaign for Hand Hygiene Research Bulletins on Patient Safety Quality Committee Lessons learned CONTENT

41. Lessons learned • To continue the actions undertaken during the previous administration it was necessary to obtain political support for the new Administration. • The management changes bring slowness in the process already started. This is easy to reduce if you can put the item on the national agenda. • The training in cascade has helped bringing the issue of patient sfety to different hospitals in the health services throughout Mexico.

42. Lessons learned • The gain international commitments facilitates and promotes actions regarding patient safety. • The investigation into patient safety has been a great tool for raising awareness of the problem, not just to get the results, but from the moment starts training and conducts research in itself.

43. Lessons learned • The dissemination of knowledge from bulletins seems to be a good tool to create awareness and commitment. • To include the best practices in patient safety indicators on the process of accreditation seems to be a good measure to encourage work in favour of safety.

44. We all can make a difference Thank you osarabia@salud.gob.mx