African Partnerships for Patient Safety (APPS): Relevant to a Ghanaian Medical Superintendent?
Dr. Shams Syed & the KATH team
Ghana, November 2012
Outline
Programme genesis
Canvass, paint and painters
What about KATH?
What it means for a Medical Superintendent?
Presenter
Presentation Notes
Before we get into our programme it may be useful to reflect on what exactly patient safety is?
Programme Genesis
World Health Assembly Resolution 55.18
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May 2002 Programme established May 2004 Agreement to establish international alliance October 2004 Launch of World Alliance for Patient Safety
Putting safety on the world's agenda
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The fact that error and adverse medical events were more the norm than the exception burst on the medical research and policy scene in 2000 with the publication of two seminal works, To Err Is Human (2000) and the UK’s Organization with a Memory (2000). In May 2002, the 55th World Health Assembly adopted WHA Resolution 55.18, which urged Member States to pay the closest possible attention to the problem of patient safety and to establish and strengthen science-based systems necessary for improving patient safety and the quality of health care. Following this, in May 2004, the 57th World Health Assembly supported the creation of an international alliance to facilitate the development of patient safety policy and practice in all Member States, to act as a major force for improvement internationally. WHO Patient Safety addresses patient safety in health care as an issue of global importance. It promotes the development of evidence-based norms for the delivery of safer patient care, global classifications for medical errors and it supports knowledge sharing in patient safety between Member States. WHO Patient Safety also advocates for a better understanding of the reasons of unsafe care and identifies the most effective preventive measures and means of evaluating them. It works with leading international experts, organizations, patient NGOs and many others, to draw international attention to the issue of patient safety.
WHO Surgical Safety Checklist
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The purpose of a checklist is to detect a potential error before it leads to harm. Human error in the complex world of modern medicine is inevitable. Harm to patients as the result of these errors is not. Checklists can help ensure consistency and completeness in carrying out complex tasks. Under the leadership of Atul Gawande at Harvard School of Public Health, WHO Patient Safety have taken the concepts and principles of a checklist and applied them to surgery. The results of a year-long pilot study of the Surgical Safety checklist in eight developed and developing countries (Canada, India, Jordan, New Zealand, Philippines, United Republic of Tanzania, United Kingdom, United States of America) were published in January 2009, in the New England Journal of Medicine. This study revealed an average reduction in mortality and morbidity of more than one-third after implementation of the checklist. With the success of the WHO Surgical Safety Checklist, it is feasible to imagine that many more processes of care could be amenable to such a safety measure. �WHO Patient Safety is currently developing a framework for identifying a range of clinical care processes where checklists would save patient lives and reduce serious harm. WHO Patient Safety, with help from other collaborating departments within the WHO, is already developing additional checklists over a range of disciplines, including labor & delivery, neonatal and trauma care.
Safe Surgery saving lives
Baseline Checklist P value
Cases 3733 3955 -
Death 1.5% 0.8% 0.003
Any Complication 11.0% 7.0% <0.001
SSI 6.2% 3.4% <0.001
Unplanned Reoperation
2.4% 1.8% 0.047
Haynes et al. A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. New England Journal of Medicine 360:491-9. (2009)
36% reduction in complications
40% reduction in SSIs
WHO AFRO Regional Committee Yaoundé, Cameroon
September 2008 10. Promote
partnerships.11. Provide adequate
funding
12. Strengthen surveillance and
capacity for research
7. Ensure health-care waste
management
8. Ensure safe surgical care
9. Ensure appropriate use,
quality and safety of medicines
4. Address the context in which health services &
systems developed
5. Minimize healthcare-associated infection
6. Protect health-care workers
1. Develop and implement national policy for patient
safety
2. Improve knowledge and
learning in patient safety
3. Raise awareness
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Presentation Notes
Mandate slide. Also mention that this was built on previous work e.g. 2005 Nairobi Kenya Ministry of Health hosted event Focused on patient safety in Africa and launched regional efforts 2007 Kigali Workshop Joint WHO AFRO and WHO Patient Safety event 50 participants from 21 countries Developed recommendations for national policies and strategies Health care associated infections (HAI) considered a priority
Studies conducted in Africa (1995-2009): 19 articles, 3 conference abstracts
Studies on HAI: 7
Studies on UTI: 1
Studies on SSI rates: 11
Studies on HAP/VAP: 3
• HAI prevalence: 2.5-14.8% • HAI incidence: 5.7- 48.5% • SSI incidence: 2.5-30.9 per 100 oper. pts • SSI incid. in clean wounds: 6.5 - 20.2% • SSI incid. in dirty wounds: 44.1 - 83.3% • UTI prevalence: 0.7 and 4.5% • HAP prevalence: 1.7 and 2.9 % • VAP incidence: 50 per 100 vent. pts
Shaping the programme – painters!
Three Core Objectives African Partnerships for Patient Safety
European APPS
Hospital
African APPS
Hospital
Objective 1: PARTNERSHIP STRENGTH
Objective 2: HOSPITAL PATIENT SAFETY IMPROVEMENTS
Objective 3: NATIONAL PATIENT SAFETY SPREAD
What is a partnership?
"Partnership can be defined as a collaborative relationship between two or more parties based on trust, equality, and mutual understanding for the achievement of a specified goal. Partnerships involve risks as well as benefits, making shared accountability critical."
• Achievements - HCAI training/capacity building & HH implementation - HCWM system: simple steps & infrastructure change - Safe surgery system: Kisiizi checklist - Drug and therapeutics committee established &
medicines systems developed - Patient safety training manual developed - Presidential award!
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Mechanism to record hospital deaths following surgery – from no to yes! Mechanism to record complications resulting from surgery – from no to yes! Is anyone at the hospital aware of the WHO Safe surgical Checklist – yes and yes! (but strengthened)
Kisiizi, Uganda – Innovative Processes
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Dr. Tonny from Uganda partnership highlighted 2 key innovations: -Utilizing local bananas to procure alcohol for ABHR WHO recipe since it is less costly than getting alcohol ingredient from outside donor. -Within Safe Surgery checklist, FBO so they incorporated the question: “Have you prayed for the patient?” into their checklist Dr. Jessie from Malawi: -Wanted to decrease on waste from plastic bottles used for ABHR use. So she procured 650 cc bottles of 50 cc ABHR from UK with a belt clip. Staff will have to go the pharmacy to fill up their personal 650 cc bottle. This way pharmacy can monitor use of ABHR per ward and there is limited waste of plastic by not throwing away ABHR bottle after it is finished.
The Improvement Continuum and APPS
A simple 6-step process…
What about KATH?
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Presentation Notes
NOTE KEY CHALLENGES AND CONSIDER HOW TO IMPROVE AND BUILD FOR THE FUTURE Complex political landscape (global/regional/country/hospital) High expectations…limited capacity Logistics – blockages at every turn! Unfamiliarity with a new way of working Demonstrating benefits to European hospitals Balancing role of APPS core team and partners Developing a sustainable spread model Planning, doing and learning at the same time
"Second Wave" APPS Partnership Workshop – November 2011
APPS: KATH (Kumasi) - St. George's (London)
• Patient safety action areas 1. HCAI 2. Safe surgical care 3. Health care waste management
• Partnership Activities - First systematic patient safety situational
analysis in a hospital in Ghana - Patient safety partnership plan finalized for
implementation in each action areas - Formation of patient safety action teams - Partnership visit from KATH to St. George's –
technical exchange! - Adaptation of safe surgery checklist - Development of IPC audit tools and workforce
development in IPC - Strengthening of health care waste
management system
What it means for a Medical Superintendent?
A simple 6-step process…
APPS Triad
Situational Analysis
Resource Map
The APPS Approach
Improving Patient Safety –
First Steps
1 Look at where the gaps are
2 Identify critical areas for action 3
Locate the resources that will help you improve
About the Situational Analysis
• Purpose? – Rapid baseline information collection by
African hospitals. • Structure?
– 3 parts • Part 1 – explanations; • Part 2 – general hospital demographics; • Part 3 – the 12 patient safety action areas.
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Presentation Notes
Emphasise that the Situational Analysis is for use by any individual or hospital team that seeks to gain a rapid understanding of the patient safety situation in their institution.
Types of resources The term resource is used to describe anything which might have utility in addressing the gaps identified as a result of undertaking the APPS Situational Analysis. The resources listed within this Map are diverse and span, not exclusively, guidance, policies, publications, templates and toolkits.
Improving Patient Safety – First Steps
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Presentation Notes
This resource outlines an approach to improving patient safety using a partnership model, structured around 12 action areas for improvement and with spread as a central aim. It lists some considerations for improvers at the start of their improvement journey. Outlines the partnership approach Structured around 12 Action Areas Lists the critical considerations for patient safety improvers at the start of their journey.
Review of literature Next steps! • Constructing the case • Both tangible and intangible benefits
• Advancing the knowledge pool • Special theme issue expected in 2013
And not to forget… Benefits to "developed" countries!
" We must never forget the importance of high-quality clinical care." "What good does it do to offer free maternal care and have a high proportion of babies delivered in health facilities if the quality of care is sub-standard or even dangerous?"
