Patient Safety in the Eastern Mediterranean Region

Health Care Delivery Unit,Health Systems and Services

DevelopmentEMRO

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Contents• The first Regional Meeting on Patient Safety…………………………………….................

– Kuwait Declaration on Patient Safety …………………………………………………..– Regional Strategy for Patient Safety ……………………………………………………

• Community Participation: Patients for Patient Safety …………………………...................– Patient Safety Champions …………………………………………………...................– Eastern Mediterranean Regional Endorsement of the London Declaration on

Patient Safety ……………………………………………………………………………..• Action at Facility level: Patient Safety Friendly Hospital Initiative ………………………….

– Guidelines and surveyor manual ………………………………………………………..• Research on Assessment of the nature and magnitude of adverse events in the

healthcare system in EMR ……………………………………………………………………..– Medical Record Review Training ………………………………………………………..– Summary of research projects team structure………………………………………….– Results ……………………………………………………………………………………..– Alternative Research Tools ………………………………………………………………

• Questionnaire on Patient Safety ………………………………………………………………• Global Patient Safety Challenges……………………………………………………………..

– Clean Care is Safer Care ………………………………………………………………..– Clean Care in EMR ……………………………………………………………………….– Hand Hygiene Campaigns ……………………………………………………………….– Safe Surgery Saves Lives ………………………………………………………………..

• Solutions …………………………………………………………………………………………• Taxonomy for Patient Safety …………………………………………………………………..• Collaboration …………………………………………………………………………………….

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The first Regional Meeting on Patient Safety Kuwait, 2004

Kuwait Declaration on Patient Safety

The first intercountry consultation for ‘Developing a Regional Strategy for Patient Safety in EMR countries’ was held from 27 to 30 November 2004 in Kuwait City in collaboration between WHO/EMRO, the Ministry of Public Health, Kuwait and the Executive Board of the Health Ministers’ Council of the Gulf Cooperation Countries (GCC).

The meeting had the following objectives:•To review activities of EMR member states on patient safety•To review a draft questionnaire on patient safety developed by WHO/EMRO•To develop a regional strategy for patient safety in the Region.•To develop a broad regional plan of implementation

Among the main products of this meeting was the Kuwait Declaration on Patient Safety and a Regional strategy was developed

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II Assess Scope

V Organizing & Running

PS programs

I Awareness

III Understanding the Causes of Error

IV Developing & Testing MethodsFor Prevention

EMR

PS

Strategy

5 Axes to enhance the safety of patients

Regional Strategy

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Community Participation:

Patients for Patient Safety

Patients for Patient Safety, one of six action areas of the World Alliance for Patient Safety (WAPS), emphasizes the central role patients and consumers can play in these efforts. Through the work of Patients for Patient Safety, the World Alliance, in conjunction with the WHO Eastern Mediterranean Regional Office (EMRO), aims to develop a network of patients, consumers, caregivers and consumer organizations worldwide to support active patient involvement in patient safety programs both within countries and the global work program of the Alliance. Our ultimate purpose is to improve health care safety in all health care settings through involving consumers as partners.

Following on from a regional event in May 2006 in the Pan-American region, the WHO World Alliance for Patient Safety will hold an EMRO Regional Patients for Patient Safety Workshop from the 26th to the 28 th of March 2007, Cairo, Egypt.

For more information, please contact HCD@emro.who.int

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Patient Safety Champions

• Several individuals have opted to serve as advocates for patient safety in their country.

• Such individuals from the community are called “Patient Safety Champions”.

• Champions are commonly patients or family members who have experienced medical error and have worked constructively with health care providers to eliminate error.

• Champions are assigned by the Patients for Patient Safety strand of the World Alliance for Patient Safety.

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We, Patients for Patient Safety, envision a different world in which healthcare errors are not harming people. We are partners in the effort to prevent all avoidable harm in healthcare. Risk and uncertainty are constant companions. So we come together in dialogue, participating in care with providers. We unite our strength as advocates for care without harm in the developing as well as the developed world.

We are committed to spread the word from person to person, town to town, country to country. There is a right to safe healthcare and we will not let the current culture of error and denial, continue. We call for honesty, openness and transparency. We will make the reduction of healthcare errors a basic human right that preserves life around the world.

We, Patients for Patient Safety, will be the voice for all people, but especially those who are now unheard. Together as partners, we will collaborate in:- Devising and promoting programs for patient safety and patient empowerment.- Developing and driving a constructive dialogue with all partners concerned with patient safety.- Establishing systems for reporting and dealing with healthcare harm on a worldwide basis.- Defining best practices in dealing with healthcare harm of all kinds and promoting those practices throughout the world.

In honor of those who have died, those left disabled, our loved ones today and the world’s children yet to be born, we will strive for excellence, so that all involved in healthcare are as safe as possible as soon as possible. This is our pledge of partnership.

EMR Endorsement of the LONDON DECLARATION

Cairo, Egypt March, 2007

Patients for Patient SafetyWHO World Alliance for Patient Safety

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Patient safety friendly hospital initiative (PSFHI)

PSFHI is a program that aims to instigate and encourage safe health practices in hospitals in the Eastern Mediterranean region (EMR). It represents a collaboration with the World Alliance for Patient Safety (WAPS), the International Islamic Relief Organization (IIRO) and Member States. The project will integrate many patient safety activities under one umbrella and ensure abidance of health care facilities by a set of validated patient safety standards. Development of standards and implementation guidelines is already in progress at EMRO. An expert panel will be recruited to examine these standards in accordance with the guidelines provided by WHO. This initiative is likely to encourage hospital participation and more importantly, to raise awareness of the issue of patient safety in the EMR. Hospital surveillance will be performed by trained surveyors. Wherever possible, in the interest of cost effectiveness and sustainability, focal points will be appointed in each participating hospital to help in the dissemination of awareness, capacity building and training as well as follow up and monitoring. Following hospital inspection for implementation of set standards, surveyors will issue a certificate indicating that the participating hospital is, indeed, a “Patient Safety Friendly Hospital”, abiding by the standards set by WAPS and approved by the local Ministry of Health (MOH).

For more information, please contact HCD@emro.who.int

Action at facility level

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Patient Safety Friendly Hospital Initiative

Guidelines and Surveyor Manual

• Guidelines for implementation and a manual for surveyors has been drafted in EMRO. Further work is required for finalization and revision.

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Research on Assessment of the nature and magnitude of adverse events in the healthcare system in EMR

With the purpose of implementation of patient safety measurement tools and training on the methods of hospital record review using the guidelines set by WHO and WAPS, 2 workshops were held at EMRO in Cairo in December, 2005 and May, 2006. 6 countries of EMR participated at the workshop, including Egypt, Sudan, Jordan, Tunisia, Morocco, and Yemen. In addition, 2 countries from AFRO were involved: S. Africa and Kenya.

Participants included a diverse array of technical expertise including, physicians, nurses, epidemiologists, statisticians, IT specialists and MOH officials. The workshops were conducted by an expert panel from Australia, U.K. and France and involved comprehensive analytical review of the current literature, description of the magnitude of the problem of patient safety and on-site training on the method of record acquisition and analysis. Tentative plans were submitted by each country describing an approximate timeline for completion of the plans of action agreed upon during the workshops.

Welcome poster at Chest Hospital, Cairo where initial training was conducted

Dr. M. Abdi Jama, Deputy Regional Director, inaugurates Patient Safety Research Workshop,

EMRO, Cairo, May, 2006

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Training in Sudan

Technical support was provided by the Northern Centre for Healthcare Improvement headed by Dr. Ross Wilson. Dr. Wilson is a member of the Australian Council on the Quality and Safety of Health Care and a board member for the British Medical Journal. Dr Wilson is a Senior Specialist in Intensive Care Medicine at the Royal North Shore and Sydney Adventist Hospitals. Dr Wilson has a strategic role in improving the quality and safety of health care, using education and research in the development and implementation of state and national policy. Additional technical support was provided by Ms. Sisse Bjorn Olsen Clinical Research Fellow Division of Surgery, Oncology, Reproductive Biology and Anaesthetics and Dr. Philippe Michel, Medical Director CCECQA (Comité de Coordination de l'Evaluation Clinique et de la Qualité en Aquitaine).In addition to hands-on technical support, the above-mentioned experts developed a web-based tool for acquisition and analysis of data on adverse events from hospitals.

Partnership On the patient safety initiatives, EMRO has partnered with WHO/HQ and AFRO. Other organizations that actively employ patient safety as a part of their overall objectives and strategy and with which WHO/EMRO has partnered to enhance patient safety include Executive Board of the Health Ministers’ council for the Gulf Cooperation Council States, the International Islamic Relief Organization (IIRO) and the World Alliance for Patient Safety (WAPS).

Egyptian team in training, Chest Hospital, Abbasiyya, Cairo

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Second training workshop on implementation of Patient Safety Plans of Action

WHO/EMRO

Cairo, 8-11 May, 2006

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On-site Training on Medical Record Review

Regional Team in training

Chest Hospital, Abbasiya, Cairo

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National Commitment

.13عمان/ / / التميمي أمل من بترا الثاني تشريناالردن بافتقار الخرابشه سعد الدكتور االدارية للشؤون الصحة وزارة عام امين اعترفللمرضى العرضية والحوادث الطبية االخطاء حجم تظهر التي واالحصائيات للدراساتالمساءلة قانون الصدار نهائية صيغة الى التوصل عدم عن فضال المستشفيات في. الخدمه ومتلقي مقدم من كل يحمي الذي الطبية

وتقييم " المرضى سالمة مشروع ل تدريبية عمل ورشة اليوم افتتاحه لدى وقالاالمنة " .. غير الممارسات ان الحكومية المستشفيات في االمنة غير الممارساتوجهت التي والشكاوى المالحظات خالل من وظهرت االخيرة السنوات في ازدادتالتي والبرامج المبادرات من العديد وضع الى الوزارة دفع والذي الخدمة لمقدمي

الصحيه الرعاية سالمة تحسين على Part of an official press release in Amman, Jordan marking the initiation .تساعدof research for detection of adverse events in Jordan.

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Summary of Patient Safety Research Projects in the Eastern Mediterranean Region

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Egypt

Jord

an

Mor

occo

Sudan

Tunisi

a

Yemen

country

Nu

mb

er

Number of Hospitalsengaged in research project

Team Members Identified

Number of nurses

Number of physicians

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Results

• 15,000 records have been reviewed and analyzed from 27 hospitals in the Region.

• The results of the study are nearing completion. They will shed light on the rate of adverse events in health care facilities in the Region.

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Alternative research tools

Tools introduced by Philippe Michel (France) in 2007

Include observation, staff interview and focus groups

Pilot testing already initiated in Jordan, Sudan and Tunisia

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Patient Safety Checklist for Ministry of HealthContents: A. Program

A.1 ConceptA.2 ScopeA.3 Policies & ProceduresA.4 Structure & ManagementA.5 Resources

B. ReportingB.1 Internal B.2 External

C. Risk assessmentD. Research

D.1 ProjectsD.2 Publications

E. StatisticsE.1 NationalE.2 International

F. Awareness/ EducationF.1 PatientsF.2 Health care providersF.3 Stakeholders

G. TrainingG.1 NationalG.2 International

H. Implementation & follow-upH.1 ImplementationH.2 Follow-up

Patient Safety Questionnaire

During the 1st Intercountry Consultation on Patient Safety, held in Kuwait in November 2004, the first draft of a Patient Safety Questionnaire was developed for completion by MOH officials. This process is a crucial prerequisite for the establishment of individual country patient safety profiles.

For more information, please contact HCD@emro.who.int

World Health OrganizationEastern Mediterranean Regional

Office (EMRO)

Patient Safety Questionnaire

Patient Safety ProgramHealth Care Delivery UnitDivision of Health Systems and Services Development

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Global Patient Safety Challenges

1st Global PS Challenge: Clean Care is Safer CareSince its launch in 2005 , the 1st GPSC has been endorsed by several countries in

the region. Countries that have pledged to address Healthcare-associated infections include Pakistan, Oman, Sudan, Bahrain, UAE, Kuwait, Qatar, Saudi Arabia, Iran and

Jordan. Egypt has proposed to launch the challenge in early 2008. Furthermore, 2 pilot sites for testing the Hand Hygiene guidelines have been established in Pakistan

and Saudi Arabia. Complementary test sites have also been established in Egypt, Iran, Saudi Arabia, Pakistan, Tunisia, Oman and Bahrain.

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1st Global Patient Safety Challenge: Clean Care is Safer Care

Launched Challenge√√Pilot site Complementary site

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Hand Hygiene Campaigns

Kuwait

Saudi Arabia

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2nd Global Patient Safety Challenge: Safe Surgery Saves Lives

• Following development of the surgical checklist at the working group meeting in London (April, 2007), a pilot site for testing of the checklist has been selected in Amman, Jordan (Al-Ameer Hamza Hospital). An implementation coordinator, as well as a data collector, were selected based on communication between WHO/HQ, EMRO and WRO-Amman. Furthermore, EMRO is in the process of studying significant pertinent bodies in the area of surgery, anesthesia and nursing to involve in the initiative to ensure regional expansion and sustainability as directed by WHO/WAPS.

A. Development of a surgical checklist for patient safety

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10-11 January 2008 sees the Second International Consultation meeting of the Second Global Patient Safety Challenge at WHO Headquarters in Geneva, Switzerland. The purpose of the meeting is to introduce the Draft Surgical Safety Checklist to a wide audience. During the meeting the group will obtain feedback regarding its use as a quality improvement device for surgical safety, review the original goals of the challenge and the process of creating the checklist, and review a set of surgical vital statistics as a measure of the public health impact of surgery.

Representatives from the Eastern Mediterranean Region have been selected for attendance such that adequate representation of the Regional perspective is ensured.

2nd Global Patient Safety Challenge: Safe Surgery Saves Lives

B. International consultation meetings

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2nd GPSC: Safe Surgery Saves Lives

Pilot site for surgical checklist

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Solutions• Over the past year, the WHO World Alliance for Patient Safety (WAPS), in

collaboration with WHO Collaborating Centre for Patient Safety Solutions (within the Joint Commission in the United States), has been working on devising the first set of patient safety solutions. In April 2007, the International Steering Committee approved nine solutions for dissemination and on 2 May 2007, the nine patient safety solutions were launched in Washington.

• The Patient Safety Solutions are as follows:• Look-alike, sound-alike medication names; • patient identification; • communication during patient hand-overs; • performance of correct procedure at correct body site; • control of concentrated electrolyte solutions; • assuring medication accuracy at transitions in care; • avoiding catheter and tubing misconnections; • single use of injection devices; and • improved hand hygiene to prevent health care-associated infection.

An information note has been sent to WRs of all EMR counties

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Taxonomy for Patient Safety

• Taxonomy for Patient Safety aims to define, harmonize and group patient safety concepts into an internationally agreed classification. This will help elicit, capture and analyze factors relevant to patient safety in a manner conducive to learning and system improvement. The classification aims to be adaptable yet consistent across the entire spectrum of health care and across cultures and languages.

Representatives from EMR have been selected for engagement with WHO/HQ expert groups in the development and refining of the International Classification on Patient Safety.

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Collaboration

• Collaboration between WHO/EMRO and the World Alliance for Patient Safety, the International Islamic Relief Organization (IIRO), the Gulf Cooperation Council (GCC) are among the most outstanding collaborations in the area of patient safety. In addition collaboration with medical institutions, syndicates and ministries of health have been critical.