06/11/2012

Patient Safety Standards in

Developing Countries of the
WHO/Eastern Mediterranean Region
Riham El-Asady, WHO/EMRO
ISQua-29th International Conference
CICG, Geneva

20-24 October, 2012

Health care systems in the EMR: In the EMR: 90% of the population
resides in middle and low countries
Patient Safety Perspective
• 23 countries and health systems covering a
population of 530 million
• Estimated annual admissions
> 30 million

3 4

TUNISIA
EGYPT

SYRIA

LIBYA

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Iraq

Afghanistan

SOMALIA

Pakistan Adverse Events in Health Care

■ Up to 18% of hospital patients in EMR suffer an adverse event

■ HAI: 5-10% of hospitalized patients (up to 37% in ICUs

■ In developing countries, the number of health care-associated

infections at any given time is 15.5 per 100 patients;

■ 2.7% of all admissions are associated with death or permanent

disability

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Regional Strategy for Patient Safety 5 Axes to Patient Safety Friendly

enhance the safety of patients
Hospital Initiative (PSFHI)
I Awareness
II Assess Scope • Promote safe practices in hospitals by assessing
adherence to PS guidelines developed by WHO
• Develop standards for assessing patient safety
EMR and guidelines for implementation
Patient Safety
Strategy
– Patient safety assessment manual
V Organizing &
Running
III Understanding the – 7 hospitals identified as pilot sites for PSFHI – EGY,
Causes of Error
PS programs JOR, MOR, PAK, SUD, TUN, YEM

IV Developing &
Testing Methods
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For Prevention

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Patient Safety Friendly Five Domains for Measuring Patient

Safety in Hospitals
Hospital Initiative (PSFHI)
Objective
• Enhance patient safety by developing harmonized
standards and indicators to which hospitals
adhere
Approach
• Assessment phase
• Improvement phase
Duration
• Since Jan 2008………
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Patient Safety Friendly Patient Safety Friendly Hospital

Hospital Initiative (PSFHI) Initiative (PSFHI) –Assessment Manual
• PS Assessment manual
developed
– Review of literature
– Internally reviewed
– Externally reviewed
– Pre-piloted in two
hospitals in Egypt
– Piloted in 7 hospitals
in 7 countries
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PSFHI: Critical Standards, Baseline assessment of

Examples pilot hospitals in 7 countries
Domain Critical Standard [Abbreviated Text]

A. Leadership & •Hospital has designated a senior staff

Management member with responsibility, accountability
Standards EGY JOR MOR PAK SUD TUN YEM
Measures and authority
B-Patient & Public •Before any invasive procedure consent is
signed and patients informed of all risks,
Critical (20) 15.5 12 10.5 13 8 11 5
Involvement
Measures pros and cons
C. Safe Evidence Core (90) 41 34 25.5 34 22 32.5 16.5
based Clinical •Hospital ensures availability of life saving
Practices medications at all times
Developme
Measures 0.5 4 1 3.5 1 3 1
ntal (30)
D. Safe
•Hospital segregate waste according to
Environment
hazard level and color code it Total (140) 57.5 50 37.5 50.5 32.5 47.5 22.5
Measures

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Baseline assessment of PSFHI: From Assessment to

pilot hospitals – By domains Improvement
Standards Total EGY JOR MOR PAK SUD TUN YEM
• Improvement Phase of the PSFHI – Develop action
plans for 7 pilot hospitals
Leadership
and 36 13.5 17 12.5 14 11 16 6.5 • Package of interventions for improving patient safety
Management • WHO hand hygiene guidelines
• Safe surgery saves lives
Patient
28 7 5.5 1.5 6 6.5 6.5 3 • Antimicrobial resistance and hospital infection
Centeredness
• Patient safety solutions
Evidence • Build regional capacity for research on PS
based 44 23.5 15 11 18 10.5 23 8 • Patient safety reporting systems
Practice
• Engage civil society to represent the – “voice of
Environment 21 13.5 11 10 10.5 4 6.5 5.5 patients”
Lifelong
learning 11 1 1 3 1 1 3 1

IS there evidence for improvement

following implementation?

Consolidate and Expand PSFHI

in EMR countries July 2010, Teheran, Iran
• MOH&ME, Iran launched
PSFHI in 10 hospitals.
Assessment manual
translated to Farsi.
• MOH, Jordan has June 2010, Islamabad, Pakistan
requested to launch PSFHI
in 23 public sector hospitals,
initiated in 8
• MOH, Pakistan has
established PSFHI covering
all federal hospitals,
expanded to 10 hospitals

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Second wave of PSFHI countries
Afghanistan, Iraq, Libya, Syria Baghdad October 2010
Challenges!!
• Patient Safety is an unfinished agenda. Covering 40
hospitals is less than 1% of EMR public hospitals;
• PS is a major problem in the unregulated private
sector of most EMR countries;
• PS has yet to be included as a key component of PHC
network of EMR countries;
• Patients lack the “voice” to be better heard in the
event of patient harm as a result of health care;
• Patient safety is yet to be universally acknowledged
as patients’ right
06/11/2012
Next steps
• In-depth research to determine if implementation
is associated with decrease in AE
• Capacity building in countries in conflict
• Expansion in countries in which initiative has
been previously initiated
• Private hospital engagement-Bahrain
• GCC country engagement
• Patient safety improvement manual under
development
Lessons learnt - PSFHI
• Provides evidence that assessment of PS is feasible in
hospitals in resource poor settings;
• PSFHI is a development initiative that is informed by
research and evidence;
• Relies heavily on the support and commitment of a
team of regional patient safety experts;
• Refinement of assessment tools is a continuous
process and should not deter the move towards
improvement;
• Patient errors should be seen as a system problem and
not as faults of individuals – avoid blame culture;
• Ownership of Ministries of Health is critical for
sustainability of this initiative