President, Society for Promotion of Ethical and Affordable Health Care
Hospitals are monuments of disease and death, not resorts of health and happiness. Sick persons are wheeled in to hospitals to bring relief from pain and prevent deterioration. No doubt, many lucky ones recover from their injury or ailments or achieve childbirth during hospitalisation, but for many others, hospital admissions may mean pushing them in the jaws of death.
However, every process of patient care involves a certain degree of uncertainty and inherent risk. With over 50 lakh Indians dying due to medical errors, patient safety in the hospitals has assumed great concern.
Entering a hospital could expose many patients to adverse drug reactions and allergies, hospital acquired infections (HAIs), medical errors, procedure errors, lack of communication, bedsores, overdose or wrong route, dehydration, poor nutrition, stress and insomnia, fears from drugs or staff, horrors of medical technology, torture of frequent puncturing of blood vessels and pushing pipes into various orifices, avoidable scans and diagnostic testing, overuse of surgical procedures or wrong limbs, etc. Many have died due to falls, electrocution, septicemia, fires, terror attacks, let alone wrong treatment. A recent report of a German nurse killing 300 patients in the ICU is hair-raising.
Should one rush to hospitals for every sickness or make arrangements for domiciliary treatment as far as possible? How often the hospitals can save a patient who is in a state of dying? Is it a state of hope against hope or only demonstrative satisfaction to claim that all efforts were made?
Clear policies, organisational leadership capacity, data to drive safety improvements, skilled health care professionals and effective involvement of patients in their own care, are all needed to ensure sustainable and significant improvements in the safety of patients.
How hospitalisation can kill
Medical errors are inevitable. Wrong or missed or delayed diagnosis and HAIs are ubiquitous. Erroneous reports from laboratories or imaging centres often put doctors and patients on the wrong path. Lack of communication among hospital workers as well as between the patient and doctor is frequent. Most of those who man the emergency and ICUs are junior doctors and not well-versed in identifying and managing unexpected adverse events, which can have an enormous impact on the outcome of a patient's condition. This needs to be corrected. All actors must, within their remit, take responsibility for the development of an improved safety culture. Above all, things can go wrong despite care.
A report published in April this year from the PGI, based on a study of 11 ICUs of leading hospitals across the country reveals increasing incidence of fungal infections in the critically ill patients admitted therein. The mortality rate was found to be 76.6 per cent in such patients due to HAIs and not due to the conditions for which the patients were admitted. The source of infection was considered to be ducts of ACs, sweeping of dusty areas in the hospitals and the ongoing construction work in the hospitals.
In a survey of patients in America, 41 per cent said they had experienced medical errors in their own care or in the care of a close relative. What could be the scenario in India where the accountability is lower? The harms resulting from these errors can have an impact on the patient's survival, physical health, emotional health, financial well-being, or family relationships.
Criminalisation of events
The last thing doctors would wish to do is to allow or cause harm to patients. Despite the medical community acting in good faith, criminalisation of unfavourable events is becoming common. In a recent judgment, the state consumer commission directed a Nagpur-based hospital to pay Rs 20 lakh compensation. The aggrieved patient had suffered brain injury due to a fall from a trolley, while being shifted for a CT scan. While the family's plea of negligence that no doctor or nurse was present while shifting the patient was accepted, the defendant's plea that cause of death was advanced cancer and that doctors were not employed for trolley-pulling was dismissed. This is not an isolated case.
Patient safety is everyone’s business
Concerned with too many mishaps in hospitals, several organisations have held conferences, seminars, workshops, expert group meetings to discuss ways to minimise the problems. The Seventh World Patient Safety, Science and Technology Summit was organised by the Patient Safety Foundation in January 2019 in the USA. It saw a large gathering of hospital leaders, medical technology companies, patient advocacy community, public policy makers and government officials from around the world.
Patient Safety Awareness Week is observed from March 10-16 annually to encourage everyone to learn more about patient safety. World Patient Safety Day is celebrated every year on December 9 to raise awareness. The International Patient Safety Day is held on September 17 every year; it is a day of campaign for all stakeholders to improve patient safety. The focus of this year’s International Day is ‘safety culture at all levels’.
Can the objective of zero hospital deaths due to lack of patient safety efforts be achieved?
What patients should do for their own safety
- Assist the hospital staff by ensuring that your history is adequate, accurate and detailed, including that of allergies.
- Read prescription carefully; ask questions if you have doubt about the treatment plan, quantity, dosage regimen, mode of administration, side-effects, likely outcome.
- Ask the doctor about the pros and cons of any medical procedure that is prescribed for you. Be a partner in management.
- Follow some basic precautions: i) Doctors and patients need to wash hands frequently. ii) Wear gloves while coming in contact with the patient. iii) Wear surgical mask, eye wear or face shield: patient as well as doctor. iv) Sterilise linen properly v) Use disposal syringes and needles. vi) Clean and disinfect reusable equipment vii) Dispose of hospital waste properly. viii) Cover the nose/mouth of the patient and doctor with tissue/ handkerchief while coughing/sneezing. ix) Take special care of the old, frail and sick patients against falling from bed/stretcher or in the toilet.
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