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Hospitals are dangerous places for patients! Safety is your own business

Dr. R.Kumar

President,  Society for Promotion of Ethical and Affordable health Care

Hospitals are monuments of disease and death and not resort of health and happiness.  Sick persons are wheeled 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 hospitalization, 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 5,000,000 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! Recent report of a German nurse killing 300 patients in 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, organizational 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 Can Hospitalization kill?

Medical errors are inevitable. Wrong or missed or delayed diagnosis and HAIs are ubiquitous. Erroneous reports from laboratories or imaging centers often put doctors and patients on 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 are not well-versed in identifying and managing unexpected adverse events, which have 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 on April 27, 2019 from PGI, based on a study of 11 ICUs of leading hospitals across the country revealed increasing incidence of fungal infections in the critically ill patients admitted therein. The mortality rate was found to be 76.6% 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 percent 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 impact on the patient's survival, physical health, emotional health, financial well-being, or family relationships.

Criminalization of unfavorable events

Last thing doctors would wish to do is to allow or cause harm to patients. Despite the medical community acting in good faith, criminalization of unfavorable events is becoming common. In a recent judgment, State consumer commission directed a Nagpur based Hospital to pay Rs 20 lakhs Compensation. The aggrieved patient had suffered brain injury due to fall from trolley, while being shifted for CT scan. While family’s plea of negligence that no doctor or nurse was present while shifting the patient was accepted, defendant’s plea that cause of death was advanced cancer and for trolley- pulling doctors were not employed was dismissed. This is not an isolated case.

How can patient participate in 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 basic precautions viz. 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)  Proper sterilization of linen v) use of disposal syringes and needles vi) Clean and disinfect the reusable equipments vii) proper disposal of hospital waste viii) Cover the nose/mouth  of patient and doctor with tissue/ handkerchief while coughing / sneezing ix) Special care for old, frail and sick patients against falling from bed/stretcher or in the toilet.

Patient safety is everyone's business! 

Concerned with too many mishaps in hospitals, several organizations hold conferences, seminars, workshops, expert group meetings to minimize the problems.  7th World Patient Safety, Science & Technology Summit was organized by Patient Safety Foundation in January 2019 in USA. It saw a large gathering of hospital leaders, medical technology companies, patient advocacy community, public policy makers and government officials, worldwide. Patient Safety Awareness Week is observed from 10–16 March annually to encourage everyone to learn more about patient safety. World Patient Safety day is celebrated every year on 9th of December to raise awareness.  The International Patient Safety Day is held on Sept 17 every year; 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?

 

 The Tribune 17th June 2019

 

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