Patient Safety Programs - Bioethics

Patient Safety Programs

Today in developed countries, efforts are being made to introduce so-called patient safety programs that set broad goals for creating a common safety culture in medical institutions. At the same time, the task of improving safety is regarded as a process that must be continuously developed. Each level reached becomes a step for a higher level of security. The culture of security as such is considered as the atmosphere of reliability, high professionalism, mutual trust and honesty.

Methods for analyzing medical errors and accidents & "Root cause analysis (RCA - Root Cause Analysis) - a group technique for investigating medical errors and accidents.

The initial setting is that the participants in the discussion should analyze the incident without charges and moral reprimands. A language is used without judgmental judgments and terms (such as "negligence", "incompetence", etc.). In order to reach the deep systemic causes of an incident, the technique of "five why" is used: the participants repeat the question "Why?" at least five times, going out at each new step to a deeper level of cause-effect relationships.

Questions can be asked not necessarily in the "Why?" form, depending on the context, you can ask questions "How it happened that ...", "What is it that ..." and the like.

Identifying the deep causes of an incident is not placing responsibility for blunders on individual workers, but research that aims to ensure that one case serves as a lesson for future possible cases in the future.

Example: The patient in the early postoperative period fell in the corridor of the hospital department. When parsing a case, a series of questions is asked: "Why did he move somewhere? How did it happen that he was alone in the corridor? Why did not anyone accompany him? and the like.

Explanations: he did not know that you can not get up; he did not have the opportunity to inform staff about his needs; the nurses were not properly instructed.

Conclusions, the control over the operated patients should be strengthened, special instructions should be introduced for the staff, the patients themselves, the notification system of the medical staff should be improved in the ward chambers.

In order for the program to really benefit, it must be carefully planned and prepared, otherwise it can cause a number of complications (including those of which just mentioned). The security program will require some effort from the staff and administration, as well as high demands on their moral qualities. At the same time, it should not turn into a certain rant, but be conducted in a calm and businesslike atmosphere.

The most important component of any safety program should be to increase attention to the compliance of the medical staff with the legal status of the patient. The various kinds of abuse (even petty) with respect to the rights of patients that staff can afford should be regarded as symptoms of unhappiness . Examples of such violations include disrespectful behavior (rudeness, indifference), non-informing the patient before medical interventions, frivolous handling of confidential information, neglect of the patient's opinion when choosing a treatment program, etc.

If the tendency to non-observance of the rights of patients is fixed, the medical staff creates a stereotype of careless actions, which carries an increased probability of medical care defects.

Improved observance of patients' rights will have a positive impact on the creation of a safety culture. After all, observance and protection of the patient's rights in the medical organization gives patients certain possibilities of self-defense against various dangers. It is enough to recall such essential rights as the right to choose a doctor, admission of a legal representative, consultation of a specialist.

Great importance is attached to the right to informed voluntary consent , the practice of which is regarded today as one of the significant factors of risk reduction.

The full information of the patient before the medical intervention, as mentioned earlier, should include information about the risks inherent in this intervention, and about possible alternatives to it, which enables the patient to make an informed decision.

The procedure of informed voluntary consent also disciplines the doctors themselves, which is also very significant. Indeed, doctors who have developed the habit of working in a full-fledged informed consent regime, always own information about the risks associated with this or that interference. This alone can keep them from choosing unreasonably risky procedures.

Thus, close interaction with patients, observance of their rights (and the rights of their representatives), maintaining a high professional and ethical level of the medical profession are the most important factors of ensuring safety in medical institutions.

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