Keeping patients safe in nigeria


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Keeping patients safe in nigeria

  1. 1. Dr Olufemi Aina Consultant Aesculapius Healthcare Consultants
  2. 2.  Competencies in Healthcare Project Management, Business Development, Idea Generation, Process Improvement, Financial Management and Healthcare Quality Management.  MasterTrainers in TeamSTEPPS Patient Safety Strategies, Certified by the US. Department of Defense and Agency for Healthcare Research and Quality (AHRQ)  Certified Project Managers with Project Management Institute (PMI) in the United States.  Certified Quality Management and Process Improvement Experts with American Society of Quality (ASQ) .  USAID SHOPS (Strengthening Health Outcomes though Private Sector)Trainers on Financial Management for Medical Directors
  3. 3.  Only TeamSTEPPS Provider in Nigeria  Hospital Quality Management and Process Improvement  Hospital Business Advisory and Financial Management  Tailored Capacity Development for Healthcare Professionals  Hospital Marketing and Branding Service  Outsourced Hospital Management
  4. 4.  Young NYSC dr. in a GH, Lagos many years ago: ordered IM drugs, nurse uncomfortable, even though gave lower dose- respiratory arrest, called and answered promptly.  Young Father in a PH, Lagos: 2 years ago: overworked nurse (esp. with reports), set up IV line, suction didn’t work, sucked manually
  5. 5. Quality: the degree of the realisation of the reasons that the patient has come to the care hospital e.g. patient comes to for an operation. Safety:results which are not the reasons for the patient coming e.g. ‘not catching an infection’ and he is implicitly confident he will not run the risk of this happening. To a certain extent, ‘safety’ thus concerns ‘anti- quality’.
  6. 6. Near Miss is defined as an act could have harmed the patient but did not do so as a result of:  chance e.g. patient received a contraindicated drug but did not experience an adverse drug reaction  prevention e.g. a potentially lethal over-dose was prescribed, but a nurse identified the error before administering the medication  mitigation e.g., a lethal drug overdose was administered but discovered early and countered with an antidote. Adverse Events cause harm to patients—causing a large number of injury, disability, and death.  errors of commission e.g., prescribing a medication that has a potentially fatal interaction with another drug the patient is taking.  errors of omission (e.g., failing to prescribe a medication from which the patient would likely have benefited, which may pose an even greater threat to health.
  7. 7.  Processes or structures which, when applied, reduce the probability of adverse events resulting from exposure to the health-care system across a range of diseases and procedures.  Healthcare-associated infection is a global problem with over 1.4 million people suffering at any given time.  Medical errors result in numerous preventable injuries and deaths.  Inadequate Patient Safety Data in African Region
  8. 8. Adverse events 4% to 16% of all hospitalized patients Developing Countries estimated 5% to 10% of patients acquire one or more infections Risk 2 to 20 times higher than in developed countries. Sentinel Events SurgicalCare- > 50% of Adverse Events, Unsafe injections, blood and medicines African Countries Mali 18.9%,Tanzania 14.8%, Algeria 9.8% Drugs 25% of medicines are counterfeit, poly- pharmacy, inappropriate use of antimicrobials; overuse of injections, lack of prescription guidelines, inappropriate self-medication, non-adherence to dosing regimes.
  9. 9. 9 2006 Patient Safety and Quality Improvement Act of 2005 Executive Memo from President DoD MedTeams® ED Study Institute for Healthcare Improvement 100K lives Campaign “To Err is Human” IOM Report TeamSTEPPS 1995 1999 2001 2003 2004 2005 JCAHO National Patient Safety Goals MedicalTeamTraining
  10. 10. Impact of Error:  44,000–98,000 annual deaths occur as a result of errors  Medical errors are the leading cause, followed by surgical mistakes and complications  MoreAmericans die from medical errors than from breast cancer,AIDS, or car accidents  7% of hospital patients experience a serious medication error 10 Cost associated with medical errors is $8– 29 billion annually. Federal Action: By 5 years;  medical errors by 50%,  nosocomial by 90%; and eliminate “never- events” (such as wrong- site surgery)
  11. 11. As many as 98,000 Americans still die each year because of medical errors. The researchers blame the:  Complexity of Health Care Systems Lack of Leadership Reluctance of to admit Errors Billing System that Reward Errors 11 05/18/2005 …little progress towards the goal Leape and Berwick, JAMA May 2005 Hospitals have taken steps to reduce medical errors and injuries. Examples:  Computerized prescriptions: 81% decrease in errors.  Including pharmacist in medical team: 78% decrease in preventable drug reactions.  Team training in delivery of babies: 50% decrease in harmful outcomes — such as brain damage — in premature deliveries. Source:Journal of the American MedicalAssociation Improvements
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  13. 13.  Workload fluctuations  Interruptions  Fatigue  Multi-tasking  Failure to follow up  Poor handoffs  Ineffective communication  Not following protocol 13  Excessive professional courtesy  Halo effect  Hidden agenda  Complacency  High-risk phase  Task (target) fixation
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  15. 15. “Initiative based on evidence derived from team performance…lever aging more than 25 years of research in military, aviation, nuclear power, business and industry…to acquire team competencies” 15 Team Strategies &Tools to Enhance Performance & Patient Safety
  16. 16. 16 •Department of Defense •Agency for Healthcare Research and Quality •Research Organizations •Universities •Medical and Business Schools •Hospitals—Military and Civilian,Teaching and Community-Based •Healthcare Foundations •Private Companies •Subject Matter Experts inTeamwork, Human Factors, and Crew Resource Management (CRM)
  17. 17.  Army aviation crew coordination failures in mid-80s contributed to 147 aviation fatalities and cost more than $290 million  The vast majority involved highly experienced aviators  Failures were attributed largely to crew communication, workload management, and task prioritization 17
  18. 18.  Cross-Training  Stress ExposureTraining  Team Coordination Training (CRM)  Scenario-BasedTraining and Simulation  Team LeaderTraining  Team DimensionalTraining  Team Assessment 18
  19. 19.  Mid to Late 80s AF bombers and heavy aircraft started CRM training  1992 Air Combat Command developedAircrew Attention Management /CRMTraining  By 1998, CRM deployed uniformly across the AF  Steady decline in human factors based mishaps since CRM training deployed  AF Medical Service adapted training, rolled out in 2000 19
  20. 20. Non-Healthcare • Combat Information Centers • Joint Forces Operations • Army Special Forces • Tank, Submarine, and Air Crews 20 Team Healthcare ED, OR, L&D, ICU, Dental Whole Hospital CombatCasualty Care …striving to be a high reliability healthcare system…
  21. 21. 21 Indemnity Experience 20 11 0 5 10 15 20 25 Malpractice Claims, Suits, and Observations Pre-Teamwork Training Post-Teamwork Training Adverse Outcomes 50% Reduction 50% Reduction (Mann, 2006) Beth Israel Deaconess Medical Center Contemporary OB/GYN 1 1.2 1.4 1.6 1.8 2 2.2 2.4 June July August Sept Oct Nov Dec Jan Feb March April May Avg.LengthofStay(days) Length of ICU Stay After Team Training 50% Reduction OR Teamwork Climate and Postoperative Sepsis Rates (per 1000 discharges) Group Mean Low Teamwork Climate Mid Teamwork Climate High Teamwork Climate 0 2 4 6 8 10 12 14 16 18 AHRQ National Average Teamwork Climate Based on Safety Attitudes Questionnaire Low  High (Sexton, 2006) Johns Hopkins (Pronovost, 2003) Johns Hopkins Journal of Critical Care Medicine
  22. 22. 50% reduction in adverse outcomes Average length of ICU stay reduced by 50% 27% reduction in Nurse turnover Decreased clinical error rate from 30.9% to 4% Reduction by 50% in post-op sepsis rate
  23. 23.  Recognize opportunities to improve patient safety  Assess your current Organizational Culture and existing Patient Safety Program components  Identify teamwork improvement action plan by analyzing data and survey results  Design and implement initiative to improve team-related competencies among your staff  IntegrateTeamSTEPPS into daily practice. 23 “High-performance teams create a safety net for your healthcare organization as you promote a culture of safety." …Improved teamwork and communications… Ultimately, a culture of safety
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  25. 25. Knowledge  Shared awareness about what is going on in theTeam and progress towards its goals.Team members are familiar with Roles and Responsibilities of theirTeammates Attitudes  Team members have a positive experience, enjoy working in teams and trust intention ofTeam mates Performance  Team members know when and how to back each other up, be more efficient in providing care, and more readily identify and correct errors if they occur
  26. 26.  Knowledge  Shared Mental Model  Attitudes  MutualTrust  Team Orientation  Performance  Adaptability  Accuracy  Productivity  Efficiency  Safety 26
  27. 27. Mutual Support Communication
  28. 28.  First step in implementing a teamwork system isTeam Development  Delineates fundamentals such as team size, membership, leadership, identification and distribution  Check the ratio of ‘WE’s to ‘I’s to assessTeam Development  Patients are part of the CareTeam  Members anticipate needs of others, adjust to each other’s actions and have a shared understanding of plan of care
  29. 29. Team Leaders impact effectiveness by:  changing behaviours  motivating members  coordinating processes  facilitating problem-solving  Leaders need to ensureTeams perform effectively and attain desired outcomes  Leaders monitor, diagnose and treatTeams  Tools include brief, huddle, and debrief
  30. 30.  To gain or maintain an accurate awareness or understanding of every situation in which the team is functioning  Results in a shared mental model among team members Elements include STEP:  Situation of Patient  Team Members  Environment  Progress towards Goals
  31. 31.  Also known as Back-up behaviour :allows teams to become self-correcting, distribute workload effectively and regularly provide feedback  Specific approach to conflict resolution  Each team member becomes part of the Safety Net
  32. 32.  Most important component ofTeam Management.  Standardized information exchange strategies- SBAR, Check-back, Call- out, Handoff, and Checklists  Complete, Clear, Brief,Timely
  33. 33. 33 Catalytic event drives need for change Build team, strategy, b uy-in, establish goals Implement Action Plan, Train, Empower Others TeamSTEPPS Change Coaching I’m staying right here. Yeah they’ll be back. What are they doing? Why do we need change? FUTURE Celebrate wins! Staying the course Sustaining DevelopAction Plan Test Intervention (Outcomes) Monitor, Integrate, Continuous Process Improvement Prepare the Climate
  34. 34.  Advocates ofTeamwork  Dynamic Presenters  Viewed as Leaders amongst peers  In positions that allow flexibility
  35. 35.  Fundamentals Course and Implementation Workshop for Hospital Leadership and Steering Committee  Assessing your Hospital in Patient Safety and Healthcare Team Functioning  Training your Healthcare Professionals inTeamSTEPPS Strategies  Developing your Quality Champions asTeamSTEPPS Coaches  Regular Assessment and Onsite Support  Certify Hospitals asTeamSTEPPS Hospitals
  36. 36.  Phone- 08052064317, 08023277559  Website-  Facebook: Aesculapius Healthcare Consultants  LinkedIn- Aesculapius VN  Twitter- @AesHealthCon  Email-,
  37. 37. ThankYou Aesculapius Healthcare Consultants