The document outlines the policies and procedures of a hospital's patient safety plan. It establishes a patient safety committee to identify risks, prevent medical errors, and improve patient outcomes. Key parts of the plan include defining terms like medical errors and sentinel events, establishing safety standard policies in various areas of care, and forming teams to address specific safety issues like surgery, medication management, infections, and environmental safety. The goal is to institutionalize patient safety as a fundamental part of healthcare delivery.
Patient Safety First - Ensuring Quality and Security in Hospital Environments...Info Global Data
In hospital environments, ensuring patient safety, maintaining quality care, and upholding security are of paramount importance. With advancements in medical technology, evolving regulations, and the need for effective communication, hospital administrators and healthcare professionals rely on valuable resources to stay informed and collaborate with industry experts. The Hospital Mailing List serves as a critical tool for connecting healthcare professionals, administrators, and vendors, enabling them to exchange knowledge, share best practices, and address challenges related to patient safety, quality care, and security in hospital settings. In this article, we will explore the significance of the Hospital Mailing List in promoting patient safety, ensuring quality care, and upholding security standards within hospitals.
Patient Safety
Presenter : Dr. Dipendra Bhusal
Moderator: Dr. Sunil Jwarchan
Department of General Surgery
Pokhara Academy of Health Sciences
Introduction
• Increased life expectancy >25years in
over last semicentennial.
The Nature Journal
Law of supply and demand applied to health
services.
• 2 big challenges in proving
safe and effective service,
• greater demand and larger options ,
• increasing complexity in healthcare
• "First, do no harm" is a fundamental healthcare principle prioritizing
patient safety.
• Global evidence indicates a significant burden of avoidable patient
harm across healthcare systems.
• Avoidable patient harm has major implications, including human,
moral, and ethical consequences.
• The prevalence of harm challenges established healthcare principles
and ethics.
• Financial implications accompany the human toll, affecting healthcare
systems globally.
• Defined as “the absence of preventable harm to a patient and
reduction of risk of unnecessary harm associated with health care to
an acceptable minimum”
• to prevent harm to patients,
caused by the process of
health care itself.
Origin of patient safety concept
• HIPPOCRATIC OATH
I will prescribe regimens for the good of my patients according to my
ability and my judgment and ‘never do harm’ to anyone
Improving patient safety means reducing patient harm
CURRENT ENVIRONMENT
• Errors and system failures repeated
• Action on known risk is very slow
• Detection systems in their infancy
• Many events not reported
• Understanding of causes limited
• Blame culture alive and well
• Defensiveness and secrecy
Prevalence of adverse health care event
• WHO estimates that, even in advanced hospital settings, one in ten
patients receiving healthcare will suffer preventable harm
• The report “To Err is Human: building a safer health system” by IOM
of the national academy of health system drew widespread attention
to the alarming statistics that there were between 44000 and 98000
preventable deaths , 7000 related to medication error only.
• If medical error was a disease then it would be 3rd leading cause of
death in USA after heart issues and cancer
Why ERROR?
• Usually not willful negligence, but systemic flaws,
-inadequate communication and wide spread process variation and
patient ignorance.
Patient safety incidents
• An Adverse event: An incident which results in harm to the patient.
• A near miss: An incident that could have resulted in unwanted
consequences but did not either by chance or through a timely
intervention preventing the event from reaching the patient.
• A no harm event: An incident that occurs and reaches the patient but
results in no injury to the patient. Harm is avoided by chance or due
to mitigating circumstances
Common causes of adverse health events
• Preventable Events
• Of these, inadequate communication ranks highest in frequency
International Patient Safety Goals (IPSG) help accredited organizations address specific areas of concern in some of the most problematic areas of patient safety.
International-Patient-Safety-GoalsGoal 1: Identify patients correctly
Goal 2: Improve effective communication
Goal 3: Improve the safety of high-alert medications
Goal 4: Ensure safe surgery
Goal 5: Reduce the risk of health care-associated infections
Goal 6: Reduce the risk of patient harm resulting from falls
patient safety and staff Management system ppt.pptxanjalatchi
Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care.
patient safety and staff Management system ppt.pptxanjalatchi
What is Patient Safety? Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care.
This presentation is prepared to enhance the adherence of patient to their specific medication as prescribed by the physician and the role of pharmacist in improving the adherence of patient to their medication including various factors influence the adherence ,methods to measure adherence and methods to improve adherence .
Patient Safety First - Ensuring Quality and Security in Hospital Environments...Info Global Data
In hospital environments, ensuring patient safety, maintaining quality care, and upholding security are of paramount importance. With advancements in medical technology, evolving regulations, and the need for effective communication, hospital administrators and healthcare professionals rely on valuable resources to stay informed and collaborate with industry experts. The Hospital Mailing List serves as a critical tool for connecting healthcare professionals, administrators, and vendors, enabling them to exchange knowledge, share best practices, and address challenges related to patient safety, quality care, and security in hospital settings. In this article, we will explore the significance of the Hospital Mailing List in promoting patient safety, ensuring quality care, and upholding security standards within hospitals.
Patient Safety
Presenter : Dr. Dipendra Bhusal
Moderator: Dr. Sunil Jwarchan
Department of General Surgery
Pokhara Academy of Health Sciences
Introduction
• Increased life expectancy >25years in
over last semicentennial.
The Nature Journal
Law of supply and demand applied to health
services.
• 2 big challenges in proving
safe and effective service,
• greater demand and larger options ,
• increasing complexity in healthcare
• "First, do no harm" is a fundamental healthcare principle prioritizing
patient safety.
• Global evidence indicates a significant burden of avoidable patient
harm across healthcare systems.
• Avoidable patient harm has major implications, including human,
moral, and ethical consequences.
• The prevalence of harm challenges established healthcare principles
and ethics.
• Financial implications accompany the human toll, affecting healthcare
systems globally.
• Defined as “the absence of preventable harm to a patient and
reduction of risk of unnecessary harm associated with health care to
an acceptable minimum”
• to prevent harm to patients,
caused by the process of
health care itself.
Origin of patient safety concept
• HIPPOCRATIC OATH
I will prescribe regimens for the good of my patients according to my
ability and my judgment and ‘never do harm’ to anyone
Improving patient safety means reducing patient harm
CURRENT ENVIRONMENT
• Errors and system failures repeated
• Action on known risk is very slow
• Detection systems in their infancy
• Many events not reported
• Understanding of causes limited
• Blame culture alive and well
• Defensiveness and secrecy
Prevalence of adverse health care event
• WHO estimates that, even in advanced hospital settings, one in ten
patients receiving healthcare will suffer preventable harm
• The report “To Err is Human: building a safer health system” by IOM
of the national academy of health system drew widespread attention
to the alarming statistics that there were between 44000 and 98000
preventable deaths , 7000 related to medication error only.
• If medical error was a disease then it would be 3rd leading cause of
death in USA after heart issues and cancer
Why ERROR?
• Usually not willful negligence, but systemic flaws,
-inadequate communication and wide spread process variation and
patient ignorance.
Patient safety incidents
• An Adverse event: An incident which results in harm to the patient.
• A near miss: An incident that could have resulted in unwanted
consequences but did not either by chance or through a timely
intervention preventing the event from reaching the patient.
• A no harm event: An incident that occurs and reaches the patient but
results in no injury to the patient. Harm is avoided by chance or due
to mitigating circumstances
Common causes of adverse health events
• Preventable Events
• Of these, inadequate communication ranks highest in frequency
International Patient Safety Goals (IPSG) help accredited organizations address specific areas of concern in some of the most problematic areas of patient safety.
International-Patient-Safety-GoalsGoal 1: Identify patients correctly
Goal 2: Improve effective communication
Goal 3: Improve the safety of high-alert medications
Goal 4: Ensure safe surgery
Goal 5: Reduce the risk of health care-associated infections
Goal 6: Reduce the risk of patient harm resulting from falls
patient safety and staff Management system ppt.pptxanjalatchi
Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care.
patient safety and staff Management system ppt.pptxanjalatchi
What is Patient Safety? Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care.
This presentation is prepared to enhance the adherence of patient to their specific medication as prescribed by the physician and the role of pharmacist in improving the adherence of patient to their medication including various factors influence the adherence ,methods to measure adherence and methods to improve adherence .
Similar to lecturepatientsafety-140713082901-phpapp02.pptx (20)
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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2. NATIONAL PATIENT SAFETY DAY
June 25, 2011
THEME:
“ Working Together Towards Patient Safety”
Slogan:
“Kaligtasan ng Pasyente, Una Lagi”
3. What is Patient Safety?
Patient Safety is the avoidance,
prevention and amelioration of
adverse outcomes/ injuries stemming
from the process of health care
4. Date: July 30, 2008
Administrative Order No. 2008-0023
National policy on Patient Safety
Goal: To ensure that the patient safety is
institutionalized as a fundamental principle of
the health care delivery system in improving
health outcomes.
6. I. PURPOSE
OBJECTIVE:
To provide a planned, ongoing, comprehensive,
coordinated and integrated Hospital-
wide mechanism to objectively and systematically
monitor and evaluate the safety of patient care,
promptly identify and resolve problems, plan
education to improve patient safety and to reduce
medical errors throughout the organization.
7. The essential elements of the program include:
•The integrated Patient Safety
Committee, supported by the COH, have
the authority to recommend changes and
take necessary actions in order to make
improvements to patient care services
provided.
8. •Responsibility for Patient Safety
activities are shared by the Medical Staff
Departments, Patient Care Services, the
Clinical Support Services and all other
hospital departments.
9. •Department Chiefs of all hospital
departments are responsible for the
ongoing education, monitoring, and
evaluation in preventing, detecting and
correcting medical errors within their
departments.
11. •Appropriate actions are taken to
resolve identified problems and/or
identified opportunities to improve
patient care and non-clinical
services rendered.
12. •The information derived from each
department’s monitoring, evaluation
and improvement activities is shared
with other departments as deemed
necessary by the Department Chief
and is integrated with information
obtained from other hospital-wide
patient safety activities as
appropriate.
13. •The Patient Safety program is
reviewed annually to assure the
program’s objectives are attained
and that improvement to patient
care and service delivery is made.
14. II. DEFINITIONS OF TERMS
The following definitions are
uniformly used in the hospital’s
Incident Report, Sentinel Event
and other relevant environment of
care and medication use policies.
15. •Sentinel Event
Unexpected incident involving death
or serious physical or psychological
injury, or the risk thereof.
The fundamental objective of sentinel
event reporting is corrective in nature
and the identification of appropriate
actions to prevent recurrence.
16.
17. •Near Miss or “close call”
An event or situation that could have
resulted in an accident, injury, or illness,
but did not, either by chance or timely
intervention.
It is a serious error or mishap that has the
potential to cause as adverse event but fails
to do so because of chance or because it is
intercepted.
18. •Latent Failure
An error precipitated as a consequence of
management and organizational processes
that poses the greatest danger to complex
systems.
Latent failures cannot be foreseen but, if
detected, they can be corrected before they
contribute to mishaps.
19. •No Blame Culture
A non-punitive encouraging voluntary
reporting of adverse events.
20. •Risk
Is any exposure to a harmful
event. It is directly related to hazard
and vulnerability and, inversely, to
capacity.
21. •Adverse Drug Reaction
Any undesirable or unexpected
medication related event that requires
discontinuing a medication or modifying
the dose, requires or prolongs
hospitalization, results in disability,
requires supportive treatment, is life
threatening or results in death, results in
congenital anomalies, or occurs following
vaccination.
22. •Medication Error
Any preventable event that may
cause or lead to inappropriate
medication use or patient harm while
the medication is in control of the
health care professional, patient or
consumer.
23. Such events may be related to
1.professional practice
2.health care products
3.procedures and systems, including
prescribing; order communication; product
labeling; packaging, and nomenclature;
compounding; dispensing; distribution;
administration; education; monitoring; and
use.
24. •Unexpected Event
Any situation that is not
consistent with the routine operation of
the affiliate or routine care and safety
of a patient. All events identified
should be reported following the
Patient Incident Report Policy utilizing
the patient incident report.
25. Policy on Patient Safety
Safety standard policies:
•Access to care and continuity of care (ACC)
Policies: Admission
Networking
Transport
Discharge
Others
26. Policy on Patient Safety
Safety standard policies:
•Patient and family rights
Policies: Information
Patient care
Autopsy
Confidentiality
Security
Others
27. Policy on Patient Safety
Safety standard policies:
•Assessment of care
Policies: Referral
Credentialing and hiring
Others
28. Policy on Patient Safety
Safety standard policies:
• Care of patients
Policies: Clinical pathways. Dse related
groups, clinical practice
Medication preparation, storage
Periodic clinical monitoring and
evaluation
Special care/Intensive care
Others
29. Policy on Patient Safety
Safety standard policies:
•Anesthesia and surgical care
Policies: pre-anesthetic evaluation
Surgical site preparation
Post –anesthetic care
Credentialing
Others
30. Policy on Patient Safety
Safety standard policies:
•Medication Management and use
Policies: Procurement
Storage/dispensing
Preparation
Medication errors/near misses
Adverse drug reaction
Others
31. Policy on Patient Safety
Safety standard policies:
•Medication Management and use
Policies: Procurement
Storage/dispensing
Preparation
Medication errors/near misses
Adverse drug reaction
Others
32. Policy on Patient Safety
Safety standard policies:
•Patient and family education
Policies: Training and education
Participative care
Others
33. Policy on Patient Safety
Safety standard policies:
•Quality improvement and patient safety
Policies: Sentinel event reporting and
handling or processing
Others
34. Policy on Patient Safety
Safety standard policies:
•Prevention and control of infection
Policies: Hand washing
Disinfection
Handling of infectious waste, sharps, specimens
Personal protective equipment (PPE)
Rational use of antibiotics (3rd gen and
above)
Others
35. Policy on Patient Safety
Safety standard policies:
•Governance, Leadership and direction
Policies: Organizational mission
Monitoring and evaluation
Periodic review of policies and procedures
Handling of complain
Patient survey
Accountability
Others
36. Policy on Patient Safety
Safety standard policies:
•Facility Management and safety
Policies: Safe Environment
Equipment maintenance
Building and environment maintenance
Patient transport maintenance
Other facility maintenance such as
electricity, generator, water, gas
management
Waste segregation and disposal
Others
37. Policy on Patient Safety
Safety standard policies:
•Staff qualification and education
Policies: Hiring
Training needs analysis
Continuing professional training
Others
38. Role:
To take the lead role in
planning, implementing,
managing,, and evaluating
safety initiatives and programs
Committee on Patient Safety
39. 7 STEPS TO PATIENT SAFETY
1. Build a safety culture
2. Lead and support your staff
3. Integrate your risk
management activity
4. Promote reporting
5. Involve and communicate with
patients and the public
6. Learn and share safety
lessons
7. Implement solutions to prevent
harm
40. Committee on Patient Safety
MEDICAL TEAM
1. Safe Surgery Team
2. Medication Safety Team
3. Blood Transfusion Safety Team
4. Fall Prevention Team
5. Adverse Event Team
6. Infection Control Team
ENVIRONMENTAL SAFETY TEAM