The Importance of Implementation

Ethics and Patient Safety in Hospitals

Dr Santi Rahayu Dewayanti, MM, SpP, FCCP, FISR

Webinar Respina 12 November 2022
 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
• harm that occur to patients during provision of health care.

A cornerstone of the discipline is continuous improvement based on learning from errors

and adverse events.

https://www.who.int/news-room/fact-sheets/detail/patient-safety
 What is Patient Safety?
• Patient safety is fundamental to delivering quality essential health services. Indeed,
there is a clear consensus that quality health services across the world should be
effective, safe and people-centred. In addition, to realize the benefits of quality
health care, health services must be timely, equitable, integrated and efficient.

• To ensure successful implementation of patient safety strategies; clear policies,

leadership capacity, data to drive safety improvements, skilled health care
professionals and effective involvement of patients in their care, are all needed.

https://www.who.int/news-room/fact-sheets/detail/patient-safety
 The burden of harm

* Every year, millions of patients suffer injuries or die because of unsafe and
poor-quality health care.
* Many medical practices and risks associated with health care are emerging as
major challenges for patient safety and contribute significantly to the burden
of harm due to unsafe care. Below are some of the patient safety situations
causing most concern

https://www.who.int/news-room/fact sheets/detail/patient-safety
 Patient safety situations causing most concern

Unsafe injections practices

in health care settings can transmit infections, including HIV, hepatitis B ,C,
and pose direct danger to patients and health care workers; they account for
a burden of harm estimated at 9.2 million years of life lost to disability and
death worldwide (known as Disability Adjusted Life Years (DALYs))

Diagnostic errors
occur in about 5% of adults in outpatient care settings, more than half of
which have the potential to cause severe harm. Most people will suffer a
diagnostic error in their lifetime

https://www.who.int/news-room/fact-sheets/detail/patient-safety
 Patient safety situations causing most concern

Unsafe transfusion practices

expose patients to the risk of adverse transfusion reactions and the
transmission of infections (14). Data on adverse transfusion reactions
from a group of 21 countries show an average incidence of 8.7
serious reactions per 100 000 distributed blood components

Medication errors
leading cause of injury and avoidable harm in health care systems:
globally, the cost associated with medication errors has been
estimated at US$ 42 billion annually

https://www.who.int/news-room/fact-sheets/detail/patient-safety
 Patient safety situations causing most concern
Health care-associated infections
occur in 7 and 10 out of every 100 hospitalized patients in high-income
countries and low- and middle-income countries respectively
Unsafe surgical care procedures
cause complications in up to 25% of patients. Almost 7 million surgical
patients suffer significant complications annually, 1 million of whom die
during or immediately following surgery
Radiation errors
involve overexposure to radiation and cases of wrong-patient and wrong-site
identification. A review of 30 years of published data on safety in
radiotherapy estimates that the overall incidence of errors is around 15 per
10 000 treatment courses

https://www.who.int/news-room/fact-sheets/detail/patient-safety
 Patient safety situations causing most concern

Sepsis
is frequently not diagnosed early enough to save a patient’s life. Because these
infections are often resistant to antibiotics, they can rapidly lead to
deteriorating clinical conditions, affecting an estimated 31 million people
worldwide and causing over 5 million deaths per year

Venous thromboembolism (blood clots)

is one of the most common and preventable causes of patient
harm, contributing to one third of the complications attributed to
hospitalization. Annually, there are an estimated 3.9 million cases in high-
income countries and 6 million cases in low- and middle-income countries

https://www.who.int/news-room/fact-sheets/detail/patient-safety
https://www.Cartoonstok.com/cartoon?searchID=CX01663z
World Patient Safety Day with articles
focused on the theme Medication
Without Harm, “September 17th 2022
https://patientsafetyj.com/index.php/patientsaf
According to the non-maleficence principle of medical ethics, ensuring patients’ safety and
preventing any injury or damage to them is a major priority for healthcare providers. Thus, it has
been the most emphasized component of the quality of health care services all around the world

Studies showed that a non-negligible percentage of patients are exposed to health care-related
injuries. Based on World Health Organization (WHO) report, the possibility of harming patients in
the process of providing health care services is 1 out of 300, whereas the possibility of aviation
accidents is 1 out of 100,000. Since 2004, with the beginning of the patient safety project, so far
140 countries have attempted to improve their patients' safety plans in their own health system.
The most common cause of injury is medication errors and falling. Although falling includes 21%
of total incidents, only 4% of them are serious.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6150915/
Kaitan keselamatan pasien dengan Kodeki,
pasal 14-17, dan pasal yg terkait pasal 8-12
Permenkes 11 tahun 2017 tentang Keselamatan Pasien
Keselamatan Pasien
Suatu sistem yang membuat asuhan pasien lebih aman, meliputi :
• Asesmen risiko
• Identifikasi dan pengelolaan risiko pasien
• Pelaporan dan analisis insiden
• Kemampuan belajar dari insiden dan tindak lanjutnya
• Implementasi solusi untuk meminimalkan timbulnya risiko dan mencegah terjadinya
cedera yang disebabkan oleh kesalahan akibat melaksanakan suatu tindakan atau
tidak mengambil tindakan yang seharusnya diambil.
Permenkes 11 tahun 2017 tentang Keselamatan Pasien

Keselamatan Pasien (lanjutan)

Insiden perlu dihindari dan diminimalisir untuk keselamatan pasien.
Insiden artinya adalah setiap kejadian yang tidak disengaja dan kondisi
yang mengakibatkan atau berpotensi mengakibatkan cedera yang dapat
dicegah pada pasien.
https://www.dreamstime.com/photos-images/patient-safety.htmlhttps://www.dreamstime.com/photos-images/patient-safety.html
Komite Nasional Keselamatan Pasien

Memiliki tugas memberikan masukan dan pertimbangan kepada Menteri dalam rangka penyusun
kebijakan nasional dan Peraturan Keselamatan Pasien.
Untuk melaksanakan tugasnya Komite Nasional Keselamatan Pasien menyelenggarakan fungsi :
• Penyusunan standar dan pedoman Keselamatan Pasien
• Penyusunan dan pelaksanaan program Keselamatan Pasien
• Pengembangan dan pengelolaan sistem pelaporan Insiden, analisis, dan Penyusunan rekomendasi
Keselamatan Pasien
• Kerja sama dengan berbagai institusi terkait baik dalam maupun luar negeri
• Monitoring dan evaluasi pelaksanaan program Keselamatan Pasien.
Tujuh Standar Keselamatan Pasien : PMKP 1691 tahun 2011
tentang Keselamatan Pasien.

1. Hak pasien
2. Mendidik pasien dan keluarga
3. Keselamatan pasien dan kesinambungan pelayanan
4. Penggunaan metoda-metoda peningkatan kinerja untuk melakukan evaluasi dan program
peningkatan keselamatan pasien
5. Peran kepemimpinan dalam meningkatan keselamatan pasien
6. Mendidik staf tentang keselamatan pasien
7. Komunikasi merupakan kunci bagi staf untuk mencapai keselamatan pasien
Tujuh Langkah Keselamatan Pasien : PMKP 1691 Tahun 2011
Tentang Keselamatan Pasien.

1. Membangun kesadaran akan nilai keselamatan pasien

2. Memimpin dan mendukung staf
3. Mengintegrasikan aktivitas pengelolaan risiko
4. Mengembangkan sistem pelaporan
5. Melibatkan dan berkomunikasi dengan pasien
6. Belajar dan berbagi pengalaman tentang keselamatan pasien
7. Mencegah cedera melalui implementasi sistem keselamatan pasien
Sasaran Keselamatan Pasien (SKP)

• Sasaran Keselamatan Pasien (SKP) merupakan sistem pelayanan yang wajib diberikan
kepada pasien.
• Tujuan; agar pasien aman dan nyaman selama menggunakan jasa layanan kesehatan di
rumah sakit.
• Pelayanan kesehatan yang dimaksud adalah pengobatan rawat inap, rawat jalan, tindakan
penunjang, tindakan operasi dan tindakan lainnya. Penerapan SKP ini dilakukan dengan
landasan :
• Undang-undang Nomor 44 Tahun 2009 tentang Rumah Sakit.
• Peraturan Menteri Kesehatan (Permenkes) Nomor 11 Tahun 2017 tentang Keselamatan
Pasien.
6 Sasaran Keselamatan Pasien

1. mengidentifikasikan pasien dengan benar

2. meningkatkan komunikasi yang efektif
3. meningkatkan keamanan obat-obat yang harus diwaspadai (high alert)
4. Kepastian tepat lokasi, tepat prosedur dan tepat pasien operasi.
5. Mengurangi risiko infeksi akibat perawatan Kesehatan
6. Pengurangan risiko pasien jatuh
Ethical Issues In Patient Safety

• What are the ethical issues of patient safety?

• Making progress in patient safety poses many challenges, practical and theoretical, to
the way physicians practice medicine.
• The ethical challenges are among the most profound
• They include the ethical imperative to do all things practical to prevent errors and injury
to patients

Lucian L Leape Thorac Surg Clin. 2005 Nov;15(4):493-501.doi:10.1016/j.thorsurg.2005.06.007.https://pubmed.ncbi.nlm.nih.gov/16276813/

Ethical issues in patient safety

The need to respond appropriately when things go wrong to find new methods to prevent
recurrence, the requirement for honesty and openness in dealing with our patients when
things go wrong, and taking responsibility for ensuring that all of our colleagues are safe and
competent. This is an immense challenge. It is not easy to "first, do no harm." But only we as a
profession can meet this challenge. No one else can do it; we must.

Lucian L Leape Thorac Surg Clin. 2005 Nov;15(4):493501.doi:10.1016/j.thorsurg.2005.06.007.https://pubmed.ncbi.nlm.nih.gov/16276813/

https://clipboardhealth.com/how-the-4-principles-of-health-care-ethics-improve-patient-care
 What are the 5 factors to be crucial to patient safety?

5 Factors that can help improve patient safety in hospitals

•Use monitoring technology. ...
•Make sure patients understand their treatment. ...
•Verify all medical procedures. ...
•Follow proper handwashing procedures. ...
•Promote a team atmosphere.

https://www.rasmussen.edu/degrees/health-sciences/blog/patient-safety-in-hospitals/
What Are The Kinds Of Errors That Can Occur During
Surgery?
Various ways surgeries are being performed can go wrong. Listed below are some ways there can be errors
in surgery
• Due to miscommunication or chart disruption, incorrect surgeries may be performed on patients.
• The surgeon performs surgery in the wrong part of the body or incorrectly accesses the body organ.
• Accidental clips of nerves result in nerve damage, loss of hearing, blood flow, sight, numbness, etc.
• Accidental damage to surrounding organs while operating on a different body part results in rupture of that
organ
• Sometimes foreign objects may accidentally be left in the patient’s body, which can cause damage to the
body.
• Reusing surgical instruments or using unsterilized instruments may lead to infections or sepsis.

PSNet. September 17th 2019.https://psnet.ahrq.gov/primer/wrong-site-wrong-procedure-and-wrong-patient-surgery

Surgical errors can be termed as errors that
have occurred during a surgery that has
altered the outcome of the surgery or
hindered the patient’s living conditions. For
example, let us consider that a patient is
undergoing surgery to get a tumor removed
from their spinal cord. Due to inexperienced
surgeons or lack of aftercare, the patient is
left impaired from below the abdomen for
life. This kind of unseen outcome due to
surgery errors has forever changed the
patient’s life in an unexpected and life-
hindering way.
Wrong-Site, Wrong-Procedure, and Wrong-Patient Surgery

• Few medical errors are as vivid and terrifying as those that involve patients who have undergone
surgery on the wrong body part, undergone the incorrect procedure, or had a procedure intended
for another patient. These "wrong-site, wrong-procedure, wrong-patient errors" (WSPEs) are
rightly termed never events—errors that should never occur and indicate serious underlying
safety problems.

• Wrong-site surgery may involve operating on the wrong side, as in the case of a patient who had
the right side of her vulva removed when the cancerous lesion was on the left, or the incorrect
body site. One example of surgery on the incorrect site is operating on the wrong level of the
spine, a surprisingly common issue for neurosurgeons. A classic case of wrong-patient surgery
involved a patient who underwent a cardiac procedure intended for another patient with a similar
last name.

PSNet. September 17th 2019.https://psnet.ahrq.gov/primer/wrong-site-wrong-procedure-and-wrong-patient-surgery

 Surgery Error

https://www.cartoonstock.com/cartoon?searchID=CS168175
While much publicity has been given to these high-profile
cases of WSPEs, these errors are in fact relatively rare. A
seminal study estimated that such errors occur in
approximately 1 of 112,000 surgical procedures, infrequent
enough that an individual hospital would only experience
one such error every 5–10 years. However, this estimate only
included procedures performed in the operating room; if
procedures performed in other settings (for example,
ambulatory surgery or interventional radiology) are included,
the rate of such errors may be significantly higher.
One study using Veterans Affairs data found that fully half of
WSPEs occurred during procedures outside of the operating
room.
PSNet. September 7th 2019 https://psnet.ahrq.gov/primer/wrong-site-wrong-procedure-and-wrong-patient-
surgery
 SUMMARY
The Importance of Implementation Ethics and Patient Safety in
Hospitals

Making progress in patient safety poses many challenges, practical and theoretical, to the way
physicians practice medicine.
The ethical challenges are among the most profound
They include the ethical imperative to do all things practical to prevent errors and injury to patients
The need to respond appropriately when things go wrong to find new methods to prevent recurrence
The requirement for honesty and openness in dealing with our patients when things go wrong, and
taking responsibility for ensuring that all of our colleagues are safe and competent.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6150915/
SUMMARY

The Importance of Implementation Ethics and Patient Safety in Hospitals

This is an immense challenge. It is not easy to "first, do no harm." But only we as a profession can
meet this challenge. No one else can do it; we must.
According to the non-maleficence principle of medical ethics, ensuring patients’ safety and
preventing any injury or damage to them is a major priority for healthcare providers.
It has been the most emphasized component of the quality of health care services all around the
world

Patient safety is in your hands

The small actions staff take on the job each day can have a big impact on patient
safety in hospitals