Professional Documents
Culture Documents
net/publication/233860971
CITATIONS READS
2 1,363
4 authors, including:
Some of the authors of this publication are also working on these related projects:
All content following this page was uploaded by Rekleiti Maria on 05 June 2014.
SPECIAL PAPER
Corresponding Author: Maria Rekleiti , RN, MSc, Korinthos General Hospital, Greece
27 Nikomidias street, GR-20100 Korinthos, Greece, e-mail: mrekliti@gmail.com
Abstract
Introduction: Due to a variety of circumstances and world-wide research findings, patient safety and
quality care during hospitalization have emerged as major issues. Patient safety deficits may burden
health systems as well as allocated resources. The international community has examined several
proposals covering general and systemic aspects in order to improve patient safety; several long-term
programs and strategies have also been implemented promoting the participation of health-related
agents, and also government agencies and non-governmental organizations.
Aim: Those factors that have negative correlations with patient safety and quality healthcare were
determined; WHO and EU programs as well as the Greek health policy were also reviewed.
Method: Local and international literature was reviewed, including EU and WHO official publications,
by using the appropriate keywords.
Conclusions: International cooperation on patient safety is necessary in order to improve
hospitalization and healthcare quality standards. Such incentives depend heavily on establishing world-
wide viable and effective health programs and planning. These improvements also require further steps
on safe work procedures, environment safety, hazard management, infection control, safe use of
equipment and medication, and sufficient healthcare staff.
Keywords: safety culture, patient safety, health service quality, quality assurance
www.inernationaljournalofcaringsciences.org
International Journal of Caring Sciences 2012 May-August Vol 5 Issue 2 75
the USA, a nationwide survey back in 2004, have faced some kind of unwanted situation,
showed that 30% of the public reported in other words 6.7 to 15 million of
medical errors (for themselves or their hospitalized patients, and more than 37
family), 55% were dissatisfied with the million users of primary health care services
quality of health care, 40% thought that health (EU Official Journal, 2008).
care had gotten worse during the past five The main problem seems to be nosocomial
years, and 50% were worried about health infections. According to several studies, 5%
care and hospitalization safety (Kaiser Family to 15% of all hospitalized patients contract at
Foundation, 2004). least one hospital-acquired infection during
In Europe, the Luxembourg Declaration on their stay; 40% of Intense Care Units patients
Patient Safety, which includes a series of contract at least one nosocomial infection,
recommendations to EU Institutions, national thus increasing mortality risk. In the United
authorities and health care providers, States, 5 million cases of hospital-acquired
promotes change in the nature of dialogue infections have been reported and 100,000
about quality and safety, encourages new patients have died because of them. Almost
incentives, and proposes fundamental 1.4 billion patients contract a nosocomial
improvements and strategies for patient safety infection each year all over the world, whilst
(European Commission, 2005). 50% of the medical equipment in developing
The European Commission defines patient countries is unusable or partly usable. Every
safety as ‘freedom for a patient from year, approximately 4.1 million patients (or
unnecessary harm or potential harm one out of twenty) are estimated to contract a
associated with healthcare’. (European hospital-associated infection in the EU; the
Commission, Health-EU, Patient Safety, number of deaths occurring as a consequence
2005) of these infections is estimated to be around
The main objective of this paper was to 37,000 (Council of the European Union,
determine factors related to unsafe health 2009).
care, according to existing WHO, EU and Diagnostic procedures or interventions are not
Greek health policies concerning patient always performed, since the equipment is not
safety. been used due to lack of trained staff or
necessary commodities. This can lead to
Factors related to unsafe health service
substandard or hazardous diagnosis, which
delivery
can result in a treatment that could put the
During the last decade, the issue of patient patient’s health/life in jeopardy. Some other
safety was brought out and several papers factors that might delay a surgical procedure
established that health services may harm the can lead to increased nosocomial infections
patients because of injuries or other rates; some of these factors are: Lack of
medical/nursing errors and omissions. The surgical consumables, operating room
healthcare industry should be aiming at the overcrowding, lack of trained nursing staff,
protection of the patients’ health, and at shortage of intensive/postoperative care beds,
avoiding any harm to them and also substandard maintenance of
International papers show that in 10% of all equipment (or total lack of it).
hospitalizations there were medical/nursing For instance, in some countries injections
errors and/or unwanted situations in other administered with reused, unsterilized
healthcare settings, such as domiciliary care, syringes reach 70 percent, which can expose
private healthcare, and chronic patient care. In millions of people to infections. Issues
has been shown that one out of ten patients in associated with surgical safety in developed
developed countries has been somehow countries account for 50% of the adverse
harmed during hospitalization, whereas in situations that may result in death or
developing countries there is an even higher disability.
medical error risk. In certain developing According to WHO, 7 million patients have
countries that risk seems to be almost 20 post-operative complications, and one million
times higher compared to developed countries patients die because of medical errors that
(Eurostat, 2010). lead to various serious infections (European
According to the EU, 8% to 12% of Commission, 2011)
hospitalized patients in EU member-states
www.inernationaljournalofcaringsciences.org
International Journal of Caring Sciences 2012 May-August Vol 5 Issue 2 76
www.inernationaljournalofcaringsciences.org
International Journal of Caring Sciences 2012 May-August Vol 5 Issue 2 77
www.inernationaljournalofcaringsciences.org
International Journal of Caring Sciences 2012 May-August Vol 5 Issue 2 78
services in their own country or even abroad. quality, can also help to ensure that the target
These initiatives depend on the international will be reached.
implementation of viable and effective health Implementing Assessment and Quality
policies. Also a series of actions concerning Assurance programs, that could monitor
safe procedures, environment safety, hazard service provided to the public, could also set
management, infection control, safe priorities for each healthcare agency.
equipment use, better clinical practice and Administrative and clerical staff should be
safe medication is also deemed necessary. In further trained in economics, computer
the past decade, patient safety has surely been science and management, which will improve
recognized as a major issue, yet targeted overall level of service.
actions should be implemented with the Yet the most important aspect is to
participation of health system agents and the understand the culture. In health systems the
patients as well. The EU has put forward a set quality and safety culture remains virtually
of actions (2009-2015) and a legislative unknown. But medical equipment and know-
framework; in the future the effectiveness of how, sufficient staffing and modern buildings
these actions will be reassessed by monitoring alone cannot ensure high quality health care
the results of similar policies in the member and patient safety.
states.
It is very important that all citizens be References
educated about safety issues; patients, non- Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber
patients, health professionals and managerial JH. (2003) “Educational Levels of Hospital Nurses
staff should be educated about safety using all and Surgical Patient Mortality”. JAMA, 290(12):
appropriate methods, including lectures, 1617-1623.
Altman DE, Clancy C, Blendon RJ. (2004) “Improving
workshops, seminars, and printed or patient safety – five years after the IOM report”. N
electronic matter. Further education of health Engl J Med, 351: 2041-2043.
professionals about safety, combined with European Commission. (2005) “DG Health and
practices that prevent and treat adverse Consumer Protection Patient Safety – Making it
events, can promote patient safety. This target Happen!” Luxembourg, Declaration on Patient
Safety.
will be reached more easily if patients are European Commission. (2005) “Health-EU, Patient
encouraged to participate in the safety Safety”. Available at: http://ec.europa.eu/health-
measures, and get information on health eu/care_for_me/patient_safety/index_el.htm (in
hazards and safety issues. On the other hand, Greek)
European Parliament. (2009) Available at:
organizational deficiencies —most of the time http://www.europarl.europa.eu/sides/getDoc.do?pubRef
the main culprit behind the patients’ adverse =//EP//TEXT+CRE+20090423+ITEM-
events— should be addressed, thus promoting 004+DOC+XML+V0//EL
safety-oriented actions. European Parliament legislative resolution of 23 April
It has been calculated that the yearly number 2009 on the proposal for a Council recommendation
on patient safety, including the prevention and control
of patients in the EU with at least one of healthcare associated infections (COM(2008)0837 -
hospital-acquired infection can be estimated C6-0032/2009 – 2009/0003(CNS). (2009) Available:
at 4.1 million patients. Thus, focusing on http://www.europarl.europa.eu/sides/getDoc.do?pubR
infection reporting systems and prevention ef=-//EP//TEXT+TA+P6-TA-2009-
0287+0+DOC+XML+V0//EN (English version)
and control programs will definitely promote Eurostat. (2010) Eurostat regional yearbook 2010.
patient safety in both primary and secondary Available at:
sector. It is also estimated that healthcare http://epp.eurostat.ec.europa.eu/cache/ITY.../KS.../KS
workers in Europe suffer one million -HA-10-001-12-EN.PDF.
needlestick injuries each year, consequently Health and Safety Executive (HSE). (2005) “A review
of safety culture and safety climate literature for the
sufficient protection measures are necessary. development of safety culture inspection toolkit”.
Hiring specialized infection control nurses Research Report, 367.
and all necessary hospital staff can also International Nuclear Safety Advisory Group –INSAG.
reduce morbidity and mortality rates. A well- (2001) “Safety Culture”. Report 75-INSAG 4-
International Atomic Energy Agency, Vienna.
trained, qualified hospital staff could also Institution of Engineering and Technology. (2009)
increase service-user trust and satisfaction Health & Safety Briefing No. 07. Available at:
levels. Consequently, continuing education of www.theiet.org/factfiles.
all health professionals and further Kaiser Family Foundation. (2004) Agency for
specialization in patient safety and service Healthcare Research and Quality, Harvard School of
www.inernationaljournalofcaringsciences.org
International Journal of Caring Sciences 2012 May-August Vol 5 Issue 2 79
Public Health: “National survey on consumers’ Official Journal of the European Union. (2009) Council
experiences with patient safety and quality Recommendation on Patient Safety, including the
information”. Menlo Park, Kaiser Family Foundation. Prevention and Control of Healthcare associated
Khowaja K, Nizar R, Merchant RJ, Dias J, Bustamante- Infections (2009/C151/01). Available at:
Gavino I, Malik A. (2008) “A systematic approach of http://ec.europa.eu/health/patient_safety/docs/council
tracking and reporting medication errors at a tertiary _2009_en.pdf
care university hospital, Karachi, Pakistan”. Official Journal of the European Union. (2009)
Therapeutics and Clinical Risk Management, 4(4): 673– Technical report ‘Improving Patient Safety in the
679. EU’, published by the RAND Corporation.
Needleman J, Buerhaus P. (2003) “Nurse staffing and World Health Organization. (2004) World Alliance for
patient safety: current knowledge and implications for Patient Safety: forward programme. Available at:
action”. Inter J Qual Health Care, 15(4): 275-277. http://www.who.int/patientsafety/en/brochure_final.pd
Official Gazette of the Hellenic Republic, First Issue, No f.
31 (2 March 2011), Law No 3918 (‘Structural Changes World Health Organization. (2011) Combating
in the Health System and other provisions’), p. 1234. Antimicrobial Resistance: Experiences From the Field
Official Journal of the European Union. (2008) Available: 2011. Available at:
http://eur http://www.who.int/patientsafety/en/
lex.europa.eu/JOHtml.do?uri=OJ%3AL%3A2008%3A1
90%3ASOM%3AEL%3AHTML
www.inernationaljournalofcaringsciences.org