Role and impact of national and international organisations in patient safety and the role of the pharmacist in advancing patient safety recommendations

Nationally in the UK, campaign to reduce harm and save lives in the NHS in England is in development. It is led by a team of NHS staff and supported by the National Patient Safety Agency (NPSA), The Health Foundation and the NHS Institute for Innovation and Improvement (NPSA, 2008). The cause of Patient Safety First campaign is ‘To make the safety of patients everyone’s highest priority’, and the aim is ‘No avoidable death and no avoidable harm’. The campaign is focused on five interventions which is leadership and four other clinical interventions.

Patient safety is not a new thing. Look back at Clinical Governance Framework in 1998, patient safety is already mentioned in one of the pillars, which is Risk Management. Though there is a system in place, still there is high number of incidents happens. By establishing new project and campaign, can patient safety be ensured? Yexist,  it can be argued that to reduce harms,to pinpoint all routine tasks to be carried out in the safety culture.

How about law enforcement? In all patient safety recommendations that are available, none of them is mentioning about law enforcement. Whether this is necessary or not, there is limited study to support this idea.

How about patients? Initiatives to improve patient safety often leave out patient’s perspective. Successful patient safety initiatives implementation need to be started by empowering patients to enhance their key role to reach appropriate treatment, identifying and reporting adverse events. In a statement based on a study by Iowa Department of Public Health: “Health care organisations and providers must get patients more involved in their care by asking them to help define roles, design educational materials, and develop useful methods of sharing information across settings.” (Durbin, 2006) Regulatory authorities’ recommendations are worked out from top to down. In my opinion, patient safety needs to be managed systematically from micro to macro.

PHARMACIST  ROLES  IN  ADVANCING  PATIENT  SAFETY  RECCOMMENDATIONS

Pharmacists have a strategic position in advancing patient safety recommendations. In micro system, such as in community pharmacies, hospitals, or other near patients care, contribution can be delivered as pharmacists are easily accessed by patients/carers. Move forward to macro system, pharmacists can have impact to other healthcare professionals within their organisations, and also to participate in developing guidelines within the regulatory authorities such as NHS, NPSA, Department of Health and other International organisations.  

Medication errors are broadly defined as any error in the prescribing, dispensing or administration of a drug. Pharmacists need to develop practical strategies to improve patient safety by emerging as medication safety leaders, collaborate with other key health care providers, implement technology, provide staff and patients/carers education, and address key patient safety issues.

Several evidence-based studies show that pharmacists can have a huge impact on increasing patient safety and reducing costs. A hospital based study, in a Paediatric Critical Care Centre has shown a decrease in the severity of errors after implementation of pharmacist-led paediatrics medication safety team, provision of education to health care providers, and addition of a clinical pharmacist. (Costello et al, 2007). In the US, Pharmacist participation with the medical rounding team on a general medicine unit contributes to a significant reduction in preventable adverse events. The rate of preventable incidents was reduced by 78%, from 26.5 per 1000 hospital days to 5.7 per 1000 hospital days. There were 150 documented interventions recommended during the rounding process, 147 of which were accepted by the team. (Kucukarslan et al, 2004). In community pharmacies, a study conducted in 2005 also has shown that implementation of a pharmacist-managed coagulation service has reduced adverse events requiring patient hospitalisation in warfarin therapy. (Locke et all, 2005)

 

Pharmacist interventions to minimise errors is not yet completed without taking proper action on avoidable adverse drug reaction. This action can be done with the current knowledge in prescribing, access to drug information, patient counselling and also advanced knowledge in pharmacotherapy, formulary. Some practical actions as in the high agenda at the moment is leadership and reporting.

The Patient Safety First Campaign (2008) asks leadership of participating organisations to begin, at a minimum, by focusing on six actions to improve quality and reduce harm. In the US, the National Quality Forum (2009) is also mentioning a greater role in patient safety initiatives and other hospital leadership activities.

In the community, pharmacists are required not only to have clinical skill and managerial skills; but also leadership skills. Role as a pharmacy manager is challenged to maintain the balance of clinical effectiveness, patient safety and business interests. These tasks are feasible as long as business profitability is maintained without leaving a perception that pharmacy is a commodity, by controlling and managing the pharmacy with leadership strategies. Successful leader in pharmacy practice will deliver an exceptional pharmaceutical care to the patients and ensure patient safety.

System improvement cannot be achieved without organisational leadership that support a culture of safety in which the reporting of medication errors is encouraged. This culture will encourage error reporting. When medication error reporting is limited, pharmacist and other clinicians are limited in the analysis and discussion. Olsen et al (2007) suggest that hospital staff should use more than one method to detect adverse events and potential adverse events: incident reporting, pharmacist surveillance and local real-time record review.

However, it can be argued that excellent incidents reporting are not completed yet without an adequate assessment. Structured record review will provide an important component of an integrated approach to identifying risk, develop risk management strategies and furthermore to disseminate appropriate safety strategies.

MONITORING AND EVALUATION

The impact of interventions for patient safety can be measured and evaluated against more recognised standards, such as patient safety indicators (PSIs) developed by the Agency for Healthcare Research and Quality (AHRQ). This low cost tools is to monitor safety patterns within specific patient populations. PSIs can be a valuable reporting tool to incorporate into patient safety plans to monitor performance and identify areas that warrant further investigation.

The indicators have been used extensively in the US for national and local quality improvement and safety measurement initiatives. Most UK organisations do not have these systems in place. The development of patient safety indicators in England is running in parallel with international efforts to derive comparative indicators of patient safety. (Raleigh, 2008)

From the monitoring and evaluation results, pharmacists can make a necessary intervention, recommendation and follow up to regulation revision. Not only is to make sure that that is a decreased in number of adverse event, near misses and sentinel events, but most importantly is also important to decrease the same events to happen again.

PATIENT  SAFETY  STRATEGIES  AND  PHARMACIST  ROLES  IN  INDONESIA

In developing country as in Indonesia, health equality still remains as challenging issues. Lacking of pharmacists and other healthcare professionals in numbers to serve 245 million populations, the focus now is to deliver basic health services and to reach suburbs and country sides. Reducing poor-rich disparities in health outcomes is also high in the government agenda.

Patient safety in Indonesia has not been well implemented. Several recommendations adopted from other countries and compiled as a national guidelines by the Department of Health (Depkes, 2006). In contrast to developed countries as in the UK and US, patient safety has not been an open and honest culture in healthcare and medical practice. The main pharmacist role is to provide health services related to medicines as a product, patient safety is second concern. As there is limited data on incidents, it is difficult to draw a better picture about which areas to improve. However, we can always learn from other countries experiences and a lot of studies that are widely available about patient safety initiatives and its implementations.

From this patient safety module, I learned that to reduce harms in Indonesia, pharmacists need to continuously promote quality and patient safety throughout the country. To ensure patient safety, first of all, pharmacists in Indonesia need to change their paradigm about pharmacy services from drug oriented to individual patient oriented. Secondly, a reward-punishment culture in Indonesia healthcare practice needs to be altered to non-blame culture to improve incident reporting. Organisation leaders need to be reminded about the importance of non-punitive error reporting. nurses, pharmacists errors.

SUMMARY

Safety of patients is a serious international problem. Patient Safety recommendations have been developed nationally and internationally. Pharmacists have a strategic position to implement these recommendations and important roles in minimising drug errors, from the professional perspective and medication process Contribution can be delivered to apply leadership strategies in educating and provide information to patient and other healthcare professionals, as well as improving reporting to enhance medication treatment regimens, and patient care. To act professionally, it .

REFERENCES

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8. Locke, C., et al. (2005). Reduction in warfarin adverse events requiring patient hospitalisation after implementation of a pharmacist-managed coagulation service. Pharmacotherapy, 25. 685-9.
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