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Patient Safety in Developing Countries

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tumader khouja

on 18 November 2013

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Transcript of Patient Safety in Developing Countries

Patient Safety in Developing Countries
Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospital.
BMJ. 2012 Mar
Objective :
to assess the frequency and nature of adverse events in selected hospitals in developing or trans economical countries
Participants :
convenience sample of 26 hospitals from which 15,548 patient records were randomly sampled
Adverse event:
an unintended injury that resulted in temporary or permanent disability or death and that was associated with health care management rather than the underlying disease process
The scale of preventable disability and death from health care in the middle east and Africa is a serious public health problem with major implication for health policy, planning and resource allocation

The average rate of adverse events (8.2%) is similar to that in developed countries(10%). However the proportion of preventable adverse events is significantly higher (83% compared to 50%)

Due to the sampling method, the results reflect those of the hospitals sampled and does not give and adverse event rate for each country

Given that the medical records was the source, factors focused on individual rather than system failures.

Tumader Khouja MMPH
Wilson RM, Michel P, Olsen S, Gibberd RW, Vincent C, El-Assady R, Rasslan O, Qsous S, Macharia WM, Sahel A, Whittaker S, Abdo-Ali M, Letaief M, Ahmed NA, Abdellatif A, Larizgoitia I; WHO Patient Safety EMRO/AFRO Working Group
retrospective medical record review of hospital admission during 2005 in eight countries
Main outcome measures:
two stage screening based on 18 criteria.
records screened positive were reviewed by a senior physician for determination of adverse event, its preventability and the resulting disability.
the adverse event could have been averted with different management or treatment. The reviewer needed to establish that there was a process of failure because of non compliance with accepted practices
Patients demographics and length of stay
Fig 1 Rates of adverse events with age in patients in hospital in developing countries
Patients demographics and length of stay
Fig 2 Rate of adverse events by length of stay.Rates increases with length of stay, starting at 4% and increasing to 25% for stays of 30 days.
Frequency and preventability of adverse event
Types of errors causing adverse events
Fig 3 Type of error related to occurrence of adverse event shown as percentage of 890 adverse events
Impact of comorbidity on rate of adverse events
Adverse events occurred when there was general consensus on diagnosis and treatment and in a relatively non complex setting
Contributory factors to adverse events
Priority is given to improving training and supervision of clinicians
Improving the availability and implementation of standardized best practice protocol
Improve record keeping
The reviewers gave low priority to lack of clinical staffing or the availability of necessary equipment or supplies
*According to Wilson et.al, the major contributing factor to adverse events in the sampled hospitals of developing countries was:
a- Defective equipment or supplies
b- Unavailable equipment or supplies
c- Inadequate staffing
d- Inadequate training or supervision of clinical staff
Importance of the topic
Studies show that the rate of adverse events in the developed world is at least 8%. Of these adverse events 50% were judged to be preventable

Little is published about the problem in developing and transeconomical countries where health systems face sever health threats and challenges in a context of scarce resources and weak infrastructure
Adverse event rate: 2.5% - 18.4%

Up to 83% (59-93%) were judged to be
highly preventable
550,000 admissions/year >10,000 die from adverse events =>1 death/day/hospital
Frequency and preventability of adverse event

30% of adverse events were associated with death of the patient
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