Risk Management and Patient Safety Strategy in Andalusia
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Transcript of Risk Management and Patient Safety Strategy in Andalusia
Marta Vázquez Vázquez
Risk Management and Patient Safety Strategy in Andalusia
Best Practices for Patient Safety and Quality ImprovementBucharest, March 27th 2014
www.juntadeandalucia.es/agenciadecalidadsanitaria
What’s the Andalusian Patient Safety Observatory?
“The global burden of unsafe medical care: analytic modeling of observational studies” Ashish K Jha, Itziar Larizgoitia, Carmen Audera-Lopez, et al. BMJ Qual Saf 2013 22: 809-815 originally published online September 18, 2013
There are 421 million hospitalisations in the world annually, and approximately 42,7 millions of adverse events , according to the World Health Organization
1 out of 10 inpatients suffers from adverse events.
23 millions of disability-adjusted life years are lost annually as a consequence of adverse events.
The global burden of unsafe medical care
Some figures…
418.500 AE (9,3 %)
2,511,000 aditional stays
Hospitalisations4,500,000/year
904,744 avoidable stays
6 hospitals of 500 beds/year
Aranaz-Andrés JM, Aibar-Remón C, Vitaller-Burillo J, Gea-Velázquez de Castro MT, Requena-Puche J, Terol-García E and grupo de trabajo ENEAS. Impact and preventability of adverse events in Spanish public hospitals. Results of the Spanish Nacional Study of adverse events (ENEAS). International Journal for Quality in Health Care 2009;21(6):408-14.
http://intqhc.oxfordjournals.org/content/21/6/408.full.pdf+html
Impact on hospitalization
International Framework2004: World Alliance for Patient Safety
“First do no harm”
2006: Council of Europe Recommendations “Patient Safety as the center of every healthcare policies”
2009: Council of the European UnionRecommendations on Patient Safety, including surveillance
and prevention of hospital acquired infections-To promote national strategies on patient safety
- To prevent and work against HAI
Patient Safety Strategy in Spain
Patient Safety Strategy in Spain
Reporting and Learning Systems
Safe practices
Training
Culture
Patients
Patient Safety
Strategy
Research
Patient Safety Strategy in Andalusia
DisseminationImplementation Evaluation of NHS indicatorsExperts Review
NHS Indicators
0 10 20 30 40 50 60 70 80 90 100
Hosp - ISMP [Ind.15]
Hosp - Conciliación [Ind.14]
Hosp - Mdto alto riesgo [Ind.13]
Pac - LVSQ [Ind.12]
Hosp - LVSQ [Ind.11]
Hosp - Incidencia IRAS [Ind.10]
Hosp - Prevalencia IRAS [Ind.9]
Prevalencia UPP [Ind.8]
Pac - Valoración UPP [Ind.7]
Hosp - UPP [Ind.6]
Hosp - Identificación [Ind.5]
DAP - UFGR/Com SP [Ind.4]
Hosp - UFGR/Com. SP [Ind.3]
DAP - SNISP [Ind.2]
Hosp - SNISP [Ind.1]
Porcentaje (%)
Indicadores despliegue de la ESP
SNS
SSPA
Patient Safety Strategy in Andalusia 2011-2014
1
2
3
4
Safety and citizenship
Safety and healthcare professionals
A safe shared space
Strategic projects
42 actionsMacromanagement
(Regional Health Ministry)
24 actionsMiddle
management(Centres)
55 actionsMicromanagement
(Units)
3 blocks, 7 aims, 22 objectives, 121 actions
Patient Safety Strategy in Andalusia 2011-2014
979 units
(85% of total)
Criteria with the highest percentage of compliance
20%
20%
26%
8%
7%
67%
71%
64%
87%
88%
0% 20% 40% 60% 80% 100%
E_012. High risk procedures (n=701)
E_031. Reporting and Learning Systems (n=681)
E_037. AE management (n=662)
E_061a. Patient identif ication (n=652)
E_075. Hand Hygiene (n=644)
Not met Parcially met Met N/A
Criteria with the highest percentage of non-compliance
40%
41%
46%
51%
52%
26%
23%
17%
16%
20%
29%
30%
31%
24%
22%
0% 20% 40% 60% 80% 100%
E_014. Information about the Strategy (n=684)
E_063. Critical points monitoring (n=630)
E_060. PS information to citizens (n=644)
E_064b. PS information in clinical pathways (n=617)
E_045. Research groups (n=641)
Not met Parcially met Met N/A
#Safe Use of Drugs
#Hand Hygiene
#Safe Surgery
#Pain Control
Safe Practices in the Observatory
#Prevention of central venous catheter-related infection
Online tools
Recommendation
Examples
Evidences and improvement areas
Resources
Assessment criteria
Sharing
Resource bank and Badge
Aditional tools
International Network
1132 centres39 Colombia
26 Argentina
25 Mexico
3 Panama
7 Peru
6 Cuba
5 Uruguay
5 Chile
2 Brazil
- Almost 1,500 reported incidents
- 159 shared improvement actions
Sharing solutions
2013
Patient Empowerment
Patient Empowerment
Pregunta por tu salud
CompruebaRecuerdaMed
Following the PaSQ Sustainability Guidelines
- Sharing patient safety practices
-Exchange mechanism of patient safety incidents and solutions
- Patient Empowerment
Agencia de Calidad Sanitaria de Andalucíawww.juntadeandalucia.es/agenciadecalidadsanitaria
Entidad gestionada por la Fundación Pública Andaluza Progreso y Salud
www.observatorioseguridaddelpaciente.esmarta.vazquez.vazquez@juntadeandalucia.es
Mulțumesc!