Is a hospital stay safe?

Our mission: Ensuring safe care in your facility

“…Because life is the highest price patients pay for a serious adverse event, and that should never happen again.”

Martha Schiller

Non-safety of care, does it cost money?

The cost of prescription errors has been estimated at US$42 billion per year. This represents almost 1% of total global health spending.

What is a Care-Related Adverse Event (CRAE)?

It is an unexpected circumstance or event associated with the care that could have or has resulted in harm to the patient and which it is hoped will not happen again.

What is the likelihood of having a CRAE?

It is estimated that there is a 1 in 3 million risk of a person dying during air travel.
In comparison, the risk of a patient dying from an adverse event during care is estimated to be 1 in 300.

Industries known to have a much higher risk than health, such as aviation and nuclear energy, have a much better safety record than health care.

What kind of mistakes are we talking about?

Medication errors

The causes of prescribing errors are related to system failures and human factors, such as staff fatigue, understaffing, treatment monitoring, etc. The causes of prescribing errors are related to system failures and human factors, such as staff fatigue, understaffing, treatment monitoring, etc. The causes of prescribing errors are related to system failures and human factors.
Each of these contributing factors, alone or in combination, can cause serious harm, disability or even death to the patient concerned.

Nosocomial infections

Healthcare-associated infections (HAIs), or nosocomial infections, are identified in general harm studies, but more accurate figures can be obtained through targeted surveys. In 2017, Swissnoso conducted a one-day spot prevalence study in 96 hospitals. The total prevalence of patients with at least one HCAI in Swiss hospitals was 5.9% (compared to 6% in the last European survey).

There are four main infection sites described in the literature. In order of frequency: pneumonia, urinary tract infections, surgical site infections and bacteremia.

Infections account for about 40% of adverse surgical events. The rate of infected surgical sites has been reported to range between 2 and 20% depending on risk factors.

Infections are the cause of additional costs, particularly due to the subsequent extension of the hospital stay.

Surgical errors

Every year, some 234 million operations are carried out worldwide. The death rate is 0.4 to 0.8% and the complication rate is between 3 and 16%, which is equivalent to approximately 1 million deaths and 7 million people suffering from serious after-effects.

No health system in the world is spared from infections, anaesthesia-related complications, or surgical site or surgical site errors.

Diagnostic Errors

5% of adults are confronted with misdiagnosis
In ambulatory care services in the United States, 5% of adults face misdiagnosis. In Malaysia, a study has established the frequency of misdiagnosis at 3.6%.

Risk of falls

In particular, the risk of falling is a defined nursing diagnosis that requires the implementation of preventive actions: avoiding falls and reducing their consequences through targeted interventions, protecting patients who have already fallen from a recurrence and its consequences, promoting systematic documentation of each fall case, etc.

The latent error factors, the "Swiss cheese model"...

At the critical point in the process of care, where the visible act of error occurs, there is the individual, who may have many factors that may contribute to the occurrence of the error.

Upstream of the individual, there is the workstation, where several elements, mainly organizational, are conditions that favour error. And even further upstream, latent factors located in particular at the strategic and budgetary level determine the circumstances favouring error, as well as the flaws in the “safety barriers” downstream of the act of care, which are supposed to protect the patient from an undesirable event.

To illustrate the consequences of these faults when they “line up” in time and place, Reason proposes the “Swiss cheese model”, where latent factors, error-prone conditions and gaps in safety barriers are holes in cheeses that, when aligned, allow the harmful process of error to proceed without ever being blocked, ultimately leading to an adverse event in the patient.

Bibliographic reference :

1. James Reason: patient safety, human error, and Swiss cheese. Interview by Karolina Peltomaa and Duncan Neuhauser. – PubMed – NCBI [Internet]. [cité 24 févr 2020]. Available: https://www.ncbi.nlm.nih.gov/pubmed?term=(reason%20J%5BAuthor%5D)%20AND%20swiss%20cheese

"Swiss cheese model"

Référence bibliographique :
1. James Reason: patient safety, human error, and Swiss cheese. Interview by Karolina Peltomaa and Duncan Neuhauser. – PubMed – NCBI [Internet]. [cité 24 févr 2020]. Disponible sur: https://www.ncbi.nlm.nih.gov/pubmed?term=(reason%20J%5BAuthor%5D)%20AND%20swiss%20cheese

Prevention of legal consequences

In the health care environment, a cautious individual attitude to these risks is essential, but does not guarantee that a patient or family will not take legal action against a physician or caregiver.

However, it is essential for the institution to have a global vision of the risks associated with care, a safety plan and a follow-up of preventive and corrective actions related to the patient care process.

In medicine, the legal consequences can be referred to Article 28 of the Swiss Civil Code, which states that

Anyone who suffers an unlawful attack on his personality may take legal action for his protection against any person involved.
An attack is unlawful unless it is justified by the consent of the victim, by an overriding private or public interest, or by law.

Types of legal consequences

The legal consequences can be of three types:

Civil liability, which is intended to provide financial compensation for harm caused to others without just cause.
Criminal liability, which aims to impose a personal sanction for the violation of a criminal provision. The penalty is deprivation of liberty and/or a fine.
Administrative liability, implemented by the employer, aimed at sanctioning the employee in his/her function within the institution. This responsibility obliges the institution to set up a body to examine the event by persons competent to judge the facts, their chronology and the responsibilities of the different actors involved, and requires the establishment of a system guaranteeing fair treatment.

Legal framework in Switzerland

At present, there is no national legal basis directly governing the safety and quality of care in Switzerland. The legislation divides competence between the national and cantonal authorities. For example, the Federal Council is responsible for ensuring the quality of care financed by compulsory health insurance, but in practice this responsibility is largely delegated to tariff partners, provider associations and insurers (De Pietro et al., 2015).

It is essential to know the starting point before programming your security strategy.

Sensitize all your staff to the prevention of clinical risks

The vulnerable patient

A study of care in a Swiss hospital found that 12.3% of patients suffered harm, half of which could have been prevented with an appropriate level of service (Halfon et al., 2017). More than 60% of these events had no serious consequences, but almost a quarter of them caused a severe and long-lasting disorder.

The second victim

Health professionals involved in a serious incident also suffer the consequences, experiencing sadness and worry, and even psychological suffering and anxiety that often go unnoticed and untreated. The term “second victim” (the “first victim” being the patient and family) is used when a caregiver is emotionally traumatized for having played a role in a harmful patient safety incident, obviously without intentional misconduct being involved.

The barriers for second victims seeking help are :

Inadequate organizational safety culture
Stigma associated with seeking help
Fear of losing respect as a professional
Fear of loss of income
Difficulty taking time off work
Doubts about the confidentiality of the services offered
For contract or casual employees, lack of organizational support

the quality of care

With regard to the quality of care in a healthcare institution, three aspects are often reported: the quality of structures (technical equipment, architectural aspects), the quality of processes (measures implemented as part of treatment) and the quality of results (performance evaluation, patient satisfaction). Patient safety is at the centre of all these concerns.

To assess quality, it is necessary to use indicators, measurable quantities that provide information on one or more parameters of the quality of care. An example of a process indicator would be the time it takes to manage a patient with a heart attack, which is determined by “good practice”. Outcome indicators may include the rate of pressure ulcers, the rate of falls, the rate of nosocomial infection, the rate of unplanned reoperations, patient satisfaction,etc.

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Training

We offer complete and specific training courses for all trades. Our goal? To improve the safety and quality of the services and care provided within your institution.

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