Exploring patient participation in reducing health-care-related safety risks

Exploring patient participation in reducing health-care-related safety risks
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the indicators reported by OECD, Portugal had the second highest rate of postoperative
sepsis (1.493%) and the lowest rate of postoperative pulmonary embolism or deep
vein thrombosis (0.108%). The country reported low rates of catheter-related BSI
(0.057%) and accidental puncture or laceration (0.116%), but the report stated that
underreporting is likely in countries with low rates for these indicators. The averages for
obstetric trauma (vaginal delivery with (1.698%) and without (0.632%) instruments)
were also close to the minimum rate, and no foreign bodies were reported to have been
“left behind” during surgical procedures (23).
National legal and regulatory framework on surgery safety and patient
engagement
This section focuses on the existing legal and regulatory documents that relate to health
literacy, patient engagement and safety. Most set out broad regulations for health care
and are applicable to surgical care. Documents that regulate surgical practice alone are
also considered.
Health literacy and the right to safety
Patients must be able to read, understand, evaluate and use health information effectively
to be involved in, and truly contribute to, improving the quality of health care services
and reducing medical errors (24). Their lack of understanding can contribute to failures
in health care and in turn may represent a hazard to patient safety.
Standards on patients’ right to information and to safety are based on several European
documents (25−28). Patients’ rights are also articulated in Portuguese law. Article 64 of
the Portuguese Constitution (29) states that: “[E]veryone has the right to the protection
of health and the duty to defend and promote health”. To ensure the right to health
protection, the state is charged with: “disciplining and inspecting entrepreneurial and
private forms of medicine and articulating them with the National Health Service
(NHS), in such a way as to ensure adequate standards of efficiency and quality in both
public and private health care institutions” (29).
Although broadly regulated and encompassed in diffuse legislation (30), some
requirements related to health literacy and the right to safety are stated in the Basic
Law on Health (31), 32 specifically in articles V (citizens’ rights and duties) and XIV
(consumers’ statute) (Table 6.1).
The right to personal integrity is also reflected in the Portuguese Constitution (Article
25) (29). The Basic Law on Health gives important rights to citizens as users of health
services. According to this law, patients have the right to be cared for by appropriate
means, with technical quality and respect. Article XIV of the same law states that a
patient has the right to be indemnified for injuries caused (31). Lobato de Faria (32),
however, considers that the norms relating broadly to patients’ rights “... are too vague
and general to be of practical use. There are no specific regulations to guide the health
provider on the detailed contents of the declared rights of a patient” (30). It would
32 The Basic Law on Health (Law No. 48/90 of 24 August 1990) (31) also comprises the revisions inducted by Law No.
27/2002 of 8 November 2002.