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

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Exploring patient participation in reducing health-care-related safety risks 100 Table 6 .1 . Key legislation and regulatory documents related to health literacy and the right to safety Right to … information about own health Convention on Human Rights and Biomedicine European Charter of Patients’ Rights Basic Law on Health, Law No. 48/90 of 24 August 1990 Portuguese Penal Code, DL No. 48/95 of 15 March 1995 Other national legal documents Charter of Patients’ Rights and Duties Chapter III, Article 10 informed consent complaint and compensation Chapter II, articles 5 and 8 Chapter VIII, articles 23 and 24 Article 3 Article 4 Article 13 (Complaint) Article XIV – Consumers’ statute Article 1.150 (Medicosurgical interventions and treatment) and Article 1.157 (Duty of clarification) Law No. 12/2005 of 26 January 2005 (Health information and personal genetic information) Bill No. 788/X of 2009 (Right to be informed and informed consent) Article 6 (Information) Article 10 (Access to data) Article XIV – Consumers’ statute Article 1.150 and Article 1.156 (Medicosurgical interventions and treatment without consent) and Article 1.157 Law No. 46/2004 of 19 August 2004 (Clinical trials for medicines: Article 6, No. 1, paragraph d) Law No. 12/2005 of 26 January 2005 (Personal genetic information and health information: Article 19, No. 5) Law No. 32/2006 of 26 July 2006 (Aided medical procreation: Article 14, No. 2) Law No. 22/2007 of 29 June 2007 (Harvest and transplant of human organs and tissues: Article 8, No. 6) Bill No. 788/X of 2009 (Right to be informed and informed consent) Article 14 (Compensation) Article XIV – Consumers’ statute Article 8 Article 12 (Complaint) safety Chapter I, articles 1, 2 and 4 Article 8 (Observance of quality standards), Article 9 (Safety) Article XIV – Consumers’ statute Article 1.156 Articles 1.144–1.150 (Crimes against physical integrity) Dispatch No. 256/2006: Transfer of National Infection Control Programme to the DGS Dispatch No. 14178/2007: Approves the National Programme of Health Care-associated Infection Prevention and Control Dispatch No. 18052/2007: Rules on the infection control commissions Article 1 (Right to human dignity) Article 3 (Right to be treated in a proper way) Despite all this, Portugal took last place in the subdiscipline “Patients’ rights” within the Euro Health Consumer Index in 2009 (54), achieving a score equivalent to “not so good/not available” in seven of the nine indicators. The low score in the subdiscipline “Information” (24th position) prompted reconsideration of national information legislation (55). One of the main recommendations from the evaluation carried out by WHO of the national health plan for 2004–2010 was that “health system stakeholders should be engaged early, broadly and consistently in the development of the next plan, and communication should be fostered” (56).
Patient participation in elective surgery safety in Portugal Elective surgery safety Some documents within the Portuguese legal and regulatory framework set out particular regulations for surgical practice, particularly elective procedures. According to Portuguese law (13,14), surgical intervention is “one or more surgical acts performed by one or more surgeons in an operating room” (14). The DGS added to this definition: “… with the same therapeutic and/or diagnosis purpose, under general, loco-regional or local anaesthesia, with or without an anaesthetist” (57,58). Elective surgery is defined in Portuguese law as being “performed in the surgery room with a previous scheduled date, not including minor surgery” (14). The need for regulation of surgical services was recognized in Council of Ministers resolution No. 79/2004, published 27 April 2004, and through the establishment of an integrated management system for the surgical waiting list (14,59) regulated by the central administration services of the Ministry of Health. The goals of the integrated management system are to improve service, ensure equity in access, increase efficiency and enhance knowledge and transparency of surgical care (elective surgery and deferred urgency) (13). Regulation of the integrated management system (14) sets out some definitions of information documents, such as consent forms, surgical proposals and treatment proposals. The third section of the regulation establishes users’ rights and duties, specifically related to the right to complain, the right to access information related to the waiting list and other administrative issues (14). Beyond the normative documents concerning health care safety in a broad sense, the DGS also publishes regulatory documents on surgical practice. The DGS regulatory memorandum No.16/DQS/QDCO of 22 June 2010, based on the WHO guidelines on safety of surgical care (10), regulates implementation of the “Safe Surgery Saves Lives” initiative in all NHS operating theatres effective from 1 July 2010 (60). It recommends the implementation of two specific tools: the surgical safety checklist (before induction of anaesthesia, before skin incision and before the patient leaves the operating room) and the surgical Apgar score, which considers the intraoperation estimated blood loss, lowest mean arterial pressure and lowest heart rate (60). HCWs and patient engagement Health care institutions, HCWs and their associations have an important role to play in guaranteeing patient participation in enhancing health care safety. This requires deep commitment at education and professional levels. This section focuses on provision for communication with, and involvement of, patients in professional training programmes at all levels and in ethical guidelines. It also addresses professional associations’ and health care institutions’ involvement in raising awareness in this field. Undergraduate and postgraduate education The stra tegic plan for training in the health sector, presented in 2003 by the national health task force nominated by the Council of Ministers (61), was expected to be a tool to support health professional education (62,63). According to the last published 101
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Exploring patient participation in
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ABSTRACT Patients’ rights have be
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iv Patient information: the link be
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vi LIST OF TABLES, FIGURES AND BOXE
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ACKNOWLEDGEMENTS The editors would
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LIST OF ABBREVIATIONS ABHR alcohol-
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FOREWORD Health is a social value a
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ChApTER 1. pATIENTS’ RIGhTS AND p
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Box 1 .1 . contd Reporting and Lear
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The causal mechanisms through which
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» be involved in routine monitorin
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elationships within the complex env
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ChApTER 2. pATIENTS’ RIGhTS AND p
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CoE Recommendation 2006/7 of the Co
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The 2005 United States act on patie
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The right to participate in policy-
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The right to participate in quality
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» engaging with patient representa
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hampered by the written and spoken
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prevents misunderstandings and shap
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Health care providers should nevert
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Recommendation 7 - Encourage the av
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20. Constitution of the World Healt
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ChApTER 3. pATIENT pARTICIpATION IN
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awareness of the sociomedical burde
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Patient participation in hand hygie
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Blood transfusion safety in France:
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Page 65 and 66: Box 4 .1 . Definitions of adverse e
Page 67 and 68: Fig . 4 .4 . Distribution of advers
Page 73 and 74: The heterogeneity of situations and
Page 83 and 84: Fig . 4 .12 . Patients’ response
Page 91 and 92: Patient safety, rights and medicati
Page 97 and 98: Fig . 5 .3 . Frequency with which d
Page 107 and 108: ChApTER 6. pATIENT pARTICIpATION IN
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Page 111 and 112: e desirable to have a special statu
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Page 135 and 136: Other studies on patient attitudes
Page 137 and 138: Information about patients’ exper
Page 139 and 140: available evidence suggests that in
Page 141 and 142: Adverse events Respondents from the
Page 143 and 144: Feeling safe Five per cent of hospi
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Page 147 and 148: care professionals’ and patients
Page 149 and 150: group recommends that patient invol
Page 151 and 152: 13. Hibbard JH et al. Can patients
Page 153 and 154: 52. Triemstra M et al. Measuring cl
Page 155 and 156: 2009 (http://www.bradfordresearch.n
Page 157 and 158: of a small-scale patient survey add
Page 159 and 160: Box 8 .2 . Curricula and CME Chapte
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Page 163 and 164: Box 8 .4 . Patient education Chapte
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ANNEX 1. QUOTATIONS FROM INTERNATIO
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(2) When designing adverse event re
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17) If yes, do you think this was m
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Box A3 .1 . Reporting procedure Pat
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Box A3 .2 . contd Haemosiderosis Ha
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ANNEX 4. pATIENT QUESTIONNAIRE ABOU
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ANNEX 6. WhO pATIENT SAFETY pROGRAM
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especially those in intensive care.
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ANNEX 7. hANDOVER pROjECT Paul Bara
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(a) Provide new insight into the ro
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Johnson J, Barach P. Handovers of p
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Enhancing the patients’ role in p
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Enhancing the patients’ role in p
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