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

Exploring patient participation in reducing health-care-related safety risks
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involvement in safety issues in, for instance, the area of medication safety. Yet patients
often lack the most basic information about the medicines they are taking (see the section
on the micro level below).
Box 8 .1 . The limits of the law
Chapter 4 (Blood transfusion safety in France)
» Despite the law, patients and the general public mostly ignore their rights.
Even though written information is compulsory by law, the written form is not systematically provided by
prescribers of blood transfusion. Prescribers, but also patients, expressed their preference for oral information.
Chapter 5 (Patient safety, rights and medication safety in primary care in Poland)
» Doctors are legally obliged to report ADRs to the National Bureau for Registration of Medicinal Products.
However, 74% of the primary care doctors involved in the survey had never reported an ADR at the time
at which it occurred.
Chapter 6 (Patient engagement in elective surgery safety in Portugal)
» Informed consent application differs among health care providers. Thirty per cent of patients in the surgery
unit of a Portuguese hospital had not received information about other treatment options.
One of the problems in relation to implementation of patients’ rights is that patients
are often dependent on providers to effect and enforce their rights. If patients’ rights are
not mirrored by providers’ obligations, difficulties may arise. As discussed in Chapter 1,
the Hippocratic Oath forms a good starting point in the development of professionals’
codes with respect to patient safety. According to Legemaate (Chapter 2), professional
obligations and standards include the rights of patients as well as the prevailing norms
regarding the quality and safety of care. Present-day professional obligations of health
professionals include a willingness to report incidents and adverse events and to
otherwise participate in activities and systems to improve the quality and safety of care.
Similarly, patients’ right to information is reflected in professional codes, such as the
Portuguese Medical Association’s ethical code (see Chapter 7). According to Article
44 of this code: “[T]he patient has the right to receive and the physician the duty to
provide clarification on the diagnosis, treatment and prognosis of his disease”.
However, if a health professional does not have sufficient communication skills or views
the duty to inform the patient as a non-medical but legalistic obligation, the goals
embodied in the rights of patients will not be adequately met (Legemaate, Chapter 2).
In most of the chapters of this report, therefore, recommendations are made with respect
to the curricula and CME of professionals (Box 8.2).
Meso level
The meso level involves health care institutions, such as hospitals. The primary
obligation and responsibility for quality and safety lies at this level. As Legemaate argues
in Chapter 2, health care institutions should facilitate health professionals to respect
patients’ rights and fulfil their other professional obligations; they should put in place
an effective and comprehensive safety management system in which there is room to
incorporate information obtained from patients and their organizations. Kutryba also
recommends involving patient organizations in providing the appropriate developments,
skills, knowledge, empowerment and encouragement for patients (Chapter 5).