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

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Exploring patient participation in reducing health-care-related safety risks 46 ChApTER 4. BLOOD TRANSFUSION SAFETY IN FRANCE: DEVELOpING TOOLS TO SUppORT pATIENTS Justine Bettinger, Josselin Thuilliez, Yves Charpak 6 Introduction This chapter addresses the link between patient safety and patients’ rights in the specific context of transfusion and blood safety. The French experience is presented, reflecting the recognized expertise and fundamental reform of the blood transfusion service and the special “year of patients and their rights” launched by the Ministry of Health in 2011. Attitudes towards historical transfusion therapy practices, from the perspective of health care professionals (prescribing and administering transfusion therapy) and patients (requesting transfusion therapy, adopting a “zero-risk” assumption) have direct safety and economic effects on quality of care and availability of blood supplies. The major challenge in the 1980s was to improve security of the production and distribution chain of labile blood products (LBPs) after the French HIV bloodcontamination crisis. Consolidation of a safety culture among medical actors and patients is the next challenge in the blood transfusion field, reflecting the fact that the epidemiology of blood transfusion risks has evolved and the average age of patients transfused has also changed (with a shift towards older recipients). The evolution of the role of the individual in the health care system also highlights the potential of information (for the general public and patients) as a means to enhance safety cultures. Clinical risks associated with blood transfusion include transfusion-transmitted infections, unexpected clinical complications, adverse effects due to error and suboptimal care during the transfusion process; all have been well documented (1). In special circumstances, transfusion absence and delay may also represent a risk to health. Davis et al. (2) suggest that there is considerable potential for patients to assume a positive role in ensuring safe practice. Several questions have previously been raised in this field of research (2), including the following. » How willing are patients to be involved? » What could they reasonably be expected to do? » Might their involvement be affected or curtailed by individual characteristics? 6 The study in Chapter 4 was undertaken by the École des Hautes Études en Santé Publique [School of Public Health] in close collaboration with the Établissement Français du Sang [Blood Transfusion Organization].
Blood transfusion safety in France: developing tools to support patients Some answers and proposals have been provided in response to these initial questions, but first, patients who could potentially participate in the process need to be identified. Such patients must: » have knowledge of how to be involved (studies have shown that many patients have a very limited understanding of the risks and benefits of transfusion); » have the physical and cognitive capacity to be able to participate – this will lead to some patients being omitted; and » be willing to participate – very few studies provide information on the profile of patients who are willing to participate. Several opportunities for patient involvement were identified by Davis et al. (2), including before, during and after transfusion, showing the direct impact potential of an informed and engaged patient in improving safety throughout the transfusion process (Fig. 4.1). Fig . 4 .1 . Patient involvement in the transfusion process Opportunities for patient involvement Questioning the appropriateness of the transfusion; the number of units of blood Asking about the risks and benefits of transfusion and (any) alternatives; giving consent to be transfused Checking: they have a wristband (or other means of identification); details on wristband correct; blood sample for compatibility testing is correctly labelled; they have been asked to state their name and date of birth Checking: they have a wristband (or other means of identification); details on wristband correct; they have been asked to state their name and date of birth; their details have been checked against bag of blood Asking questions about what they can and cannot do while receiving a transfusion; asking how they should feel during transfusion and what to expect, such as how often their temperature and blood pressure should be taken Making sure their observations are taken Assess clinical need Inform patient/ consent Order product Request form Blood sample Clinical staff involved at different stages Doctors Nurses/doctors/ phlebotomists Crossmatching Laboratory staff Delivery Porters Identity check Administration of product Recording Monitoring how they feel Observation Reporting to staff if they do not feel well or if they think there is a treatment complication Respond to adverse event/reaction Note: Processes shown in bold indicate stages of the pathway in which patient involvement is possible. Source: Davis et al. (2). Nurses/doctors Doctors/nurses/ laboratory staff 47
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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
Page 9 and 10: ACKNOWLEDGEMENTS The editors would
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Page 13 and 14: FOREWORD Health is a social value a
Page 15 and 16: ChApTER 1. pATIENTS’ RIGhTS AND p
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Page 19 and 20: The causal mechanisms through which
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Page 27 and 28: CoE Recommendation 2006/7 of the Co
Page 29 and 30: The 2005 United States act on patie
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Page 33 and 34: The right to participate in quality
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e desirable to have a special statu
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Patient participation in elective s
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inspections of surgical services to
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» being involved in monitoring and
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Other studies on patient attitudes
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Information about patients’ exper
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available evidence suggests that in
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Adverse events Respondents from the
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Feeling safe Five per cent of hospi
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probability proportional to populat
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care professionals’ and patients
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group recommends that patient invol
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13. Hibbard JH et al. Can patients
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52. Triemstra M et al. Measuring cl
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2009 (http://www.bradfordresearch.n
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of a small-scale patient survey add
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Box 8 .2 . Curricula and CME Chapte
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is provided through interaction of
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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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