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

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Exploring patient participation in reducing health-care-related safety risks 80 state of health, diagnosis, suggested diagnostic methods and treatment, expected results and prognosis. The same regulatory aspects are formulated for nursing care. Article 45a states that the doctor is obliged to report ADRs to the National Bureau for Registration of Medicinal Products. There is a separate Ministry of Health regulation related to the standardized method of reporting and the design of the reporting formulary. The Law on the Profession of Nurses and Midwives lists the medicines a nurse (and a midwife) may administer to a patient without instruction by a doctor. The Law on Pharmacy defines the content of the “summary of product characteristics”, including factors such as indications, dosage and method of administration, contraindications, drug interactions and ADRs. Article 86 states that hospital pharmacies must also participate in reporting ADRs to the National Bureau for Registration of Medicinal Products. The Law on Patients’ Rights and the Ombudsman for Patients’ Rights lists the rights to obtain health care services in line with recent medical knowledge and receive information on the process of care, covering the principles listed in Article 31 of the Law on the Profession of Doctor and Dentist. Patients have the right to receive this information and, having obtained it, to comment and present their own viewpoint. They also have the right to obtain information about patients’ rights. The Law on Accreditation regulates the process of accreditation of hospitals and primary care facilities. Accreditation programmes developed for these two levels of patient care address patients’ rights in medication safety by setting accreditation standards. Patients’ rights at both levels are therefore concurrent with those listed in the Law on Patients’ Rights and the Ombudsman of Patients’ Rights. The accreditation standards do not refer directly to patients’ rights in terms of medication safety, nor do they define the standardized content of a checklist or patient history. The two main patient organizations –the Polish Patients Federation (5) and the Institute of Patients’ Rights and Health Education (6) – do not deal with medication safety and/or provide related patient education. Focused pilot survey: “patient safety rights and medication safety” Methodology The survey was designed for the specific purposes of the study and focused on ADRs at PHC level. It covered 50 family physicians and 50 patients using PHC services. Respondents from both groups were located in five cities in southern Poland: Kraków, Wieliczka, Nowy Targ, Zakopane and Krzeszowice. Inclusion criteria for participation in the patients’ survey (Annex 4) were continuous and repetitive pharmacotherapy (the use of at least one medication taken for a chronic disease). The pilot aimed to describe whether patient safety rights can influence and improve safe pharmacotherapy. Patients were asked to mark the appropriate response for each of the questions. From the group of 50 patients approached, 49 completed the survey.
Patient safety, rights and medication safety in primary care in Poland The physicians were providing services within the public health care sector (with contracts with the public purchaser, the National Heath Fund) and were randomly selected (Annex 5). The pilot aimed to discover whether safe medication practices were being used in everyday practice, including when prescribing new medication and during continuing patient medicine treatment. The response rate was 100%. The pilot study was anonymized: respondents were assured information obtained would be used solely for the purpose of the pilot survey. The only personal features were respondents’ gender and age, along with (in the doctors’ survey) the degree of specialty. Both pilots consisted of 12 multiple choice and dichotomous questions. Collected data were stored in an SQL 25 database that enabled their distribution on simple pie and bar charts; however, more specific methods for data analysis were also used (histograms, cross analyses). Results of the “patient” pilot All patients were subject to continuous and repetitive pharmacotherapy as a result of chronic disease and most were women (71%). The respondents were elderly, with an average age of just under 65 years (women 65.3 years; men 63.8). Regarding the number of medicines taken each day, 25% were taking from 5 to 7 and 41% over 7 (Fig. 5.1): 65.3% (62.8% of women and 71.4% of men) were therefore taking more than 5 medicines daily. Attention should be focused on these two groups of respondents, as there is evidence that pharmacotherapy consisting of 7 or more medicines taken in parallel always results in drug interactions. In addition, in the group of patients taking 5–7 medications, adding an over-the-counter (OTC) drug or a supplement to the medicines might contribute to the medicine–medicine and/or medicine–dietary supplement interaction. Fig . 5 .1 . Number of medicines per patient per day 24% 41% Only 39% of patients knew the names and dosages of the medicines taken (64% men and 60% women). Understanding of one’s medicines – including their names and dosages – decreases with the number of medicines taken (Fig. 5.2). 25 Structured Query Language. 14% 20% Up to 3 (7) 3–5 (10) 5–7 (12) More than 7 (20) Number of responses: 49 81
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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
Page 43 and 44: Recommendation 7 - Encourage the av
Page 45 and 46: 20. Constitution of the World Healt
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Page 49 and 50: awareness of the sociomedical burde
Page 51 and 52: Patient participation in hand hygie
Page 61 and 62: Blood transfusion safety in France:
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 93: Patient safety, rights and medicati
Page 97 and 98: Fig . 5 .3 . Frequency with which d
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Page 109 and 110: Patient participation in elective s
Page 111 and 112: e desirable to have a special statu
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Page 133 and 134: » being involved in monitoring and
Page 135 and 136: Other studies on patient attitudes
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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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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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Exploring patient participation in reducing health-care-related safety risks

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