Adv Dip (Med Sci), MBBS, MBA (Healthcare Management) Overview of Malaysian Patient Safety Goals Orientation Program Duchess of Kent Hospital Dr Paul Chan Adv Dip (Med Sci), MBBS, MBA (Healthcare Management) Deputy Director HDOK

Introduction The Malaysian Patient Safety Goals are designed : To stimulate health care organizations in improving patient safety . To outline important patient safety areas that need to be improved To act as a “Performance Measurement” in areas that are critical to a safe health care system. For Patient Safety Council to monitor and evaluate the status of patient safety in the country. 9th December 2013 drnoraishah@moh.gov.my

Introduction Philosophy of Patient Safety Goals “Patient safety shall be given prime importance in health care and preventable adverse events should be avoided at all costs”. Scope: Applicable to all public and private health care facilities Hospitals, medical clinics, dental clinics 9th December 2013 drnoraishah@moh.gov.my

Derivation of Goals, Indicators & Targets Goals originally based on WHO Patient Safety Program Areas and JCI Patient Safety Goals PIs and targets are based on: Philosophy of goals, current MOH standards, statistics on previous performance of Malaysian health care facilities and consensus decision of Patient Safety Council Members, Officers from State Health Departments, Hospital Directors, Clinicians and discussion with Sir Liam Donaldson (Patient Safety Advisor to WHO Director General) Initially there were 15 goals, 59 PIs which were reduced to 29 PIs after first meeting and further reduced to: 13 goals and 19 PIs – for hospitals 4 goals and 6 PIs – for clinics 9th December 2013

Malaysian Patient Safety Goals To implement Clinical Governance To implement WHO’s 1st Global Patient Safety Challenge: “Clean Care is Safer Care” To implement WHO’s 2nd Global Patient Safety Challenge: “Safe Surgery Saves Lives” To implement WHO’s 3rd Global Patient Safety Challenge: “Tackling Antimicrobial Resistance” To improve the accuracy of patient identification To ensure the safety of transfusions of blood and blood products To improve medication safety 8) To improve clinical communication by implementing a critical test and critical value program 9) To reduce patient fall 10)To reduce the incidence of healthcare- associated pressure ulcer 11) To reduce Catheter-Related Bloodstream Infection (CRBSI) 12) To reduce Ventilator Associated Pneumonia (VAP) 13) To implement the Patient Safety Incident Reporting and Learning System 9th December 2013

Clinical Governance Framework Accountable High Standards of Care Excellence in Clinical Care Continuous Improvement of Service Quality 9th December 2013 Source : UK NHS

Goal, Indicator & Target Goal no Goal Indicator Target 1 To implement Clinical Governance Implementation of Clinical Governance Clinical Governance implemented Clinical governance A framework through which organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence will flourish. Corporate accountability for clinical performance Compliance to Clinical Governance can be evaluated using “Clinical Governance Assessment Tool” available in “Guideline on Achieving Excellence in Clinical Governance” produced by Patient Safety Council Malaysia & MOH 9th December 2013

Goal, Indicator & Target Goal no Goal Indicator Target 2 To implement WHO’s 1st Global Patient Safety Challenge: “Clean Care is Safer Care” Hand hygiene compliance rate ≥ 75% at each audit 9th December 2013

1. Number of wrong surgery performed zero Goal no Goal Indicators Target 3 To implement WHO’s 2nd Global Patient Safety Challenge: “Safe Surgery Saves Lives” 1. Number of wrong surgery performed zero 2. Number of retained foreign body 9th December 2013

ESBL – Klebsiella pneumoniae ≤ 0.3%/month Goal no Goal Indicators Target 4 To implement WHO’s 3rd Global Patient Safety Challenge: “Tackling Antimicrobial Resistance” Incidence rate of MRSA infection ≤ 0.4% /month ESBL – Klebsiella pneumoniae ≤ 0.3%/month ESBL-E.coli infection ≤ 0.2%/ month 9th December 2013

To improve the accuracy of patient identification Goal no Goal Indicator Target 5 To improve the accuracy of patient identification Compliance rate of at least 2 identifiers implemented 100% 9th December 2013

To ensure the safety of blood and blood products Goal no Goal Indicators Target 6 To ensure the safety of blood and blood products No of transfusion error (actual) Zero No of ‘near misses’ during the transfusion process - Transfusion error (actual): wrong pack of blood or its product is given for the patient Transfusion error (near miss): transfusion error that almost occur but prevented/ intervened resulting in no harm 9th December 2013

To improve medication safety 1. No of medication error (actual) Zero Goal no Goal Indicators Target 7 To improve medication safety 1. No of medication error (actual) Zero 2. No of medication error (near miss) - Type of Medication error - Prescribing error, Omission error, Wrong time error, unauthorized drug error, Dose error, Dosage form error, Drug preparation error , Route of administration error, Administration Technique error, Deteriorated drug error, Monitoring error, Compliance error Medication error (actual) – An error occurred and reached the patient Medication error (near miss) - An error occurred but the error did not reach the patient, managed to be intervened 9th December 2013 drnoraishah@moh.gov.my

% of critical value notified within 30 minutes 100% Goal no Goal Indicator Target 8 To improve clinical communication by implementing a critical test and critical value program % of critical value notified within 30 minutes 100% Definitions Critical test: test which requires rapid communication of result. Critical value: unexpected result that fall significantly outside the normal range and has the potential for serious adverse outcome to the patient if not dealt with promptly. Criteria Inclusion: critical list provided by hospital (chemical pathology/ hematology tests) 9th December 2013

List of Critical Test - Haematology 9th December 2013

List of Critical Test – Chemical Pathology 9th December 2013

10% reduction per year based on previous year’s data as a baseline Goal no Goal Indicators Target 9 To reduce patient fall 1. Number of fall (adult) 10% reduction per year based on previous year’s data as a baseline 2. Number of fall (pediatrics) 9th December 2013

To reduce the incidence of healthcare-associated pressure ulcer Goal no Goal Indicator Target 10 To reduce the incidence of healthcare-associated pressure ulcer Incidence rate of pressure ulcer ≤ 3 % 9th December 2013

To reduce Catheter-Related Bloodstream Infection (CRBSI) Rate of CRBSI Goal no Goal Indicator Target 11 To reduce Catheter-Related Bloodstream Infection (CRBSI) Rate of CRBSI <5 per 1000 catheter days Central Venous Catheter Care Bundle (CVC-CB) It consists of five evidence-based procedures recommended by CDC (Center of Disease Control and Prevention) Hand hygiene Maximal barrier precautions upon insertion Chlorhexidine skin antisepsis Optimal catheter site selection, with subclavian vein as the preferred site for non-tunneled catheters Daily review of line necessity with prompt removal of unnecessary line 9th December 2013 drnoraishah@moh.gov.my

To reduce Ventilator Associated Goal no Goal Indicator Target 12 To reduce Ventilator Associated Pneumonia (VAP) Rate of VAP <10 per 1000 ventilator days *VAP: Ventilator Associated Pneumonia: Pneumonia that occurs after 48 hours of intubation The ventilator care bundle has four key components: Elevation of head of the bed to between 30- 45 degrees Daily sedation vacation Peptic ulcer disease prophylaxis Deep venous thrombosis prophylaxis unless contraindicated 9th December 2013

To implement the Patient Safety Incident Reporting and Learning System Goal no Goal Indicator/s Target 13 To implement the Patient Safety Incident Reporting and Learning System Implementing of Incident Reporting system (including RCA) or other methods to investigate the incidents (e.g clinical audit) System implemented 9th December 2013

drpaul.chk@moh.gov.my

SUMMARY Malaysian Patient Safety Goals is ready for implementation nation wide this year June 2013 Need to know what to do to ensure patients safety Prevent litigation drnoraishah@moh.gov.my