1. Cambodia Situation on Patient Safety
Dr. Sok Po
Deputy Director Hospital Services Department
In Charge of Quality Improvement
Ministry of Health

2. GEO- SOCIO DEMOGRAPHY OF THE KINGDOM OF CAMBODIA
GEOGRAPHY
- Location : South-east Asia
- Surface area : 181,035Km2
- Border : Vietnam, Laos, Thailand
- Administration : 25 Provinces/Cities
- Capital : Phnom Penh
- Language : Khmer
Religion : Buddhism 90%
- Climate : Tropical climate (Rainy/Dry Season)
THAILAND
LOA PDR
Pailin
Battambang
Banteay MeanChey
Udor Meanchey
Siem Reap
Pursat
Kg. Chhang
Sihanouk Ville
Kampot
Kep
Kandal
Kg. Speu
Kg. Cham
Svey Rieng
Prey Veng
Kratie
Mondul Kiri
Rattanakiri
Steung Treng
Kg. Thom
Preah Vihear
Takeo
Koh Kong
Gulf of THAILAND
VIETNAM

3. Operational District (OD): A Referral hospital and HCs
Overview of Government Health Care System
Central
Level
Provincial Level
Operational District (OD): A Referral hospital and HCs
Ministry of Health
University Health Science
Nat’l. programs
Nat’l. hospitals
Nat’l. Institute for PH…
Provincial Health Dept.
Regional Training Centers:
(4 Kg. Cham, Battambang,
Steung Traeng & Kampot )
The OD is the most peripheral and sub-unit within the health system closest to the population which consist of health centers and a referral hospital. 3

4. Policy and National Initiative to Improve Patient Safety
QI roadmap
Accreditation for health care facilities in 2015

5. National Policy for Quality in Health
Oct 2005
Six strategies:
Empowering consumer
Institutional Management
Clinical Practice
Professional Development
Management Development
Institutionalization of Quality

6. Road map for Quality Improvement, Oct 2006

7. Health Strategic Plan 2008-2015
Chapter 1, Policy Direction no.5:
“Reinforce health legislation, professional ethics and code of conduct, and strengthen regulatory mechanisms, including for the production and distribution of pharmaceuticals, drug quality control, cosmetics, food safety and hygiene, to protect providers and consumers’ rights and their health.

8. Health Strategic Plan 2008-2015
Chapter 1, Policy Direction no.6:
“Improve quality in service delivery and management through establishment of and compliance with the national protocols, clinical practice guidelines and quality standards, in particular establishment of accreditation systems.”

9. Master Plan for Quality Improvement in Health 2010-2015
Activities
Monitor client satisfaction in public health service through regular client surveys; and improved communication and coordination between health facilities and Health Centre Management Committees (HCMC), VHSGs, Health Equity Fund implementers, health insurance agencies or HI committee and Commune Councils.

10. Activities on Patient Safety
Ministry of Health, with technical assistance from WHO, developed the 'Clinical pathway for safe surgical care' (2013)
based on WHO Surgical Safety Checklist
local advisory group (Cambodian surgeons, anesthetists, nurses and Cambodian Society of Surgery) participated
Pilot tests (Nov 2012 – Jan 2013)
Rolled out nationwide to all national and provincial level hospitals with operating theaters (Feb 2013)

11. Results 33 (67.3%) hospitals routinely use clinical pathway
Provincial hospitals generally showed higher utilization rate compared to national hospitals
National Hospitals
Provincial Hospitals
Total
Number of hospitals visited 6 43 49
Number of hospitals currently using the CP
4 (66.7%)
29 (67.4%)
33 (67.3%)

12. Results
Routine use of clinical pathway contributes to a decrease in surgical complications
Data from 4 National hospitals
Before
After
Number of cases reviewed
112
117
Post-surgical complications
Overall complication rate
13 (11.6%)
3 (2.6%)
Surgical site infection
1 (0.9%)
Fever after surgery
12 (10.7%)
2 (1.7%)
Data from 2 pilot test hospitals
Before
(July-Oct, 2012)
During pilot test
(Nov2012 – Jan 2013)
After
(Mar-Apr 2014)
Number of cases reviewed
100
177 50
Post-surgical complications
Overall complication rate
20 (20.0%)
4 (2.3%)
1 (2.0%)
Surgical site infection
16 (16.0%)
3 (1.7%)
0 (0.0%)
Unplanned blood transfusion
2 (2.0%)

13. Results Staff agreed that the clinical pathway:
improved the safety of patients
Improved communication among the surgery team
National Hospitals
Provincial Hospitals
Total
Number of staff interviewed 57
192
249
CP is easy to use
53 (93.0%)
173 (90.1%)
226 (90.8%)
CP improves the safety of patients who have operations
57 (100.0%)
173 (90.0%)
230 (92.3%)
CP improves communications among the operation team
CP should continue to be used in this hospital
I experience some difficulties when using the CP
11 (19.3%)
11 (6.4%)
22 (8.8%)

14. Results
Staff’s reception of clinical pathway is higher in pilot test hospitals where more intensive staff training was provided
Data from 2 pilot test hospitals
Before
Nov-Dec 2012
After
Mar-Apr 2014
Number of staff interviewed 69 20
CP is easy to use
64 (92.7%)
20 (100.0%)
CP does not take long time to complete
CP improves the safety of patients who have operations
68 (98.5%)
CP improves communications among the operation team
CP should continue to be used in this hospital
69 (100%)

15. Results
“What do you think is the most important factor for sustainable use of the clinical pathway?”

16. Difficulties faced by hospitals in using the clinical pathway
Insufficient understanding of the clinical pathway
Lack of cooperation and coordination among staff and teams
Lack of staff (esp. anesthetists)
Lack of commitment from senior staff
Lack of guidance materials and information sources
Recommendations by hospitals for better use of clinical pathway
On-site staff training on proper usage of the clinical pathway
Refreshment courses for trainers
Monitoring, coaching and follow-up by MoH or other recognized body (e.g. professional societies, universities)
Continuous medical training on patient safety in general

17. Recommendations by hospitals for better use of clinical pathway
On-site staff training on proper usage of the clinical pathway
Refreshment courses for trainers
Monitoring, coaching and follow-up by MoH or other recognized body (e.g. professional societies, universities)
Continuous medical training on patient safety in general

18. Activities on Patient Safety
Infection Prevention and Control (IPC)
National Strategy Plan for IPC
( )
Policy on Infection Control

19. Activities on Patient Safety
Infection Prevention & Control Guideline
IPC Curriculum for training

20. Challenges
Lack of guidance materials and information sources on Patient Safety
There is no training on patient safety in general
Health care provider fear to report on medical error

21. E-mail: soksrun@camnet.com.kh
Thank You
For your Attention
25 Oct 2002