الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 251 |  |  |
| | | from | 251 | | |
Abstract
Primary health care services are at the heart of health care in many countries. They provide an entry point into the health system and directly impact on people‘s well-being and their use of other health care resources. Unsafe or ineffective primary health care may increase morbidity and preventable mortality and may lead to the unnecessary use of scarce health care and specialist resources. Thus, improving safety in primary care is essential when striving to ensure universal health coverage and the sustainability of health care. Safer primary care is fundamental to ensure healthy lives and promote well-being for all at every age. Understanding the magnitude and nature of harm in primary care is important because a significant proportion of health care is offered in this setting, yet there is little clarity about the most effective ways to address safety issues at this level.
The aim of the present work was to evaluate an interventional training program on patient safety in family health centers in Alexandria. The specific objectives were:
1- To assess patient safety program in family health centers.
2- To assess patient satisfaction regarding patient safety in the selected family health centers.
3- To construct an interventional training program for family health personnel based on the results of the previous assessment and re-evaluate them after program implementation.
To conduct the present study, the following techniques were used:
1. An assessment tool based on WHO PSFHI was utilized and implemented to assess the patient safety standards
This assessment tool covered five domains divided into 16 sub domains as follow:
A. Leadership and management (4 sub domains) including:
Leadership and management commitment to patient safety, data to improve safety performance, equipment and supplies, and technically competent staff for safer patients.
B. Patient and public involvement (5 sub domains) including:
Patient rights, patient identification, communication of the patient safety incidents to patient, health awareness, and patient involvement.
C. Safe evidence-based clinical practice (4 sub domains) including:
System to reduce health care-associated infections, safe injections, infusions, and immunizations, medication management system, and medical records system.
D. Safe environment (2 sub domains) including:
Safe physical environment and waste management.
E. Lifelong learning (one sub domain) including: Staff professional development program.
Summary
135
2. A predesigned interview questionnaire was utilized to assess patients’ satisfaction regarding patient safety components in the studied family health centers, which included:
Records and registration procedures, general opinion about the center, waiting time and areas, family clinic services, pharmacy services, laboratory services, dental clinics, emergency service, radiological service, and patient involvement.
3. An in-service intervention-training program was constructed, based on discovered shortcomings in the mentioned domains and implemented for the family health personnel in two family health centers (those with the lowest patient safety scores); namely El Hadra Kebly and El Atarine both in Middle health district.
Data were subjected to statistical analysis and interpretation.
The results of the present study could be summarized as follows:
1. The total scores of patient safety domains in the studied family health centers ranged from (44.3 to 80.7%) with a mean of (63.4±11.4).
2. The safe environment domain got the highest total score with a mean of (74.2±10.3), while lifelong learning domain got the lowest score with a mean of (44.2±13.6).
3. Total score percentages of leadership and management domain ranged between (41.1 and 79.5%) with a mean of (61.8±13.0). The highest sub domains‘ score belong to technically competent staff for safer patient care with a mean of (81.3±18.9) and the lowest score to the presence of data to improve safety performance with a mean of (32.5±32).
4. All the studied family health centers did not meet the standards of presence of patient safety executive walk reports, presence of a staff member responsible for patient safety, and if patient safety is included in the employee‘s satisfaction questionnaire.
5. Patient and public involvement domain total score percentages varied between (41.2 and 83.8%) with a mean of (63.8±14.2). The highest sub domains‘ score in the studied centers belongs to patient identification with a mean of (71.9±23.9), while the lowest score belongs to patient rights with a mean of (59.4±14.6).
6. All the studied centers did not meet the standard of patient safety being incorporated in patient rights, and the standard of involving the patients in setting policies and implementing quality improvement and patient safety.
7. The safe evidence based clinical practice total score percentages varied between (59.1 and 90.9%) with a mean of (73.2±9.9). The highest sub domains‘ score percentage belongs to medication management system with a mean of (83.7±13.2), while the lowest score belongs to medical records system with a mean of (51.6±13.2).
8. All health centers had not met the standards of presence of automated information management and electronic medical records and the presence of an effective automated clinical alarm system.
9. The total score percentages of safe environment domain in the studied family health centers varied between (58.9 and 92.0%) with a mean of (74.2±10.3). The sub domain waste management got the highest score with a mean of (87.8±8.1), while safe physical environment got the lowest score with a mean of (64.1±15.9).
10. The total score of lifelong learning domain ranged between (21.4 and 64.3%) with a mean of (44.2±13.6). All the health centers had not met the standards of presence of patient safety orientation training manual, availability of documents indicating the percentage of the staff trained on patient safety, and familiarity with reporting procedures and steps to be taken during or after an adverse event.
11. The total scores of patients‘ satisfaction regarding patient safety measures ranged between (36.3 and 94.2%) with a mean of (75.9±12.8). The majority of the participants (83.5%) were satisfied, while only (16.5%) gave neutral response to the studied safety measures.
12. Records and registration procedures got the highest score of participants‘ satisfaction with a mean of (89.1±15.4), while the lowest score belongs to patient involvement with a mean of (52.8±18.8).
13. The total patient safety domains‘ scores after patient safety training program had increased in both El Hadra kebly and El Atarin health centers. El Hadra kebly health center‘s total score after the program was (70.6%) in comparison with (44.3%) before the program which was statistically significant (t=7,290, p< 0, 0001). Also, El Atarin health center‘s total score after the program had been changed to (74.8%) in comparison with (59.1%) before program, which was statistically significant (t=5.447, p< 0, 0001).
14. Leadership and management domain total score in both El Hadra kebly and El Atarin health centers showed an increase after the program to (68.8 and 74.1% respectively), in comparison with (41.1 and 52.7% respectively) before the program.
15. Concerning patient and public involvement domain, the total score increased to (64.7%) after the program in comparison with (41.2%) before the program in El Hadra kebly, and from (58.8%) to (75%) in El Atarin health center.
16. The total score percentage of safe evidence based clinical practice domain increased after the program from (59.1 to75.8 %) in El Hadra kebly health center and from (58.8 to 75%) in El Atarin health center.
17. Safe environment domain total score in both El Hadra kebly and El Atarin health centers increased to (73.2% for both) after the program in comparison with (58.9 and 68.8% respectively) before the program.
18. The total score of lifelong learning domain moderately increased in El Hadra kebly health center from (21.4%) before the program to (57.1%) after the program.
Accordingly, the following can be recommended
A. Recommendations directed to policy maker and stakeholders
1. Introducing the concept of ―patient safety‖ and making it a top priority on the health agenda of policymakers and within the organizational structure of the health system through:
Development and implementation of national policy for patient safety. Designing competent and effective patient safety committee that reviews all safety issues across the health care facilities, and promotes the culture of patient safety to address the underlying causes of medical errors and harm to patients and remove obstacles for improvement.
Performing continuous situation analysis of system performance in patient safety through improving data and information system for safer health care.
Providing technical support to those who work in the health system to enable them to deliver safer patient care.
Provision of essential equipment and supplies maintenance.
Building awareness and understanding of health care safety.
Setting up mechanisms for patient engagement at the systems level.
2. Allocation of funds for patient safety activities by national authorities will demonstrate government commitment to improve safety in health-care settings.
3. Including risk management in the accreditation of PHC services.
4. Emphasizing the importance of education in patient safety.
5. Ensuring decision makers allocation of resources for patient safety education.
B. Recommendations for family health centers providers (primary health care providers)
1. Supporting health care professionals to find solutions through:
Focusing on creating a culture where the workforce feels comfortable discussing safety incidents.
Offering feedback about patient safety threats to professionals in order to raise their awareness of errors, and helping them to develop relevant solutions locally.
Using walk rounds and team meetings as a way to identify areas for improvement.
Focusing on improvements in high-risk areas, such as record keeping, use of diagnostic test results and transitions of care.
2. Strengthening patient safety incident reporting and learning systems
Supporting the development of taxonomy of errors which is consistently used to identify errors.
Supporting health care providers to access regional or national patient safety incident reporting systems so that data on threats to safety in PHC can be collected at regional or national levels.
Strengthening blame-free reporting system on adverse events that encourage healthcare workers for active reporting.3. Educating health care providers about patient engagement
Educating health care providers to involve patients, both at the organizational and individual level.
Including patient engagement and safety in educational curricula.
Encouraging patients to report on safety incidents, and safety concerns; actively promoting patient feedback systems.
Providing patients with appropriate, accurate and up-to-date information about treatment and safety issues in a user-friendly language and format.
Promoting open disclosure about safety incidents to patients.
Giving feedback to patients on follow-up actions taken about the issues they raised.
Considering campaigns aimed at raising public awareness about patient safety in PHC.
4. Improving record systems
Reducing the burden of unnecessary administrative tasks for PHC practices to facilitate the processes and reduce the risk of error.
Improving any format used for medical recording by clearly indicating all the essential details to be completed.
Enhancing the use of clinical record systems with alerts to help health care professionals be aware of issues with processes and communication.
Using electronic records rather than paper records.
Designing record systems where important information is highlighted and easily available, such as allergies to medications.
5. Implementing medication reviews
Ensuring that pharmacists actively review prescriptions.
Encouraging and supporting the use of medication reconciliation by clinicians.
Using computerized systems in medications management through electronic prescribing and alert systems.
C. Recommendations for education managers
1. Developing education specifically about patient safety in PHC
Making education about safety in primary care mandatory and part of assessment procedures and starting it at the pre-service phase.
Drawing on existing curricula about patient safety in PHC and using on job training, and incorporating a wide range of topics in safety education, such as human factors, leadership, inter-professional communication, incident reporting, how to measure safety and quality in PHC, and how to learn from errors.
Summary
139
Providing education about quality improvement approaches so that workers are not only able to identify incidents, but also know how to minimize them in the future.
2. Thinking creatively about how to provide education
Educating workers using a mix of pre-service and in-service education. General training in safety could be provided for all workers with more specific training targeted as needed.
Offering practical education in a workplace context, by using direct observation, feedback, videos and rotations.
Providing opportunities to learn about and practice safer primary care in a team based setting.
Evaluating the effectiveness of different education methods.
Monitoring improvements in trainee and patient outcomes so that changes in practices and patient safety can be tracked over time.