Dr. Juri Bharat Kalita
In ‘Notes on Hospitals’, Florence Nightingale begins with the following declaration: “It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm.”
What a chilling statement! If you examine it carefully, the implication is that the sick patient in a hospital is actually potentially susceptible to harm by the hospital which he actually visits with the expectation of being relieved of the harm that is caused by his disease. Looking at it another way, it says, a patient coming to a hospital also may possible be harmed by the hospital in a way that is not linked to his actual disease.
During her course of giving nursing services, Nightingale made several observations. She not only pioneered the concepts of modern nursing but was also an astute administrator, hospital designer and statistician who introduced documented medical records, keeping from her observations which brought her to the statement that we are discussing. The germ theory (that germs are responsible for disease) was not yet accepted during her times. War injury soldiers were often treated by amputation of which 50 percent died at the point of time when the hygiene conditions in the makeshift barracks were appalling. They died due to infection. As many as 80 percent soldiers undergoing surgery would have infections.
Today, because of the observations and trials of Nightingale (she reduced infection rates to as low as 2% during her times), Semelweiss (who demonstrated that simple hand-washing reduced the number of post-delivery infections by as much as fifty percent), and Lister (who demonstrated that use of disinfectants reduced rates of post-surgery infection dramatically), modern medicine so rapidly achieved a level of sophistication and advancement, which would have seemed unachievable to a person living in the 19th century. And hospital infection is only one of the factors that may cause harm to a patient.
We should not forget this. Medical advancement is directly proportional to the level of patient safety. This is therefore kept in mind in the building design and practices of the modern hospitals. Patient safety goals are prepared annually, hospital standards and guidelines, like the NABH and JCI, address patient safety in great detail and are the benchmarks that hospitals now need to follow.
So what is it that a hospital needs to do to keep patients safe? (Adapted from Hospital National Patient Safety Goal: From the Joint Commission Accreditation for Hospitals)
Ø Identify patients correctly
Ø Use at least two ways to identify patients: For example, use the patient’s name and date of birth. This is done to make sure that each patient gets the correct medicine and treatment. Make sure that the correct patient gets the correct blood when they get a blood transfusion.
Ø Improve staff communication: Get important test results to the right staff person on time.
Ø Use medicines safely: Before a procedure, label medicines that are not labeled. For example, medicines in syringes, cups and basins. Do this in the area where medicines and supplies are set up. Take extra care with patients who take medicines to thin their blood. Record and pass along correct information about a patient’s medicines. Find out what medicines the patient is taking. Compare those medicines to new medicines given to the patient. Make sure the patient knows which medicines to take when they are at home. Tell the patient it is important to bring their up-to-date list of medicines every time they visit a doctor.
Ø Use alarms safely: Make improvements to ensure that alarms on medical equipment are heard and responded to on time.
Ø Prevent infection: Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization. Set goals for improving hand cleaning. Use the goals to improve hand cleaning. Use proven guidelines to prevent infections that are difficult to treat. Use proven guidelines to prevent infection of the blood from central lines. Use proven guidelines to prevent infection after surgery. Use proven guidelines to prevent infections of the urinary tract that are caused by catheters.
Ø Identify patient safety risks: Find out which patients are most likely to try to commit suicide.
Ø Prevent mistakes in surgery: Make sure that the correct surgery is done on the correct patient and at the correct place on the patient’s body. Mark the correct place on the patient’s body where the surgery is to be done. Pause before the surgery to make sure that a mistake is not being made.
(Dr. Juri Bharat Kalita is Senior Consultant, Clinical Microbiology and Health Care Management, and a NABL Assessor at Ayursundra Hospitals, Guwahati. She can be reached by email at firstname.lastname@example.org)