Is Patient Safety a Global Scenario?

Iatrogenic injuries, illness or ill effects have been occurring in the course of treatment by the best of healers in the best of hospitals and are a well-known fact.

Recognizing, the primacy of patient safety in medical practice, the Hippocratic Oath written way back in 4th Century B.C., required a doctor to make a commitment to, “prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.”

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As per the Code of Hammurabi, laid down by Hammurabi, the great king of Babylon (2000 BC), physicians ran the risk of stringent punishment, even death, for therapy proved wrong.

The Nightingale Pledge (1893) requires the nurses to take a pledge, “I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug and devote myself to the welfare of those committed to my care.”

Since those early days, therefore, Primum non-noncore (first do no harm) has been accepted as a sacrosanct tenet in medical practice. In spite of that, however, medical errors have been occurring in all ages throughout the history of medicine. What was not known, until recently, was the extent of the problem.

First time, the attention was drawn towards the problem of medical errors in April 1982 by the ABC television program 20/20 entitled.

The Deep Sleep stating that every year 6000 Americans die or suffer brain damage on account of anesthesia mishaps.

Shaken by the revelation, the American Society of Anesthesiologists established the Anesthesia Patient Safety Foundation in 1984 to address the issue of patient safety.

An Australian study (1989) reported 18000 annual deaths due to medical errors in Australia and lead to the establishment of Australian Patient Safety Foundation in 1989 for monitoring the anesthesia errors.

The process of reporting of adverse patient events so started, further revealed in 1990s a staggering number of patients harmed and killed by medical errors, in many other countries.

Recognizing that healthcare errors impact 1 in every 10 patients around the world, the World Health Organization called patient safety an endemic concern.

The full magnitude of the horror, however, was not appreciated until 1999 when the Institute of medicine (IOM) of the national Academy of Sciences (USA) released its report titled, “To Err is Human: Building a Safer Health System”.

The statistics were eye openers— “From 44000 to 98000 preventable deaths every year due to medical errors, out of which seven thousand deaths due to medication errors alone”.

The report recommended certain far reaching nationwide efforts include establishment of a center for patient safety, expanded reporting of adverse events, development of safety programs in health care organizations and attention by regulators, healthcare purchasers and professional societies.

It stirred the US government and the Congress into action. Another study report, “Patient Safety in American Hospitals”, published by Health grades (a health care rating organization) in 2004 stated that there were more than a million adverse events associated with Medicare hospitalizations during 2000-2002 resulting in up to 1,95,000 yearly accidental deaths. That caused further outrage and added a sense of urgency to prevent the errors.

The problem was just as bad in European countries. In UK, in 2000, the incidence of harmful medical events in NHS hospitals was reported to be as high as 8, 50,000 every year.

A similar Canadian study in 2004 revealed the occurrence of adverse events in more than 7% of hospital admissions with 9000 to 24000 annual deaths due to avoidable medical errors. The situation was found to be no better in other countries such as New Zealand and Denmark.

By now, it is an established fact that the problem of medical errors and their consequential harm to the patients is a global problem of vast proportions.

Although, the facts and figures about incidence of medical errors in Asian and African countries are not available, it can be safely assumed that the situation would be far worse in these countries.

If one does not hear any alarm bells in these countries, it is not because errors are not happening but because of lack of probity and non-availability of data.

Infections, surgical and medical errors, disabilities and deaths, due to negligence of care providers have been happening and continue to happen in India also, but they do not cause any alarm.

Often, the public does not even come to know because of a poor system of dissemination of information. As a result, often the incidents evoke little more than a local reaction, are treated as isolated aberrations and are forgotten.

The single most important reason behind all these continuing medical errors is the fear of public reaction and legal liability that forces the care providers to actively hide, deny and disown the occurrence of any adverse events.

It is due to total lack of systemic transparency, coupled with professional dishonestly on the part of care providers, that not only these adverse events remain undisclosed and unknown but continue unchecked, affecting the patients who have little understanding of these technical matters.

The public reaction to the reports on magnitude of medical errors was strong enough to set the reform process rolling in the western countries.

A large number of public and private initiatives were started with the twin aims of getting the care providers to report the adverse medical events and institute corrective measures to prevent recurrence in future.