cambodia situation on patient safety dr. sok po deputy director hospital services department in...
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Cambodia Situation on Patient Safety
Dr. Sok PoDeputy Director Hospital Services DepartmentIn Charge of Quality ImprovementMinistry of Health
THAILAND LOA PDR
Pailin
Battambang
Banteay MeanChey
Udor Meanchey
Siem Reap
Pursat
Kg. Chhang
Sihanouk Ville KampotKep
KandalKg. Speu
Kg. Cham
Svey Rieng
Prey Veng
Kratie Mondul Kiri
RattanakiriSteung Treng
Kg. Thom
Preah Vihear
Takeo
Koh KongGulf of THAILAND
VIETNAM
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)
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)
GEO- SOCIO DEMOGRAPHY OF THE KINGDOM OF GEO- SOCIO DEMOGRAPHY OF THE KINGDOM OF CAMBODIACAMBODIA
Overview of Government Health Care System
• 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 )
Central Level
Provincial Level
Operational District (OD): A Referral hospital and
HCs
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.
Policy and National Initiative to Improve Patient Safety
Accreditation for health care facilities in 2015
QI roadmap
National Policy for Quality in Health
• Oct 2005• Six strategies:
1. Empowering consumer2. Institutional Management3. Clinical Practice4. Professional Development5. Management Development6. Institutionalization of Quality
Road map for Quality Improvement, Oct 2006
Planning
Environment QA office QI working group Working group Hosp Reform Group HTA core group HR (MoH) Med Co NIPH, HRG
Regulation and licensing (private sector) Basic safety PHDs Performance management (public sector) Competence
Enabling legislation Agency Accreditation (public and private facilities) Excellence
National quality policy 2005
Health care financing Human resource management Professional self-regulation Decentralization of management
Six strategies
1 Empowering consumers
2 Institutional management
3 Clinical practice
4 Professional development
5 Management development
6 Institutionalization of quality (MoH)
Patients’ charter MoH
Management standards
Clinical standards
Training, CME
Training, CPD
International principles and frameworks eg EBM, AGREE, ISQua
Plus
CPA, URC tool
Health Sector Strategic plan Institutional development plan
Clinical governance
Information
ST
AN
DA
RD
S
A road map for organisational standards Cambodia, October 2006
Health Strategic Plan 2008-2015Chapter 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.
Health Strategic Plan 2008-2015Chapter 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.”
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.
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)
• 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 49Number of hospitals currently using the CP 4 (66.7%) 29 (67.4%) 33 (67.3%)
Results
• Routine use of clinical pathway contributes to a decrease in surgical complications
Data from 4 National hospitals Before AfterNumber of cases reviewed 112 117Post-surgical complications Overall complication rate 13 (11.6%) 3 (2.6%) Surgical site infection 1 (0.9%) 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 50Post-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%) 0 (0.0%) 0 (0.0%)
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 57 (100.0%) 173 (90.0%) 230
(92.3%)CP should continue to be used in this hospital 57 (100.0%) 173 (90.0%) 230
(92.3%)I experience some difficulties when using the CP 11 (19.3%) 11 (6.4%) 22 (8.8%)
Results
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 BeforeNov-Dec 2012
AfterMar-Apr 2014
Number of staff interviewed 69 20CP is easy to use 64 (92.7%) 20 (100.0%)CP does not take long time to complete 64 (92.7%) 20 (100.0%)CP improves the safety of patients who have operations
68 (98.5%) 20 (100.0%)
CP improves communications among the operation team 68 (98.5%) 20 (100.0%)
CP should continue to be used in this hospital 69 (100%) 20 (100.0%)
“What do you think is the most important factor for sustainable use of the clinical pathway?”
Results
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
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)
Policy on Infection ControlNational Strategy Plan for IPC (2011-2015)
19
Activities on Patient Safety Infection Prevention & Control GuidelineIPC Curriculum for training
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
25 Oct 2002 E-mail: soksrun@camnet.com.kh 21
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