17 September is a day to celebrate Patient Safety and remember that patient harm can be avoided. In this article I share five ways healthcare professionals can reduce the risk of causing harm to patients and live up to their oath.
I have been struggling with an eating disorder for the past few years. I am afraid to eat and afraid I will gain weight. The fear is unjustified as I was never overweight. I have weighed the same since I was 12 years old, and I am currently nearing my 25th birthday. Yet, when I see my reflection, I see somebody who is much larger than reality.
I told my therapist that I thought I was fat. She said it was 'body dysmorphia'.
She explained this as a mental health condition where a person is apprehensive about their appearance and suggested I visit a nutritionist. She also told me that this condition was associated with other anxiety disorders and eating disorders. I did not understand what she was saying as I was in denial; I had a problem, to begin with. I wanted a solution without having to address my issues.
Upon visiting my nutritionist, he conducted an in-body scan and told me my body weight was dangerously low.
I disagreed with him.
I felt he was speaking about a different person than the person I saw in the mirror. I felt like the elephant in the room- both literally and figuratively. He then made the simple but revolutionary suggestion to keep a food diary to track what I was eating.
This was a clever way for my nutritionist and me to be on the same page. By recording all my meals, drinks, and snacks, I was able to see what I was eating versus what I was supposed to be eating. Keeping a meal diary was a powerful and non-invasive way for my nutritionist to walk in my shoes for a specific time and understand my eating (and thinking) habits.
No other methodology would have allowed my nutritionist to capture so much contextual and behavioural information on my eating patterns other than a daily detailed food diary.
However, by using a paper and pen, I often forgot (or intentionally did not enter my food entries) as I felt guilty reading what I had eaten or that I had eaten at all.
I also did not have the visual flexibility to express myself through using photos, videos, voice recordings, and screen recordings. The usage of multiple media sources would have allowed my nutritionist to observe my behaviour in real-time and gain a holistic view of my physical and emotional needs.
I confessed to my therapist my deliberate dishonesty in completing the physical food diary and why I had been reluctant to participate in the exercise. My therapist then suggested to my nutritionist and me to transition to a mobile diary study.
Whilst I used a physical diary (paper and pen), a mobile diary study app would have helped my nutritionist and me reach a common ground (and to be on the same page) sooner rather than later.
As a millennial, I wanted to feel like journaling was as easy as Tweeting or posting a picture on Instagram. But at the same time, I wanted to know that the information I provided in a digital diary would be as safe and private as it would have been as my handwritten diary locked in my bedroom cabinet.
Further, a digital food diary study platform with push notifications would have served as a constant reminder to log in my food entries as I constantly check my phone. It would have also made the task of writing a food diary less momentous by transforming my journaling into micro-journaling by allowing me to enter one bite at a time rather than the whole day's worth of meals at once.
Mainly, the digital food diary could help collect the evidence that I was not the elephant in the room, but rather that the elephant in the room was my denied eating disorder.
The elephant in the room
As a public health enthusiast, today is a very exciting day for me because we are celebrating the third annual World Patient Safety Day, organized by the World Health Organization (WHO).
In celebration, you might notice orange lighting in public spaces and monuments. It's the hallmark of the international campaign that was established in 2019.
World Patient Safety Day is celebrated on 17 September.
Most of us do not think of patient safety issues until a misfortune hits close to home. I must say that I was unaware of it as well before starting my medical training, that's when I realized how much of a burden patient harm can be.
World patient safety day is a global call to prevent errors and decrease avoidable harm in healthcare.
The WHO estimates that 1 in every 10 patients is harmed by various accidents while hospitalized and that 50% of this harm could be prevented.
In this article, I will be sharing with you 5 easy ways to increase patient safety, but first, I will highlight some key areas of concern about preventable errors and the barriers that lead to patient harm.
Everybody knows that the goal of every healthcare worker is to recover the well-being of patients, or at least help ease their suffering. Unfortunately, the contrary happens sometimes.
Harmful events can occur in various ways. For example, surgical errors can happen when the operation is performed in the wrong location of the body. These errors are the consequence of insufficient planning before the surgery or failure of reviewing the patient's medical record.
Other examples of patient harm are missed or delayed diagnosis, and medication errors; they happen when wrong doses of the drug are prescribed or because of illegible handwriting.
I have seen with my own eyes doctors experiencing intense negative emotions when they commit errors. Tragically, some physicians go as far as taking their own lives because of the intense guilt, disappointment and shame they have to live with.
Obviously, patients too suffer tremendous physical and psychological effects when they are victims of harm, such as paralysis, blindness and even death. Sadly, patient harm is considered the 14th leading cause of mortality and morbidity globally.
This year, researchers observed differences in outcomes between ethnic categories of black and white patients even within the same hospital . It is disheartening to say that Black patients were more likely to experience adverse patient safety events.
Many studies in the United States have found that ethnic disparities impact patient safety, with immigrant patients experiencing more medical harm incidents in hospitals than US-born patients.
Research also pointed out that Black patients were roughly 20% more at risk of being a harm victim than White patients.
Ethnic inequalities are observed even among newborns, who experience higher rates of birth trauma and infections .
Delivering healthcare equally and without discrimination to patients of different racial backgrounds is a fundamental human right, and it should be a priority to all physicians.
The patient-doctor relationship is a fundamental element that influences health outcomes positively. If this relationship is defective, the patient might not even understand his health problem or follow his treatment plan properly.
Dangerous actions like skipping a medication dose, over or under-dosing can result in terrible consequences that could be prevented simply with proper communication,
Physicians experience intense fatigue when overloaded with work; their mental health worsens because of higher stress levels and lack of sleep.
This year, 42% of over 15,000 physicians surveyed in the US by Medscape stated feeling burned-out. This percentage is undoubtedly higher in other countries with a shortage of doctors.
In South Africa, for example, 59% of doctors last year were found to be burned out, and 20% had anxiety and depression.
This lack of medical staff and poor mental health negatively impacts work performances, leading to an increased risk of making mistakes.
Hospital-acquired infections, for example, are responsible for 1.7 million infections and 99,000 deaths annually in American hospitals .
These numbers can only be worse in other parts of the world, like Africa, where these statistics aren't available.
According to statistics from developed countries, 1 out of every 10 patients is a victim of medical harm. In Africa, the chance of being injured in a hospital is 20 times higher, just like the probability of acquiring a hospital infection .
Issues like the unfamiliarity with digital systems and storing patients' information in paper format are observed in some parts of the world, like Africa and Latin America.
Luckily, there are tools like Teamscope that can promote patient safety and store patient data in countries that lack electronic health records.
Video monitoring systems in hospitals are another simple technique to increase safety. They are addressed to Patients who are at risk of falling; to be watched remotely.
Their effectiveness was proven by a recent study, which showed a significant reduction in hospital falls after a year of usage .
Following simple methods, like hand washing, strict hygiene, and asepsis rules significantly reduce the risks of acquiring deadly hospital-acquired infections by as much as 40% .
Other good examples of free-cost procedures are checklists, self and peer checks of medication administration, and patient information. Performing them might take some time and effort, but their value in error reduction greatly surpasses the burden.
In 2008, the WHO launched global actions to prevent surgical harm by creating surgical checklists . Actually, checklists are estimated to reduce errors in operative emergencies by 75%, proving the slogan "Safe Surgery Saves Lives" right .
Physicians and nurses need to feel safe to report and learn from their errors. Fearing strict disciplinary actions make them reluctant to do so.
The United Kingdom, for example, had established Incident Reporting Systems in 2001. They are designed to assist health-care systems in learning from their mistakes.
England publishes official statistics about medical incidents every six months . It is estimated that 237+ medication errors are made annually in England.
Without a doubt, establishing effective improvement strategies is only possible by creating an environment that favours identifying and reporting errors in the first place.
A survey of 45,700 participants from 24 European countries has shown that individuals' beliefs about doctor-patient relationships are the principal element influencing the decision to follow the treatment plans .
This study has proved that shared decision making, proper and adequate communication impact the adherence to prescribed medications, increasing thus safety.
Establishing a strong connection with the patient can also be achieved by showing empathy, providing emotional support and engaging in an interactive dialogue.
A Stanford study has found that a patient's reassurance from his doctor can even make symptoms, like itchiness, diminish faster .
Simply put, If the patient feels heard, seen and understood, his health outcomes will be impacted positively.
The only way to make patient safety issues more visible globally is to raise awareness about errors to encourage health care workers and the public to become more educated and learn from others about the matter.
Throughout my medical training, I have heard people say endless times, "First, do no harm", and I couldn't be more grateful for each and every time I heard of this ethics oath.
People who have a personal story related to medical errors have a strong commitment to spread awareness about patient safety. Many have lost their parents, spouse, children because of medical errors. The heartbreak of these families is even more devastating when you know that the cause is preventable in 50% of cases.
We should not wait until a similar tragedy happens to our loved ones or to us to raise our voices for patient safety!
Always remember that by raising your voice, you might help save a life! It could be the life of a newborn baby, as this year's theme is about "safe maternal and newborn care".
If you believe in the importance of promoting patient safety culture, as I do, you can show your support today by sharing the slogan "Act now for safe and respectful childbirth".
3. Flores, G., & Ngui, E. (2006). Racial/ethnic disparities and patient safety. Pediatric Clinics, 53(6), 1197-1215.
6. Cournan M, Fusco-Gessick B, Wright L. Improving Patient Safety Through Video Monitoring. Rehabil Nurs. 2018 Mar/Apr;43(2):111-115. doi: 10.1097/RNJ.0000000000000089. PMID: 29499009
7. Kampf G, Löffler H, Gastmeier P. Hand hygiene for the prevention of nosocomial infections. Dtsch Arztebl Int. 2009;106(40):649-655. doi:10.3238/arztebl.2009.0649
9. Chinthapalli, K. (2013). Checklists can reduce errors in intraoperative emergencies by 75%, says expert.
11. Stavropoulou, C. (2011). Non-adherence to medication and doctor–patient relationship: Evidence from a European survey. Patient education and counseling, 83(1), 7-13.
West African Lead, ALMA Youth Advisory Council/Zero Malaria Champion
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Dear Digital Diary,
I realized that there is an unquestionable comfort in being misunderstood. For to be understood, one must peel off all the emotional layers and be exposed.
This requires both vulnerability and strength. I guess by using a physical diary (a paper and a pen), I never felt like what I was saying was analyzed or judged. But I also never thought I was understood.
Paper does not talk back.Using a daily digital diary has required emotional strength. It has required the need to trust and the need to provide information to be helped and understood.
Using a daily diary has needed less time and effort than a physical diary as I am prompted to interact through mobile notifications. I also no longer relay information from memory, but rather the medical or personal insights I enter are real-time behaviours and experiences.
The interaction is more organic. I also must confess this technology has allowed me to see patterns in my behaviour that I would have otherwise never noticed. I trust that the data I enter is safe as it is password protected. I also trust that I am safe because my doctor and nutritionist can view my records in real-time.
Also, with the data entered being more objective and diverse through pictures and voice recordings, my treatment plan has been better suited to my needs.
No more elephants in this room