Teresita de Jesús Ramírez-Sánchez,1 Luz María Alejandra Rosales-López2
1Unidad de Vinculación y Evaluación de Delegaciones, Coordinación de Evaluación en IMSS-Prospera; 2Área de Gestión del Conocimiento, División de Innovación Educativa, Coordinación de Educación en Salud. Instituto Mexicano del Seguro Social, Distrito Federal, México
Correspondence: Teresita de Jesús Ramírez-Sánchez
Keywords: Patient safety, Quality of health care
International health policy on patient quality and safety emerges as a need of the World Health Organization (WHO) to promote the issue as a fundamental principle for all health systems. That is why in 2002, at the 55th World Health Assembly, WHO urged Member States to pay greater attention to the problem and strengthen systems that improve patient safety. In 2004 the World Alliance for Patient Safety was created to coordinate, disseminate, and accelerate improvements worldwide. In 2007, WHO presented nine measures to reduce damage related to healthcare consistent with international goals of the Joint Commission International (JCI), related to look-alike/sound-alike drugs; patient identification; communication during patient transfer; the performance of the right procedure at the right place in the body; control of concentrated solutions of electrolytes; ensuring the accuracy of medication in care transitions; avoiding connection errors in catheters and tubes; single use of injection devices; and improved hand hygiene to prevent healthcare-associated infections.1,2
With this approach to improving the technical quality and perceived quality as well as in the management of health services for patient safety, the Ministry of Health in Mexico implemented the Cruzada Nacional por la Calidad de los Servicios de Salud and the Sistema Integral de Calidad en Salud (SI Calidad), as well as for the accreditation and certification of medical units by the 2009 JCI standards in order to meet international patient safety goals. Among other initiatives, the Instituto Mexicano del Seguro Social established the Modelo Institucional para la Prevención de Infecciones Nosocomiales (MIPRIN), in response to international policy and the increase in nosocomial infections amounting in the year 2012 to 118,837 for 1,957,764 hospital discharges. The MIPRIN consolidates two priority lines of action: the effective hand hygiene program with fourteen actions and the Comité de Detección y Control de Infecciones Nosocomiales (CODECIN).3
In the national context of nursing in Mexico, the Sistema Nacional de Indicadores de Calidad en Salud (INDICAS) was developed in the public and private sector health institutions, through the measurement of standards and indicators of basic nursing procedures to control unnecessary risks and harm to the patient concerning interpersonal quality, compliance with oral administration medications, surveillance of installed drip equipment, dignified treatment, prevention of urinary tract infections, urinary catheters installed, inpatient falls, and prevention of pressure ulcers. The actions were coordinated by the Comisión Permanente de Enfermería (CPE) and the Dirección General de Calidad y Educación of the Secretaría de Salud.4
To implement a successful damage prevention system, not a punitive one, a change is needed in the culture of institutions on quality and patient safety. In such change there must be a set of characteristics and attitudes in organizations and individuals that determine safety issues.4 Therefore it is necessary to perform a deliberate search for the identification of risks and threats to all levels of the chain of process of care and at the same time to develop the legal policies that affect the preventive nature of malpractice and adverse effects.5
It is necessary to mediate between the organizational aspects of health institutions in terms of quantity and quality of resources and the intellectual and ethical professional skills for the efficient performance of its functions and activities. However, professional practice is not exempt from confronting events or circumstances that cause or could cause unnecessary damage to the patient —incident without damage— and when this occurs, it is an adverse event (AE).4 In the United States the number of AE is greater than that of traffic accidents, breast cancer, and AIDS; in Canada, New Zealand (10%) and Australia (16.6%) patients suffer adverse effects during hospitalization; according to the IBEAS study, pioneer network in patient safety in Latin America, they report that AE occurs in 10.5% of hospitalized patients and 50% of cases could have been avoided, along with consequent economic repercussions, days of extended stay, compensation payment, preventable hospital infections, and disability.4
Such a situation is identified during health services monitoring. Through the experiences of patients, families, and health professionals, the high probability of AE is shown, just by the presence of factors inherent in the system, such as bureaucracy; scant communication between services; communication with the patient, family, and primary caregiver; the conditions of the infrastructure and equipment; waste and hazardous waste management; attachment to the flow of continuity of care; and factors related to malpractice.
The analysis of the factors inherent in the system and the process of attention and nursing care, as well as their relationship or association, may be cause for the generation of research projects or daily practice on issues of quality and patient safety; the approach may be in the areas of pressure ulcers, infections associated with intravenous therapy, safe medication administration, international patient safety goals, effective communication with the patient, comprehensive care of the chronically ill, the event notification system and its effect on improving the quality of care.
Future research topics in patient quality and safety depend on the country's health policies and its organizations. In the case of Mexico, the magnitude of the problem is yet unknown and little is known about the characteristics of the damage or loss of life, also of the causes of the most common events and solutions to avoid or reduce the event; the effects on the health system, the sustainability of the solutions, and support of information systems for monitoring adverse events are still untested.