Further need to improve patient safety

Medical: Having other organs damaged during surgery or finding instruments left in the body following surgery, and being misdiagnosed are some of the anecdotes that have emerged as a result of medical care gone wrong in Bhutan.

While some efforts to record such cases and improve patient safety have been introduced, there is still no systematic study that has been carried out to provide a true picture of how many patients are actually harmed while receiving medical care.

To address the absence of such data, a comprehensive study is expected to be carried out next year. This was a key recommendation made at the 6th technical meeting of the Medical Councils Network of the World Health Organization (WHO) being held in Paro.

The meeting is providing a platform for South East Asian countries to share experiences and best practises on how patient safety can be improved, and on how medical councils can contribute in this effort.

In his opening address, health minister Tandin Wangchuk, pointed out that as many as one in 10 patients are harmed while receiving hospital care in developed countries despite the best technology and trainings being available. “In the developing countries, the incidence is likely to be even higher,” he said.

The minister hoped that the meeting’s outcomes would address the issues and challenges being faced in improving patient safety in the region.

Khesar Gyalpo University of Medical Sciences registrar, Dr Pakila Drukpa, explained that while some statistics are available, such as the recording of “complications” resulting from health care in the annual health bulletins a true picture of the issue is not yet available. According to the 2015 bulletin, 1,814 complications were reported in 2014. A total of six deaths occurred following complications between 2010-2014.

But Dr Pakila Drukpa pointed out that it is not known what the complications were caused by. “How many due to wrong injections, wrong drugs, or during procedures like surgeries,” he said.

“It’s not safe to comment on this, there’s no baseline, but what I can safely say it’s prevalent,” the doctor added when asked to provide an estimate or percentage of the number of patients that are harmed.

He added that the way forward is for a national survey to be carried out. The medical university will carry out the survey in collaboration with relevant agencies. But carrying out the survey may also be dependent on the ability to mobilize the required funds.

The nursing department at the Jigme Dorji Wangchuck National Referral Hospital also carried out small case studies in this area. In one carried out in 2012, it was found that the incidence of bed sores among inpatients was high as a result of their long stays but also because of deficiencies in nursing care to prevent sores. In another 2014 study, a few other incidents, including one maternal death, were attributed to lapses in nursing protocol and procedures which were subsequently addressed.

A mandatory incident reporting system has been introduced into the health care system and so far, 12 incidents, none leading to deaths, have been reported. These include patients falling of their beds, lookalike drugs in the same dispensing box, miscalculating medicine dose, a wrong blood transfusion, and a patient inflicting self injury, among others.

However, Dr Pakila Drukpa questioned if this system is actually implemented. He said that a culture of covering up incidents does exist.

While a number of measures to improve patient safety are already in place such as policies, regulatory mechanisms, standards, guidelines, among others, there remains a lot to be done to strengthen a culture of patient safety in Bhutan, it was pointed out at the meeting.

Dr Pakila Drukpa said that students of the recently introduced postgraduate residency programme at the medical university undergo a module on patient safety and medical laws and ethics. He said that the module would ingrain in the students the fundamental principles of patient safety. A second batch of students are currently in the postgraduate programme.

Dr Prakila Drukpa also pointed out that there is a lack of awareness among the public about the avenues available to them when they are harmed by the medical system. He said that complaints can be lodged with the Medical Council which would then conduct an investigation and hold those responsible accountable.

The three-day meeting in Paro, which is being supported by the WHO, ended yesterday.

Gyalsten K Dorji

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