Man. Fasilitas Keselamatan Pertemuan 7A

  HOSPITAL PATIENT SAFETY DESIGN Dr. ADIB A YAHYA, MARS

  7 STATE – OF – THE - ART

despite all the known power of modern medicine to cure and ameliorate illness,

hospitals were not safe places for healing.

  

Instead, they were places fraught with risk

of patient harm

  4 Historically hospitals were not the safest places

  4

  

“TO ERR IS HUMAN” CORRIGAN, KOHN AND DONALDSON

US ACADEMY OF SCIENCES /

  INSTITUTE OF MEDICINE ,

2000

• • 1984 New York -2.9% of admissions suffered an adverse event, 58% of

  

which were preventable

• 1992 Colorado and Utah - 3.7% of admissions suffered an adverse event,

  

53% of which were avoidable

• Over 33.6Mn US hospital admissions pa between 44,000 and

  

98,000 avoidable deaths occur

8th most frequent cause of death ahead of AIDS ( 16,516 deaths pa), breast cancer ( 42,297 deaths pa) and

  To Err is Human:

Building a Safer Health System

(1999/2000)

Active Failures ( “sharp end “ ) - Procedure

  Latent Failures (“BLUNT END”)

• Professionali
• Emergency

  sm

  Emergency

• Diagnose

  Diagnose

• Team
• Pemeriksaan

  Pemeriksaan ^{1. PATIENT 2. TASK AND TECHNOLOGY 3. INDIVIDUAL} Planning, Designing , Management Decisions/ Organisational Processes Error Producing Conditions Violation Producing Conditions Error Violation Organisational & Corporate Culture Contributary Factors Influencing Clinical Practice Task Defence Barriers

  Thought leaders in health care offered persuasive arguments that errors could be reduced by redesigning systems and processes using human factors principles. These could reduce mistakes through design features , including standardization, simplification, and the use of constraints (which is a design characteristic that makes error impossible)

Initially, perhaps, blunt-end factors were typically thought of as

organizational policies and processes that shaped the behavior

PENGERTIAN Patient safety (WHO/Europe | Patient safety) Patient safety (WHO/Europe | Patient safety)

  adverse effects

  Keselamatan Pasien Rumah Sakit – KPRS

  .

  associated with health care associated with health care .

  to patients

  to patients

  adverse effects

  and

  The simplest definition of patient

  prevention of errors prevention of errors and

  is the

  is the

  safety

  safety

  The simplest definition of patient

• Suatu sistem dimana RS membuat asuhan pasien lebih aman.

  Key Concepts Key Concepts

  Human fallibility / Human fallibility /

  “ to err is human “ “ to err is human “

  Anatomy of error / Anatomy of error / incident types incident types

  System approach System approach

  “ “

  Just Culture “ Just Culture “

  / no blaming culture / no blaming culture

  Organizational Learning by Organizational Learning by reporting reporting

  

The role of hospital design

in

patient safety

Hospital design refers to the physical environment that

  includes :

• the indoor environment (e.g. noise, air quality and lighting),

• - the interior design (e.g. furniture, fixtures and materials)

  and
• the configuration (e.g. relative locations and adjacencies of spaces) of a hospital.

Factors Influencing the Built Environment

  

With human factors in mind, there are several aspects of the built environment that should be considered.

The following design elements were identified as critical in ensuring patient safety and quality care, based

on the six quality aims of the Institute of Medicine’s report, Crossing the Quality Chasm: A New Health

  System for the 21st Century:

• Patient-centeredness , including
• using variable-acuity rooms and single-bed rooms
• ensuring sufficient space to accommodate family members
• enabling access to health care information
• having clearly marked signs to navigate the hospital
• Safety , including
• applying the design and improving the availability of assistive devices to avert patient falls
• using ventilation and filtration systems to control and prevent the spread of infections
• using surfaces that can be easily decontaminated
• facilitating hand washing with the availability of sinks and alcohol hand rubs
• preventing patient and provider injury

• - addressing the sensitivities associated with the interdependencies of care, including work spaces

  and work processes

• • Effectiveness , including
• use of lighting to enable visual performance
• use of natural lighting
• controlling the effects of noise
• • Efficiency , including
• standardizing room layout, location of supplies and medical equipment

• - minimizing potential safety threats and improving patient satisfaction by minimizing

  patient transfers with variable-acuity rooms
• • Timeliness , by
• ensuring rapid response to patient needs
• eliminating inefficiencies in the processes of care delivery
• facilitating the clinical work of nurses
• • Equity , by
• ensuring the size, layout, and functions of the structure meet the diverse care needs of
According to the model of system accidents

proposed by Reason, research has shown

that Hospital design may : - directly impact safety in hospitals.

• - indirectly impact safety by triggering adverse

  events that cause harm to patients and staff.
• impact safety in hospitals by working as a barrier to harmful events.

  Adverse events in hospitals are related to both active and latent failures.

  Active failures are unsafe acts (slips, lapses, fumbles, mistakes -

  and procedural violations) committed by the individuals in direct contact with the patient.

• latent failures create local conditions that in specific situations may lead to active failures.

  Latent failures may become embedded within systems as a result of wrong decisions made by designers, builders, procedure writers and

  top level management .

Direct impacts on patient safety

  Aspects of hospital design such as air quality, lighting, patient room design and other interior design elements can directly impact safety outcomes such as nosocomial infections, patient falls and medical errors.

  Air quality and nosocomial infections Single bedrooms and nosocomial infections Lighting conditions and patient outcomes

  Lighting conditions and medical errors

  Noise in hospitals and patient outcomes

  Hospital design and patient falls

  

Impact of the environment

on staff working conditions

A poorly designed physical environment creates latent

conditions such as staff stress, fatigue, annoyance, burnout

and lack of handwashing compliance that may potentially lead to adverse events in hospitals.

  Noise in hospitals and staff outcomes Variable acuity patient rooms and transfers Unit layout and staff effectiveness

Environmental barriers/defenses to healthcare accidents

  The environment potentially acts as a defense to adverse events by providing opportunities for staff and families to prevent accidents before they occur.

  Visibility to patients

  Presence of family

Active Failures ( “sharp end “ ) Environmental barriers/defense

  Latent Failures (“BLUNT END”)

• Emergency

  Emergency

• Diagnose Diagnose
• Pemeriksaan

  Pemeriksaan ^{Direct impacts on patient safety : Air quality and nosocomial infections} _{Single bedrooms and nosocomial} Management Decisions/ Organisational Processes Error Producing Conditions Violation Producing Conditions Error Violation Organisational & Corporate Culture Contributary Factors Influencing Clinical Practice Task Defence Barriers Impact of the environment _{Noise in hospitals and staff on staff working conditions : outcomes}

  

Direct impacts on patient safety

Air quality and nosocomial infections

  

Airborne infections are spread when dust and pathogens are released during

hospital construction and are caused by contamination and malfunction of hospital ventilation systems .

fungal load in the air may be linked to humidity, temperature and construction

activity .

  High-efficiency particulate air (HEPA) filters can be highly effective in preventing airborne infections in hospitals .

Air contamination is least in laminar airflow rooms with HEPA filters, and this

approach is recommended for such areas as operating-room suites and ultraclean rooms for immunocompromised patients.

Single bedrooms and nosocomial infections

  single-bed patient rooms with high-quality HEPA filters and with negative or positive pressure ventilation are more effective in preventing air-borne pathogens. multibed rooms are more difficult to decontaminate and have more surfaces that act as a reservoir for pathogens.

  On the basis of the study findings, the 2006 American Institute of Architects Guidelines for Design and Construction of Healthcare

  

Single rooms now required in new hospitals in 40+ U.S.

states “In new construction, the maximum number of beds per room shall be one . .”

2006 Guidelines for Design and Construction of Health

Care Facilities (section 3.1.1.1, p. 40)

  Published by: The Facility Guidelines Institute American Institute of Architects U.S. Department of Health and

Lighting conditions and patient outcomes

  different psychological and physiological effects of lighting in hospitals, some of which may be directly related to patient safety. For example, ‘ICU psychosis ’ in adult patients can be partly attributed to bright or constant lighting conditions in ICUs that lack night/day cues.

  A similar phenomenon has been described among children in pediatric ICUs . the mortality rate may be higher in dull patient rooms , poor lighting conditions may negatively impact physiological developments among infants . studies suggest that lighting conditions should be considered more

Lighting conditions and medical errors Performance on visual tasks gets better as light levels increase

  errors in dispensing medications in a high volume outpatient pharmacy were significantly lower at an illumination level of 146 foot-candles (2.6%) as opposed to the baseline level of 45 foot candles (3.8%).

  58% of all medication errors among hospital workers occurred during the first quarter of the year when daylight hours were less . importance of appropriate lighting levels for complex tasks requiring excellent vision