1. Customer/Patient Safety
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Dr. N. Gopal Reddy Narra
Associate Professor
Kamineni Institute of Medical Sciences
Narket pally- Telangana

2. Medical Customer Safety
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3. Learning objective
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1.Understand the discipline of customer safety,
2.Challenges in customer safety
3. Impact of adverse events or medical errors
4 .Financial constrains and effects,
5. Preventive measures.

4. Hospital
 Hospital is a people sensitive place, Provide services to sick
people round the clock.
 People have a free access to enter any part of the hospital
at any time for advice and treatment.
 The hospital atmosphere is filled with emotions,
excitement, life & happiness, death & sorrow.
 Since hospital operates under continuous strain, it gives
rise to irritation, confrontation, conflicts and aggression,
threatening the life of hospital staff and hospital properties.
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5. Hospital
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 Hospitals are scary places to be in.
 Volumes of investigations, life saving and life threatening
medications, life support devices, complex diseases,
delicate interventional procedures and marathon surgeries
– an error can be disastrous.

6. MEDICAL ERROR-Def
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 A medical error is a preventable adverse effect of
care, whether or not it is evident or harmful to the
customer.
 This might include an inaccurate or incomplete
diagnosis or treatment of disease, injury, syndrome,
behavior, infection, or other ailment.
 Medical errors are all called Never events.
 50% of them are preventable.

7. :.
Data regarding various errors and cost of it in developed
countries, developing countries and India
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No. Events Developed Developing Total India
1 Surgeries 80 millions 54 millions 234 millions 29 millions
2.Errors 14million 27millions 43millions 5.2 millions
3 Readmissions 14.20% 12.70% 13.50% 12.50%
4 Drug errors 5% 9% 6.50% 9.50%
5. Infections 2.50% 3% 2.90% 3%
6. Temporary
disability 59% 55% 56% 55%
7.Permanent
disability 33% 35% 33.60% 35%
8. Deaths (major surgeries)
6.60% 10% 8% !0%
9. Working days lost
7.2million days 15.5 million/d 22.7 million/d 3.5million/d
10.Financial implications
$1.3billion $1.5 billion $2.8 billion $0.4billion
•
RS.2000 CORES

8. Why/ what is safety
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S– Sense the error
A – Act to prevent it
F – Follow Safety Guidelines
E – Enquire into accidents/Deaths
T – Take appropriate remedial measure
Y – Your responsibility

9. Ten Systemic causes for healthcare
errors:
1. Poor communication, between staff.
2. Poor customer to nurse staffing ratio.
3. Disconnected reporting systems within a hospital: poor hands-
offs of customers results in lack of coordination and errors.
4. Drug names that look alike or sound alike
5. No error reporting system.
6. Inadequate systems to share information about errors, analysis
and improvement strategies.
7. Cost-cutting measures by hospitals.
8. Environment and design factors.
9. In emergencies, customer care may be rendered in areas poorly
suited for safe monitoring.
10. Un safe design and construction of health care facilities and
Infrastructure failure.
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10.  The purpose of the National customer Safety Goals is to improve
customer safety.
 The goals focus on problems in health care safety and how to solve
them.
 Identify customers correctly
 Use at least two ways to identify customers. For example, use the customer’s name and date of birth.
This is done to make sure that each customer gets the correct medicine and treatment.
 Make sure that the correct customer gets the correct blood when they get a blood transfusion.
 Improve staff communication
 Get important test results to the right staff person on time.
 Use medicines safely
 Before a procedure, label medicines that are not labeled. For example, medicines in syringes, cups and
basins.
 Do this in the area where medicines and supplies are set up.
 Take extra care with customers who take medicines to thin their blood.
 Record and pass along correct information about a customer’s medicines.
 Find out what medicines the customer is taking.
 Compare those medicines to new medicines given to the customer.
 Make sure the customer knows which medicines to take when they are at home.
 Tell the customer it is important to bring their up-to-date list of medicines every time they visit a
doctor.
2015- Hospital National customer Safety Goals
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11. 2015 -Hospital
National customer Safety Goals
 Use alarms safely
 Make improvements to ensure that alarms on medical equipment are heard and
responded to on time.
 Prevent infection
 Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or
the World Health Organization. Set goals for improving hand cleaning. Use the goals to
improve hand cleaning.
 Use proven guidelines to prevent infections that are difficult to treat, to prevent infection
of the blood from central lines , to prevent infection after surgery and to prevent
infections of the urinary tract that are caused by catheters.
 Identify customer safety risks
 Find out which customers are most likely to try to commit suicide.
 Prevent mistakes in surgery
 Make sure that the correct surgery is done on the correct customer and at the correct
place on the customer’s body.
 Mark the correct place on the customer’s body where the surgery is to be done.
 Pause before the surgery to make sure that a mistake is not being made.
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12. International customer Safety Goals
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Goal1: Identify customers Correctly
Goal 2: Improve Effective Communication
Goal 3: Improve the Safety of High-Alert
Medications
Goal 4: Ensure Correct- Site, Correct-Procedure,
Correct customer Surgery
Goal 5: Reduce the Risk of Health Care –Associated
Infections
Goal 6: Reduce the Risk of customer Harm Resulting
from Falls

13. Others Goals including:
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 Reducing bloodstream infections
 Preventing bloodstream infections from central lines,
venous catheters.
 Reporting and learning systems
WHO Draft Guidelines for Adverse Event Reporting and
Learning Systems is designed to improve reporting and
learning systems in order to improve the safety of customer
care.
 Technology: Identifying and clarifying the role and
objectives of technology in improving customer safety.

14. High-quality healthcare should be:
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The proposed six components that define quality in healthcare should be:
• Safe: Avoiding injuries to customers from the care that is intended to help
them.
• Effective: Providing services based on scientific knowledge to all who could
benefit and refraining from providing services to those not likely to benefit.
• Customer centered: Providing care that is respectful of and responsive to
individual customer preferences, needs, and values and ensuring that
customer values guide all clinical decisions.
• Timely: Reducing waits and sometimes harmful delays for both those who
receive and those who give care.
• Efficient: Avoiding waste, including waste of equipment, supplies, ideas,
and energy.
• Equitable: Providing care that does not vary in quality because of personal
characteristics such as gender, ethnicity, geographic location, and
socioeconomic status.(There should not be discrimination).

15. Quality care
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Key Concepts
• Quality consists = Quality principles, x current professional
knowledge (professional practitioner skill), and meet the
expectations of healthcare users (the marketplace).
• Successful healthcare organizations—will have understood,
identified, and put into practice all of the following essential
principles: leadership, measurement, reliability, practitioner
skills, and the marketplace.
• Access to the customer (both by volume and payment level) is
being determined by demonstrating high quality and cost
efficiency.
• Quality metrics and practices will help define both success and
failure for physicians, hospitals, and the executives who lead
in the healthcare industry.

16. Nine initial solutions
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Nine initial solutions were developed and made available
for use:
• Look-alike, sound-alike medications
• Customer identification
• Communication during customer handovers
• Performance of correct procedure at correct body site
• Control of concentrated electrolyte solutions
• Assuring medication accuracy at transitions in care
• Avoiding catheter and tubing misconnections
• Single use of injection devices
• Improved hand hygiene to prevent Hospital Acquired Infections

17. Safe technology
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Focusing on the new technologies to improve the safety of
care, four work streams were identified:
 Information technology for customer safety;
 Making technology safer;
 Introducing new technology safely;
 Training and simulation technology.

18. World Health Organization Safety check list
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19. Finances-Safety
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Some measures require no or little costs, only
dedication and patience. They are-
 Infection control measures,
 Medication safety,
 Surgical safety,
 Error response and rectifying actions.
Factors involved with finances are,
 Equipment and monitors
 Adequate trained staff
 Infrastructure
 Reasonable salary to staff.

20. Anesthesia Safety Checklist Before
induction of anesthesia
 Is an experienced and trained assistant available to help you with induction?
Yes/ No
 Has the customer had no food or drink for the appropriate time period?
Yes / No
 Is there intravenous access that is functional? Yes . No
 Is the customer on a table that can be rapidly tilted into a head-down position in
case of sudden hypotension or vomiting? Yes / No
 Equipment check: If compressed gas will be used, is there enough gas and a reserve
oxygen cylinder? Yes/ No
 Anesthetic vaporizers are connected? Yes/ No
 Breathing system that delivers gas to the customer is securely and correctly
assembled? Yes/ No
 Breathing circuits are clean? Resuscitation equipment is present and working?
Yes/ No
 Laryngoscope, tracheal tubes and suction apparatus are ready and clean? Needles
and syringes are sterile? Yes/ No
 Drugs are drawn up into labelled syringes? Yes/ No
 Emergency drugs are present in the room, if needed? Yes/ No
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21. Safe Surgery & Safe Anesthesia
 The operating theatre is a room specifically for use by the anesthesia and
surgical teams and must not be used for other purposes.
 Ensure that procedures are established for the correct use of the O.R. and
all staff is trained to follow them:
 Keep all doors to the O.R. closed, except those required for the passage
of equipment, personnel and the customer
 Store some sutures and extra equipment in the O.R. to decrease the
need for people to enter and leave the O.R. during a case
 Keep to a minimum the number of people allowed to enter the O.R.,
especially after an operation has started
 Keep the O.R. uncluttered and easy to clean
 Between cases, clean and disinfect the table and instrument surfaces
 At the end of each day, clean the O.R.: start at the top and continue to
the floor, including all furniture, overhead equipment and lights. Use a
liquid disinfectant at a dilution recommended by the manufacturer
 Sterilize all surgical instruments and supplies after use and store them
somewhere protected and ready for the next use.
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22. SPONGE AND INSTRUMENT COUNTS
 It is essential to keep track of the materials being used in the O.R. in order
to avoid inadvertent disposal, or the potentially disastrous loss of sponges
and instruments in the wound. An OR requires the following:
 Good lighting and ventilation
 Suitable equipment for procedures
 Equipment to monitor customers, as required for the procedure
 Drugs and other consumables for routine and emergency use
 Before beginning a case Before final closure On completing the
procedure
 The aim is to ensure that materials are not left behind or lost.
 Pay special attention to small items and sponges.
 Create and make copies of a standard list of equipment for use as a
checklist to check equipment as it is set up for the case and then as counts
are completed during the case.
 When trays are created with the instruments for a specific case, such as a
Caesarean section, also make a checklist of the instruments included in that
tray for future reference.
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23. POSTOPERATIVE CARE
Look for the following in the Recovery Room:
Airway obstruction
Hypoxia
Hemorrhage: internal or external
Hypotension and/or hypertension
Postoperative pain
Hypothermia, shivering
Vomiting, aspiration
Residual narcosis
Falling on the floor
The recovering customer is fit for the ward when he or she is:
□ Awake, opens eyes
□ Extubated
□ Breathing spontaneously, quietly and comfortably
□ Can lift head on command
□ Not hypoxic
□ Blood pressure and pulse rate are satisfactory
□ Appropriate analgesia has been prescribed and is safely established
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24. OPERATIVE PROCEDURE LIST
 An operative procedure list is needed whenever the surgical team will perform
several operations in succession.
 The list is a planned ordering of the cases on a given day.
 Elements such as urgency, the age of the customer, diabetes, infection and the
length of the procedure should all be considered when drawing up the list.
 Operate on “clean” cases before infected cases since the potential for wound
infection increases as the list proceeds.
 Also consider other factors when making up the operative list: children and diabetic
customers should be operated on early in the day to avoid being subjected to
prolonged periods without food.
 Ensure that between operations:
 Operating theatre is cleaned
 Instruments are re-sterilized
 Fresh linen is provided It is essential to have clear standard procedures for
cleaning and the storage of operating room equipment; these must be followed by all
staff at all times.
 The probability of wound infection increases in proportion to the number of
breaches of aseptic technique and the length of the procedure
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26. Conclusion
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 Do no harm to our customer.
 Adopt infection control measures
 Clean hands save lives.
 Medical safety.
 Medication safety
 Surgical safety.

27. Conclusion
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Pointers towards improved customer safety measures
 Make customer safety an awareness priority amongst healthcare
personnel and customers.
 Create a healthcare culture of safety
 Initiate routine safety assessment
 Implement vigorously known safety practices
 Incorporate customer safety into all healthcare professional training
 Deal promptly with professional misconduct leading to medical errors.

28. Sources
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 N. Gopal Reddy. “Medication errors in Anesthesia and Critical Care”. Journal of
Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 15, February 19;
Page: 2586-2594, DOI: 10.14260/jemds/2015/371 .
 Narra Gopal Reddy. “Preventable Errors: Never Events”. Journal of Evolution
of Medical and Dental Sciences 2014; Vol. 3, Issue 29, July 21; Page: 8162-8172,
DOI: 10.14260/jemds/2014/3027
 Reddy N. G., “Prevention of errors in health care- customer (medical customer)
safety” Med. Res. Chron., 2015, 2 (3), 371-383
 Dr. Narra Gopal Reddy, M.D.; Associate Professor, Department of
Anaesthesiology, KIMS-NKP customer safety challenges in finance
constrained hospitals.

29. Your turn
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