In 1 in 3 cases, teamwork is the cause of the errors suffered by patients in the hospital. HAS unveils its strategy to reduce risks.
In 2011, a French survey revealed that a serious adverse event associated with care would occur every 5 days in a health establishment (in a department with thirty beds). One in 10 hospitalized patients would therefore be a victim. “Few and non-exhaustive studies”, according to the Haute Autorité de Santé.
So, to refine these results, the HAS collected data from accredited physicians concerning these “Risk-Carrying Events” (EPR). These are undesirable events that have occurred in a healthcare establishment which could have been harmful to the patient but which could have been avoided by the caregivers, since the safety barriers were in operation.
Among them, we find the medication error made up before its administration, the error in the patient record corrected before an operation, or the failure to transmit information that delays the start of treatment. In a review published on Wednesday, the independent public authority unveils the circumstances and reasons for these potential accidents.
27% of EPRs are related to a problem in the team
Of the 47,276 risk-carrying events (RPE) declared by accredited doctors and validated by accredited bodies for accreditation, the first cause identified is the dysfunction linked to the team (27%), most of the time due to a problem in oral or written communication between professionals.
23% of EPRs are linked to dysfunctions in the tasks to be accomplished. We can observe that in more than a quarter of the cases (29%) it is the unavailability, the inadequacy or the non-use of the protocols which is in question.
Finally, 15% of RPE are linked to the patient, his state of health being the main factor (more than 43% of cases), followed by his medical history (21%). Personality problems, social and family factors represent for their part 10% of the causes.
Faced with this observation, the HAS is mobilizing to reduce the risks associated with care and unveils its strategy on Wednesday. Contacted by Why actor, Dr Laetitia May-Michelangeli, head of the patient safety mission at the High Authority, confides that “to achieve this mission, we are increasingly trying to act on the care teams”.
Listening, mutual aid … on the team menu
More concretely, the HAS has launched an unprecedented experiment in the territory known as the “Pacte” (Continuous Improvement Program for Teamwork), to help multi-professional teams to work on organizational and human factors: listening, mutual aid, taking into account stress, communication, etc.
Since 2013, eighteen teams have already experimented with the approach. With the first positive results.
Indeed, after a year of experimentation, the teams have initiated actions on risk management, communication and team synergy (better definition of the alert, improvement of the content of transmissions, establishment of multiple staff. -professional, …).
This program is now entering a larger pilot phase with almost 70 teams already volunteering. It is also planned, in the long term, to enhance these teams in terms of hospital certification, which is the quality labeling of health establishments. One more argument to push hospitals to play the game.
Dr Laetitia May-Michelangeli, head of the patient safety mission at HAS: “Thes teams have already initiated changes, for example by letting everyone speak. The caregiver, like the nurse… “
Effective programs according to the literature
In addition, the PACTE program incorporates practical tools developed or adapted by HAS and intended to help professionals communicate better and work together at each stage. For example, the teams have systematically set up a briefing / debriefing before taking charge of the patient. “So everyone agrees on what to put in place and the team coordinates effectively,” says Dr May-Michelangeli.
From there to say that the HAS reduced the risks associated with the care there is only one step … A step which one cannot yet cross according to this doctor for whom it will take time. “We will do a first assessment in 3-4 years but we believe in it because the scientific literature and identical experiments carried out abroad show us that it works. “
Dr Laetitia May-Michelangeli : ” We intend to generally reduce adverse events related to care. Both in the perioperative field and in that of nosocomial infections. “
The active or passive role of the “patient-tracer”
Finally, the HAS wants to remind the patient that he is also a full player in his safety. “He can play an active role in reporting adverse events himself,” says Dr May-Michelangeli. But the patient can also play a passive role in improving the quality of care, by entering into devices such as the “patient-tracer”, in particular.
With this method, in practice, during visits to establishments by visiting experts from the HAS, part of the assessment is now based on patient files in order to check at each stage whether the treatment was appropriate. During this examination, the feelings of the patients are directly collected. And while a transposition to the city is being tested, the first beneficial results of this device are already being felt in the hospital.
Jean-François Bretagnon, senior health manager at the Henri Laborit Hospital in Poitiers (86), explains as well as by studying the entire course of patient care, “the professionals were able to see that there is a a number of possible risks most often linked to communication or traceability problems. “
Jean-Francois Bretagnon, senior health manager at Henri Laborit Hospital in Poitiers: “ If we take the example of pain assessment, the point of view expressed by a patient on the value of this assessment allowed the team concerned to better understand… “
This senior health manager concludes by recalling the challenge of bringing the patient more into the health system: “Studies have shown that making the patient an active partner in the medical team is a good thing. When we share governance with users, we are between five and ten times more efficient than when we do not share it. It also goes towards more health democracy, and that’s good! “
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