Patient safety has received an increasing amount of attention recently from the European Commission. The important issue arising from the Communication and proposed Recommendation is how this would add value and contribute to the existing work on patient safety at national level ? (The EPHA briefing on Patient Safety can be found here)
The Issue
"Patient safety is a fundamental principle of health care. Every point in the process of care-giving contains a certain degree of inherent unsafety." (WHO)
Every time a patient enters a hospital or receives care in Europe they run the risk of experiencing an adverse event. Various national studies from Member States have revealed that large numbers of people suffer from care-related harm ranging from events involving medical devices to medicinal products. Overall, between 8% and 10% of patients experience an adverse event when admitted to hospitals in Europe. based on national studies, between 35-43% of these events have been deemed preventable.
The most common and perhaps the most serious adverse events, however, are healthcare associated infections (HCAIs). HCAIs affect, an estimated one in twenty patients receiving care in hospital, that’s 4.1 million patients per year. These HCAIs represent a huge threat to human health and are a breeding ground for multi drug resistance in bacteria making some HCAIs hugely difficult to treat. An example of the difficulty faced in treating HCAIs is the ’superbug’ MRSA (Methicillin Resistant Staphylococcus-aureus) that caused 1,629 deaths in England and Wales in 2005.
The Commission’s Communication states the following as key organisational reasons for the worrying prevalence of HCAIs : high bed occupancy, increased movements of patients within and between healthcare systems, sub-optimal staff to patient ratios, insufficient compliance with hand hygiene and other infection prevention and control practices, incorrect use of indwelling devices by healthcare staff .
So the problem is one that is in part preventable, so how can mortality and morbidity rates due to Adverse Incidents be cut ? and how can we develop safer and cleaner hospitals where one in ten people do not come out worse off than they came in ?
In order to answer this question we have to look at what is being done on a European level and perhaps further afield. There are several projects currently under way that are sponsored by the European Commission as well as plenty of national patient safety campaigns and initiatives. The Commission’s Communication and Council Recommendation aims to support these initiatives.
The Projects
In 2004 World Health Organisation (WHO) launched the World Alliance for Patient Safety as the result of a World Health Assembly] Resolution that called Member States and the WHO to pay greater attention to the problem of injury and harm caused in care. The aim of this Alliance is to raises awareness and political commitment to improve the safety of care and facilitate the development of patient safety policy and practice in all WHO Member States. Each year, the Alliance delivers a number of programmes covering systemic and technical aspects to improve patient safety around the world.
In April 2005 the Luxembourg Presidency of the EU issued the ’Luxembourg Declaration’ "Access to high quality healthcare is a key human right recognised and valued by the European Union, its Institutions and the citizens of Europe. Accordingly, patients have a right to expect that every effort is made to ensure their safety as users of all health services."
The High level group on health systems and medical care, established in 2004, contains six working groups one dealing with Patient Safety. In 2007 the High Level group made a set of recommendations, identifying areas where EU collaboration and coordination would bring useful and effective results.
In 2008 the European Network for Patient Safety (EUNetPaS) was launched with the intention of establishing a network of all 27 EU Member States and EU stakeholders to encourage and enhance collaboration in the field of Patient Safety. "EUNetPaS unites representatives of the European medical community and the institutional partners involved in patient safety with the states of the European Union. The network will promote the involvement of stakeholders through national platforms organized around one EUNetPaS national contact point in every EU Member State." (EUNetPaS)
These initiatives are the EU’s and the WHO’s attempts to deal with the problems presented by Patient safety in Europe today. The question remains of how dealing with this problem, can be done most effectively, would it be through national schemes coordinated at a national level ? Or is patient safety really the remit of a broader coordinated approach from the EU institutions ? The answer to this question some would argue lies in the EC treaty : article 152 which states that ’Community action in the field of public health shall fully respect the responsibilities of the Member States for the organisation and delivery of health services and medical care.’
However the EU does have a certain mandate in the very same article stating the EU’s legal right to act, in cooperation with Member States, in : ’improving public health, preventing human illness and diseases, and obviating sources of danger to human health.’
So where does the balance lie between cooperation and harmonisation in Patient Safety ? Solid binding legislation, may not be the way forward in this instance but perhaps the best approach is to encourage effective, long term, well funded safety projects that raise awareness, promote the best practice and embed patient safety into all training for all health professionals in Europe.
For more information
Czech Presidency Ministerial Conference
EPHA Briefing on Patient Safety Recommendation and Communication
EPHA related articles
European Antibiotics Awareness Day : 18 November 2008
European Parliament addresses antibiotic resistance
Tackling antimicrobial resistance : EU Member States must do more
Deadly new form of MRSA emerges
**UPDATED** Public Consultation on Patient Safety
Europe for Patients
