HOSPITAL
PATIENT SAFETY DESIGN
Dr. ADIB A YAHYA, MARS
9 JUNI 2017
despite all the known power of modern
medicine to cure and ameliorate illness,
hospitals were not safe places
for healing.
4
Historically hospitals were
not the safest places
“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
motor car accidents (43,458 deaths pa)
• Total cost to the US economy of avoidable deaths due to healthcare error $17 - $29 Bn pa
HRRI.Healthcare Risk Resources International
To Err is Human:
Building a Safer Health System
(1999/2000)
Latent Failures
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)
The simplest definition of patient
The simplest definition of patient safety is the safety is the prevention of errors prevention of errors
and
and adverse effectsadverse effects to patients to patients associated with health careassociated with health care..
Keselamatan Pasien Rumah Sakit – KPRS
•
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
“We shape our buildings and afterwards our buildings shape us.”
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
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
• 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
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
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.
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
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.
Latent Failures
- Visibility to patients - Presence of family
•EmergencyEmergency
•DiagnoseDiagnose
•PemeriksaanPemeriksaan
•PengobatanPengobatan
•PerawatanPerawatan
Direct impacts on patient safety :
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 Management
Adapted from Reason (revised)
Impact of the environment on staff working conditions :
Noise in hospitals and staff outcomes
Variable acuity patient rooms and transfers
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.
Lower rates of surgical site infections in the newer operating rooms with laminar
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
Facilities has adopted the single bed room as the standard for all
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
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 .
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.
