EH 3_2015

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A hospital-acquired infec- tion (HAI) is also considered a medi- cal error. For the past few years, the relevant commissions and mediation bodies in Germany reported stable figures: around 25% of 8,000 alleged medical errors investigated were indeed classified as such. However, the number of alleged medical errors has risen significantly every year dur- ing the last decade, with a current estimation of more than 40,000 per year. According to the most recent figures 1,380 patients suffered irre- versible health damage, 150 died. In view of this situation, in 2013 the health objectives working group (Gesundheitsziele) declared patient safety to be the new nation- al health objective. Moreover, safe patient care was included in the Patient Rights Act in 2013. Since 2014 the Federal Joint Committee, (Gemeinsamer Bundesausschuss), the highest decision-making body in German healthcare self-governance, has mandated that hospitals imple- ment more and significant meas- ures regarding patient safety. Modern error management is mostly based on a system-oriented approach, i.e. the entire process landscape is taken into account when prevention and continuous improvement measures are designed. An anonymous error register has been demanded for a Report: Mark Nicholls New figures for the UK’s key National Health Service (NHS) Trusts have revealed their total deficit of more than €1.1 billion for the year 2014- 15. This rise on the previous year’s deficit of €160m comes against a backdrop of health authorities being required to find ‘efficiency savings’ of almost €1.4bn over the last five years. The NHS was also a major issue in the recent UK general elec- tion, which saw David Cameron’s Conservative Party win an outright majority following the previous coalition administration with the Liberal-Democrat party. Figures from health regula- tor Monitor show that Foundation Trusts (FTs) – which run hospitals, ambulance and mental health ser- vices and are not controlled by central government – have a deficit of €500m, compared to the planned deficit of €14m – while other trusts were €665m in the red and it fears those amounts could become even worse. The Department of Health believes trusts need to become bet- ter at balancing the books, and said the government had already invest- ed around €11.3bn in the future of the NHS. However, health managers say staffing issues were a key factor, with trusts spending over €2.5 on contract and agency staff - more than double the amount planned. Monitor, which assesses NHS Trusts before they can become FTs, expressed concern at ‘over-reliance’ on agency staff. long time, to support an error culture that promotes insights rather than punishment. However, risks must be clearly identified so as to influence the sys- tem towards damage prevention. The German Society for Thoracic Surgery (DGT) established a Working Group Patient Safety and Risk Management. While data analysis reported by more than 100 pneumology departments, from all over Germany, indicated that in thoracic surgery the number of medical errors is rather low, the data did show that adverse events can be classified with regard to their risk management requirements •damage prevention (P) •compliance (Patient Rights Act, statutory quality management requirements) (C) •insurance-related requirements (I) Most medical errors were not caused by surgeon’s poor skills but by shortcomings in documentation or communication, or by lack of standards, e.g. regarding wound management. DGT certifies so-called ‘Thoracic centres – Competence cen- tres for Thoracic surgery’. Hospitals that wish to obtain this voluntary cer- tification must meet defined quality standards. Based on findings by the Working Group Risk Management, the requirements P, C and I were integrated into the certification specs as of 1 January 2015, with a special focus on prevention. This very methodical professional prevention may well serve as a blue- print for the insurer-initiated evalua- tion of hospital-related risks. At the surgeons’ congress DGT last year a model project for risk miti- gation in lung surgery was presen ted. Meanwhile, the Working Group Patient Safety and Risk Management – in collaboration with an insur- ance broker – published initial find- ings. ‘The total number of alleged medical errors is 23, an extremely low risk range,’ said Dr Christian Kugler, President of DGT and Medical Director at the Department of Thoracic Surgery, Lungen Clinic, Grosshansdorf. ‘In the lung clinics wound infections were the major issue, accounting for 34%,’ he added. The second impor- tant issue was pain, mostly caused by nerve damage in the thorax. ‘These damages can occur when the rib cage is opened – a well-know sur- gery risk that’s routinely included in the pre-surgery patient information process,’ Kugler explained. The same holds true for vocal cord paralysis, which accounted for 9% of all report- ed alleged medical errors. Kugler: ‘Another possible adverse event in thoracic surgery is when tissue has to be removed in the vocal cord area.’ Devices that are left within the patient are a completely different problem. In four of the cases ana- lysed swaps, gauze pads or small haemostats had remained in the body after wound closure. ‘This is an obvi- ous medical error.’ Kugler concedes and recommends loud enumeration of all objects that are being inserted in the patient body, applying the four-eye principle. ‘Two people in the operating room (OR) call out the number of objects being used loudly and clearly.’ Moreover, he adds, it is advisable to keep material taken from the patient body after the interven- tion in a separate container for con- trol purposes. ‘When there is profuse bleeding and a lot of material is need- ed, it’s very possible that the OR team lose track, or the surgeon overlooks a blood-soaked gauze pad.’ To avoid such incidents, many years ago the German Surgery Society demanded the introduction of the WHO check- lists to increase patient safety in the OR. As far as wound infections are concerned, wound management and hygiene standards might go a long way. ‘Fixed rituals help, for example using the same wash and cover pro- cedures in the OR can automatically turn into a standard,’ Kugler advised. Experts estimate between 30-50% of all hospital medical errors could be avoided. The DGT responded to the error analysis: risk management has been integrated into the certificate ‘Thoracic Centre (DGT)’. Errors are unavoidable but rare in thoracic surgery Scanning and printing patient da Stringent medical risk management Curbing agency Comprehensive la President of the German Society for Thoracic Surgery (since 2009), Christian Kugler is also Medical Director of the Department of Thoracic Surgery at Lungen Clinic, Grosshansdorf, near Hamburg. With medical studies and dissertation at Ludwig Maximilian University Munich (LMU) behind him, Kugler became a junior physician at the Department of Cardiac Surgery, München- Grosshadern University Hospital, and later at Ulm University Hospital. He trained in tho- racic surgery at the Heidelberg Thorax Clinic. Up to 2009 he was senior consultant at the Department of Thoracic Surgery, Hamburg Thorax Centre, Harburg General Hospital (currently Asklepios). ©DGCH Source:Honeywell In German hospitals, medical treat- ment errors account for 19,000 patient deaths every year, accord- ing to the 2014 Health Insurance Scheme Hospital Report. Mistaken patient identity is cited among the errors, which also include inter- changed drugs or incorrect drug dosages. ‘Scan2Print solutions ensure greater patient safety, far fewer mistakes and less organisation- al effort,’ according to Mediaform Informationssysteme GmbH, which provides applications, developed specifically for healthcare. The firm’s solutions are based on scan- ners made by the US company Code, which are particularly small, compactly constructed devices. Sales manager Steffen Marienfeld explained: ‘They’re no bigger than a mobile phone and fit easily into any coat pocket. The long-life bat- tery lasts several days without recharging. A special advantage is that we supply each unit with a JavaScript license and a selection of pre-installed applications.’ Code scanners are usable via Bluetooth or WLAN. ‘For safe, quick working, the reader provides feedback about a successful scan. For this the user can choose between an LED, audio sound or a vibration signal. It is also possible to switch off the acous- tic signal and to activate it only if the data is non-compliant, thus sig- nificantly reducing the background noise in everyday hospital life,’ the firm reports. The application can be used dur- ing surgical discharge, after Xray exams or when admitting in-patients SterileA100_European_Hospital_52215.qxp_EuropeanHospital_Sterile_2015 5/22/1511:40 AM Page 1

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