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THE PHARMA REVIEW (APRIL - MAY, 2008)

Implementing Patient Safety in Indian Clinical Practice

Anantha Naik Nagappa, Kishore G Sam, Manish S Kadam, Kiran M Bhusare, and Pranay Wal

Abstract: Patient safety is a serious global public health issue. Clinical practice in India being poorly organized and there is no systematic documentation of clinical practice. Limited resources of health care facility have a negative impact on the performance of the health care system. Clinical practice in modern times has become highly complex due to conflicting interests from stakeholders and providers. The Government, Pharmaceutical industry, Regulatory bodies, Corporate hospitals are stakeholders and where as doctors, pharmacist and nurses are main providers. A largely unregulated private sector in India is one of the greatest challenges for government regulation. For lack of policies and resources, governments have trouble in fulfilling their core responsibility of provision of health and patient safety.

Universally health professionals are reluctant to register or talk publicly about adverse events and medical errors for fear of embarrassment, punishment and malpractice litigation. Incident patterns thus go unnoticed and weaknesses in the system stand uncorrected. The Relationships between members of the health team tend to be highly hierarchical and non-confrontational. Indian clinical practice can be described as dominant doctors, thumbs down pharmacist and submissive nurses. This results in oneway communication in clinical setting which has negative impact on patient safety. The Pharmaceutical industry focuses on commerce and Government aims to regulate cost effective and safe drug therapy. There are more than l00000 branded drugs with just 500 molecules. The manufactures of branded drugs extensively compete with each other for market share. The current marketing strategy employed by pharmaceutical industries directly or indirectly influences prescribing habits of doctors. India being developing country, the government has preferred Industrial practice than patient safety. This has resulted in gross confusion among public and providers of health care regarding the status of drugs in diseases. The time has come now to change the priorities for the patients instead of drugs. The assessment of patient safety and implementation of patient safety program in clinical care is the requirement of the day.

Global scenario of patient safety

In 1989, Mannesse published a series of article entitled medication use in an imperfect world drug misadventure as an issue of public policy. This has initiated the discussion on the risks associated with medication misadventure and concern regarding patient safety in clinical practice. In recent years, globally patient safety is been increasingly recognized as subject of prime importance. In 2002, WHO member states agreed on a World Health Assembly resolution on patient safety. The WHA (world health assembly) in 2002 has announced the resolution A55/13 “Quality of care: patient safety” signifying WHO concern regarding global situation of patient safety in clinical setup. Patient safety is a serious global public health issue. Estimates show that in developed countries as many as 1 in 10 patients is injured while receiving clinical care.

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