WHO states that 'around 1 in 10 patients is harmed in health care' and that 'above 50% of harm (1 in every 20 patients) is preventable'
https://www.who.int/news-room/fact-sheets/detail/patient-safety
What is meant here by 'preventable' and how is this assessed?
Here are some extracts from a BMJ paper 'Preventable harm: getting the measure right' BMJ 2019;366:l4611 doi: 10.1136/bmj.l4611 (Published 17 July 2019)
https://www.bmj.com/content/bmj/366/bmj.l4611.full.pdf
'Separating harm into outcomes that are deemed either preventable or inevitable is a necessary step to advance efforts toward patient safety. Yet no consensus exists as to what constitutes preventable harm, and even experienced clinicians vary in the extent to which they agree on whether an error is preventable. Panagioti and colleagues define preventable harm as the result of an identifiable modifiable cause and an event the recurrence of which can be avoided by the adaptation of a process or adherence to guidelines. This approach, although reasonable, has important limitations.'
'Patient harm, however, is usually caused by the interplay of many linked failings across the system, not just a missed process of care.'
'In addition, many complications are only partially preventable, and therefore distinguishing the preventable from the inevitable becomes difficult.'
PREVENTABLE HARM
Harm is classified as preventable when reviewers identify a modifiable factor that contributed to the event and believe that changing a process of care, following a guideline, or taking a different action would probably have avoided it.
Examples:
Wrong medication administered because of a labelling error.
Failure to provide recommended thrombosis prophylaxis.
Infection resulting from failure to follow established infection-control procedures.
In such cases, reviewers can point to a specific action or system change that might reasonably have prevented the outcome.
One definition of unpreventable harm is 'harm that occurs despite appropriate care and when no identifiable, feasible intervention is thought likely to have avoided it'
However, if care is appropriate then it cannot be classified as 'unsafe'.
I'm unclear how we define unpreventable harm due to unsafe care. Can anyone help with this?
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org