This document provides a comprehensive overview of Strategic Objective 3: Assuring the Safety of Clinical Processes, detailing global efforts, progress, and challenges in enhancing patient safety across various healthcare settings. Based on a survey of 108 Member States, the overall performance for this strategic objective is moderate, with a score of 63 out of 100, indicating that countries have established patient safety improvement programmes for key clinical service areas and medical products.
The strategic objective is broken down into five core strategies:
- Strategy 3.1: Safety of risk-prone clinical procedures.
- This strategy focuses on identifying major sources of significant patient harm and implementing patient safety improvement initiatives.
- Health care-associated infections (HCAIs) and medication errors are prioritized in the majority of countries, with 82% focusing on HCAIs and 78% on medication errors.
- Only 27% of countries report having identified major sources of significant patient harm in local contexts, with significant disparities across income groups and WHO regions.
- The WHO Surgical Safety Checklist has been widely adopted due to demonstrated benefits in reducing mortality and morbidity, especially in LMICs. However, successful implementation requires more than just the checklist; it needs standardized care pathways, multidisciplinary training, leadership support, and equipment infrastructure to drive a lasting culture of patient safety.
- Strategy 3.2: Global Patient Safety Challenge: Medication Without Harm.
- Launched by WHO, this challenge aims to reduce severe, avoidable medication-related harm by 50% globally.
- It encompasses four key domains: engaging patients and the public, enhancing the competence of health care professionals, improving the safety of medicines as products, and strengthening systems and practices of medication.
- While 74% of countries have endorsed and are implementing this challenge, only a quarter are actively addressing all three priority areas: high-risk situations, polypharmacy, and transitions of care.
- The document also highlights that traditional and complementary medicines (TCMs), despite being perceived as safer, can pose significant health risks and require robust research and appropriate regulation, including inclusion in national pharmacovigilance systems.
- Comprehensive reporting of adverse drug events (ADEs), including errors and near misses, is vital, yet the majority of low-income countries (LICs) and lower-middle-income countries (LMCs) currently only report adverse drug reactions (ADRs), indicating a significant gap in learning from medication errors.
- Strategy 3.3: Infection prevention and control (IPC) and antimicrobial resistance (AMR).
- HCAIs are a major patient safety challenge, particularly in LMICs, where the risk of infection is about twice as high as in high-income countries (HICs).
- Around 60% of countries report having national IPC programmes, and half have active surveillance systems for HCAIs.
- While most countries have developed national IPC guidelines (91%), only about half implement them using WHO multi-modal strategies.
- Despite policies for in-service IPC training for nearly all health workers (91%), less than half of countries have a national curriculum that is consistent with guidelines for both in-service and pre-service trainings.
- Over half of the surveyed countries (51%) have an active and reliable surveillance system for HCAIs, with surgical site infections being the most frequently reported category.
- Strategy 3.4: Safety of medical devices, medicines, blood, and vaccines.
- This strategy emphasizes that quality-assured, safe, and effective medical products are fundamental to a functioning health system.
- Substandard and falsified medicines pose a serious threat, contributing to many preventable deaths globally.
- Almost all countries have functional pharmacovigilance programmes, and nearly 80% have implemented blood safety programmes.
- While nearly all countries have established immunization safety systems to monitor adverse events following immunization (AEFIs), there is variability in reporting rates to the global VigiBase database.
- Only 49% of countries have implemented post-market surveillance systems for medical devices, with these systems being more prevalent in HICs and upper-middle-income countries (UMCs).
- Strategy 3.5: Patient safety in primary care and transitions of care.
- This area is less prioritized compared to safety in hospitals, with only 17% of countries systematically including safety in primary care programmes.
- Up to 40% of primary care patients may experience harm, highlighting the critical need for improvement in these settings.
- Around three-quarters of countries have developed standard operating procedures (SOPs) for safe handovers during care transitions, but only a quarter have widely implemented these SOPs.
- Only 26% of countries have implemented certification and accreditation programmes in primary care settings.
- Regarding patient safety interventions in primary care, 67% of countries have begun implementing at least one intervention, but only 17% have adopted a comprehensive approach.
- The document also draws attention to patient safety in mental health services, noting that only about a quarter of countries are implementing patient safety interventions in primary mental health care facilities, with significant regional and income-based disparities.
- A dedicated section highlights diagnostic safety, defining diagnostic errors as delayed, wrong, or missed diagnoses, or diagnoses not communicated to the patient. These errors are frequent, with most adults experiencing at least one in their lifetime, and are caused by a combination of cognitive and systemic factors.
In conclusion, the document underscores that improving patient safety necessitates tailored interventions that address the unique challenges and needs of different health care settings. While progress has been made, significant disparities exist in implementation and adherence to safety protocols across regions and income groups, signaling the need for more integrated global collaboration, knowledge exchange, and tailored resource allocation.
Reference: World Health Organization. (2024). Global patient safety report 2024. World Health Organization.
