Summary of SEGURIDAD DEL PACIENTE - Parte 1

00:00:00 - 00:40:00

In the "SEGURIDAD DEL PACIENTE - Parte 1" YouTube video, Professor Jose Gilberto Orozco Diaz from the Universidad Nacional de Colombia discusses patient safety . The concept originated from Hippocrates' admonition "First do no harm," and its importance is underscored by historical events like Semmelweis' hand washing discovery and Florence Nightingale's emphasis on proper patient care. Patient safety gained significance after the Thalidomide tragedy in the 1960s, reveal the importance of monitoring medication safety. Dr. Harwood's research expanded the focus to include medical procedures and other activities. In Colombia, patient security is central to institutional accreditation, with regulations dating back to the 1979 Sanitary Code. Various types of errors, both intentional and unintentional, are discussed. Liapses and slips are two main types of unintentional errors. Understanding these types of errors is essential for implementing safety measures. The video also covers different types of errors and violations in patient care and the importance of recognizing and learning from incidents, adverse events, and near-misses

• 00:00:00 In this section of the "SEGURIDAD DEL PACIENTE - Parte 1" YouTube video, Professor Jose Gilberto Orozco Diaz from the Universidad Nacional de Colombia discusses the topic of patient safety. She begins by explaining the origin and purpose of patient safety, which is to minimize errors in healthcare, using Hippocrates' admonition "Primum non nocere" or "First do no harm." The professor then mentions the early notions of patient safety, including Semmelweis' discovery of hand washing, and Florence Nightingale's emphasis on proper patient care and organized healthcare services. Additionally, she brings up the more recent example of the Thalidomide tragedy in the 1960s, which revealed the importance of patient safety in preventing birth defects caused by drug use. Throughout the discussion, she highlights famous quotes and historical figures who have influenced the concept of patient safety
• 00:05:00 In this section of the "SEGURIDAD DEL PACIENTE - Parte 1" YouTube video, the speaker discusses the importance of patient safety, specifically as it relates to pharmacovigilance and medicinal reactions. The speaker highlights how incidents like the Talidomide crisis in the 1950s and 1960s brought about the development of systems for monitoring medication safety. medicine's regulatory history is parallel to major medication adverse reaction disasters. These tragedies, such as the 2004 withdrawal of rofecoxib (a highly marketed anti-inflammatory drug), underscored the significance of patient safety. The speaker also mentions a study published in 1991 called the "Harvard Medical Practice Study," which revealed that nearly 4% of hospitalized patients suffered adverse events due to medical care, and about 27.6% of those events were due to negligence or inadequate treatment. These findings generated significant discussions in both the academic and societal realms, emphasizing the risks associated with medical care. Additionally, the study emphasized that a considerable proportion of these incidents were preventable
• 00:10:00 In this section of the YouTube video titled "SEGURIDAD DEL PACIENTE - Parte 1," Dr. Harwood from Harvard University is discussed for his research on patient safety, which expanded the focus from medications to medical procedures and other Activities done to patients. In a systematic review, he found that adverse reactions to medications are the fourth leading cause of mortality in the United States. This discovery caused significant alarm, and various expert groups were established in the late 90s to study the issue. The result was a human-authored document from the Institute of Medicine in the United States, which emphasizes that healthcare is a human endeavor and errors will occur. Furthermore, the document suggests that it is essential to learn from mistakes rather than hiding them and establishing a distinct culture for handling errors. This concept, that errors in the complex healthcare systems can and do happen, has led to a significant increase in research on patient safety, as evidenced by a graph showing a surge in publications on the subject since the late 1990s
• 00:15:00 In this section of the "SEGURIDAD DEL PACIENTE - Parte 1" YouTube video, the speaker discusses the significance and importance of patient security in Colombia's healthcare system. The country has produced various documents and regulations since the 1979 Sanitary Code to ensure patient safety and quality of healthcare. Patient security is a central requirement for institutional accreditation, aimed at improving healthcare effectiveness and efficiency, saving resources, and ensuring equitable access to services. The speaker emphasizes the importance of addressing preventable adverse events as they not only impact individual patients but also consume limited healthcare resources. The discussion highlights the recent focus on patient-centered care, which prioritizes patients' needs and interests to provide effective and efficient healthcare services for all
• 00:20:00 In this section of the "SEGURIDAD DEL PACIENTE - Parte 1" YouTube video, the speaker discusses the development of patient security in response to increasing demands for autonomy and respect for patients' rights. The concept of patient security emerged from recognizing errors and their human and economic implications. The speaker then delves into the concept of healthcare attention, explaining that while its intention is to do good, it also has the potential to produce harmful effects. These harms are defined as physical or psychological damage to individuals and can also include social damages. Ivan Denis, mentioned in the video, categorized these injuries into three groups: the harm caused to the body through medical treatment, the harm caused by the medicalization of daily life, and social harm. The speaker intends to explore each of these types of harm in greater detail later in the session
• 00:25:00 In this section of the "SEGURIDAD DEL PACIENTE - Parte 1" YouTube video, the speaker discusses the importance of avoiding excessive and unnecessary spending on healthcare services, known as medicalization of life, and the structural damage caused by abandoning personal responsibility for health. The speaker also emphasizes the need to consider social and mental aspects of health in addition to physical health. The concept of patient safety is not limited to preventing physical hazards but also involves avoiding social harms and the medicalization of healthcare, allowing less autonomy and accountability for individuals' health. The definition of patient safety includes identifying and minimizing unnecessary risks, considering available resources and context, and acknowledging that errors are inherent to human activity. The ultimate goal is to reduce errors to an acceptable minimum, which may differ depending on the circumstances. The speaker encourages recognizing errors as a collective issue resulting from shared human knowledge and resources
• 00:30:00 In this section of the "SEGURIDAD DEL PACIENTE - Parte 1" YouTube video, the speaker discusses the concept of patient safety, which aims to reduce the risk of harm to patients. The speaker explains that the definition of risk is distinct from danger and that patient safety focuses on errors. Errors are defined as the failure to carry out intended actions or the use of incorrect plans, which can be intentional or unintentional. Unintentional errors, also known as mistakes, can occur due to inattention, distractions, or memory lapses. When a person is not fully focused on a task or is overwhelmed, they may make mistakes due to lack of attention or memory issues. These types of errors can lead to significant consequences, making it crucial to minimize their occurrence through collective efforts. The video goes on to discuss two main types of unintentional errors: lapses and slips. Lapses result from inattention, distractions, or other issues that prevent a person from carrying out the intended action. Slips, on the other hand, are memory-related errors in which a person executes the incorrect action instead of the intended one. Understanding these types of errors is essential for implementing effective safety measures and minimizing the risks to patients
• 00:35:00 In this section of the "SEGURIDAD DEL PACIENTE - Parte 1" YouTube video, the speaker discusses different types of errors and violations that may occur in patient care. The first type of error is when a healthcare worker follows incorrect procedures due to misunderstanding or lack of knowledge. For example, a healthcare worker might not wash their hands before seeing a patient, even though they know they should, because they believe the situation does not require it. This would be considered a violation. The second type of error is when a healthcare worker intentionally acts against the patient's best interests, known as sabotage. While sabotage is not directly related to patient security, preventing such incidents is an important consideration. The speaker also differentiates between errors that do not reach the patient and those that do. An error that does not affect the patient is called a quasi-incident or a near-miss, while an error that harms the patient is called an incident. Examples of incidents include administering the wrong medication or dose to a patient. The speaker emphasizes the importance of recognizing and learning from these incidents to improve patient safety
• 00:40:00 In this section of the YouTube video entitled "SEGURIDAD DEL PACIENTE - Parte 1," the speaker discusses the importance of recognizing both incidents with and without harm in patient safety, and the concept of adverse events. An adverse event, like an incident with harm, is the unintended result of healthcare treatment that causes harm to the patient. These events can be preventable or not, and some are related to errors in care. The speaker mentions that errors are not just the result of human error but also the result of certain conditions that cause or contribute to errors. These conditions include fatigue, pressure to improve indicators, and long working hours. Adverse events are classified into various categories, including administrative issues and clinical procedure issues. Overall, this section highlights the complexity of patient safety and the importance of understanding both the human error and the conditions that contribute to errors