What stage are low-income and middle-income countries (LMICs) at with patient safety curriculum implementation and what are the barriers to implementation? A two-stage cross-sectional study.

OBJECTIVES: The improvement of safety in healthcare worldwide depends in part on the knowledge, skills and attitudes of staff providing care. Greater patient safety content in health professional education and training programmes has been advocated internationally. While WHO Patient Safety Curriculum Guides (for Medical Schools and Multi-Professional Curricula) have been widely disseminated in low-income and middle-income countries (LMICs) over the last several years, little is known about patient safety curriculum implementation beyond high-income countries. The present study examines patient safety curriculum implementation in LMICs. METHODS: Two cross-sectional surveys were carried out. First, 88 technical officers in Ministries of Health and WHO country offices were surveyed to identify the pattern of patient safety curricula at country level. A second survey followed that gathered information from 71 people in a position to provide institution-level perspectives on patient safety curriculum implementation. RESULTS: The majority, 69% (30/44), of the countries were either considering whether to implement a patient safety curriculum or actively planning, rather than actually implementing, or embedding one. Most organisations recognised the need for patient safety education and training and felt a safety curriculum was compatible with the values of their organisation; however, important faculty-level barriers to patient safety curriculum implementation were identified. Key structural markers, such as dedicated financial resources and relevant assessment tools to evaluate trainees' patient safety knowledge and skills, were in place in fewer than half of organisations studied. CONCLUSIONS: Greater attention to patient safety curriculum implementation is needed. The barriers to patient safety curriculum implementation we identified in LMICs are not unique to these regions. We propose a framework to act as a global standard for patient safety curriculum implementation. Educating leaders through the system in order to embed patient safety culture in education and clinical settings is a critical first step

Global burden of preventable medication-related harm in health care: a systematic review

A series of WHO initiatives, such as the Global Patient Safety Challenge: Medication Without Harm and the Global Patient Safety Action Plan 2021-2030, address patient harm associated with use of medications. Medication-related harm is considered preventable if it occurs as a result of an identifiable,modifiable cause and its recurrence can be avoided by appropriate adaptation to a process or adherence to guidelines. Understanding the prevalence, natureand severity of preventable medication-related harm is critical for setting targets for clinically relevant, implementable improvements in patient safety. This report presents an updated systematic review and meta-analysis of studies of the prevalence, nature and severity of preventable medication-related harm in theinternational literature including in low- and middle-income countries (LMICs). A total of 100 studies were included in the review, involving 487 162 patients. Ofthese reports, 70 were from high-income countries (HICs) and 30 from LMICs. The results were as follows. Global prevalence and severity of preventablemedication-related harm: The pooled prevalence of preventable medication-related harm in all 100 studies was 5% (1 in 20 patients). One fourth of the harm was severe or potentially life-threatening. Geographical distribution of preventable medication-related harm: The prevalence of preventable medication-related harm was 7% in 30 studies in LMICs and 4% (3–5%, one in 25 patients) in 70 studies in HICs. The highest prevalence rates of preventable medication-related harm were in the African (9%) and South-East Asian regions (9%). Health care settings in which the most vulnerable patients are managed for preventable medication-related harm: Globally, the highest prevalence ratesfor preventable medication-related harm are for patients managed in geriatric care units (17%) and among patients in highly specialized or surgical care (9%).Stages of medication at which most preventable medication-related harm occurs: Globally about half (53%) of all preventable medication-related harmoccurred at the “ordering/prescribing” stage and 36% at the monitoring/reporting” stage. In LMICs, almost 80% of preventable medication-related harm occurred during the “ordering/prescribing” stage. Medicines that contribute most to medication- related harm: Antibacterials, antipsychotics,cardiovascular medications, drugs for functional gastrointestinal disorders, endocrine therapy, hypnotics, sedatives and non-steroidal anti-inflammatory products contributed most to medication-related harm globally.Way forward: The analysis showed that at least one in 20 patients are affected by preventable medication-related harm globally and that more than one fourthof preventable harm is severe or life-threatening. The prevalence of preventable medication-related harm in LMICs was almost twice as high as in HICs;however, few data were available on the severity and nature of medication-related harm in LMICs. A prerequisite for the success of future strategiesto mitigate preventable medication-related harm in LMICs would be to encourage reporting of any preventable medication-related harm and commission high-quality studies with standard methods for assessing and reporting such harm and also studies of the underlying causes for designing interventions that are most likely to work in LMICs. There is also an urgent need to implement improvement strategies in settings in which patients are managed, especially those who are vulnerable to preventable medication related harm, such as geriatric care and surgical care settings. Finally, most of the evidence summarized in this report was produced in hospitals and should be strengthened with more research in major specialties, including primary care, and mental health

Agreeing on global research priorities for medication safety: an international prioritisation exercise.

OBJECTIVES: Medication errors continue to contribute substantially to global morbidity and mortality. In the context of the recent launch of the World Health Organization's (WHO) Third Global Patient Safety Challenge: Medication Without Harm, we sought to establish agreement on research priorities for medication safety. METHODS: We undertook a consensus prioritisation exercise using an approach developed by the Child Health and Nutrition Research Initiative. Based on a combination of productivity and citations, we identified leading researchers in patient and medication safety and invited them to participate. We also extended the invitation to a further pool of experts from the WHO Global Patient Safety Network. All experts independently generated research ideas, which they then independently scored based on the criteria of: answerability, effectiveness, innovativeness, implementation, burden reduction and equity. An overall Research Priority Score and Average Expert Agreement were calculated for each research question. FINDINGS: 131 experts submitted 333 research ideas, and 42 experts then scored the proposed research questions. The top prioritised research areas were: (1) deploying and scaling technology to enhance medication safety; (2) developing guidelines and standard operating procedures for high-risk patients, medications and contexts; (3) score-based approaches to predicting high-risk patients and situations; (4) interventions to increase patient medication literacy; (5) focused training courses for health professionals; and (6) universally applicable pictograms to avoid medication-related harm. Whilst there was a focus on promoting patient education and involvement across resource settings, priorities identified in high-resource settings centred on the optimisation of existing systems through technology. In low- and middle-resource settings, priorities focused on identifying systemic issues contributing to high-risk situations. CONCLUSIONS: WHO now plans to work with global, regional and national research funding agencies to catalyse the investment needed to enable teams to pursue these research priorities in medication safety across high-, middle- and low-resource country settings