zohair al aseri. md, fcem (uk). frcpc (em&ccm). consultant, departments of emergency medicine...

Zohair Al Aseri. MD, FCEM (UK). FRCPC (EM&CCM).Consultant, Departments of Emergency Medicine & Critical Care.Chairman, Department of Emergency MedicineDirector, Master Public Health.King Saud University Hospitals.Riyadh, KSA Email: zalaseri@ksu.edu.sahttp://fac.ksu.edu.sa/zalaseri

What You Can Do to Stay Safe

الطبية األخطاء من التقليلوتحديات واقع

What You Can Do to Stay Safeالطبية األخطاء من والتقليل المريض ثقافة

Health Education and Medical Error

• Be an active member of your health care team.

i.e. taking part in every decision about your health care.

أن هو الطبي الطاقم مع المريض لتعامل طريقة أفضل إنالطبي القرار اتخاذ في فعال ) عضوا يكون

Research shows that patients who are more involved with their care tend to get better results.

الطبية األخطاء من المريضوالتقليل الطبية ثقافة األخطاء من المريضوالتقليل ثقافة

Medicines األدوية

• Make sure that all of your doctors know about every medicine you are taking.

This includes prescription and over-the-counter medicines and dietary supplements, such as vitamins and herbs.

التي األدوية بجميع اطالع على الطبي الطاقم أن تأكد.تتعاطاها

الطبية األخطاء من المريضوالتقليل ثقافة •. تتعاطاها التي األدوية بجميع اطالع على الطبي الطاقم أن .•تأكد تتعاطاها التي األدوية بجميع اطالع على الطبي الطاقم أن تأكد

الطبية األخطاء من والتقليل المريض ثقافة Health Education and Medical Error

• Bring all of your medicines and supplements to your doctor visits.

•. بذلك قائمة أو أدويتك جميع أحضر

It can also help your doctor keep your records up to date and help you get better quality care.

Medicines األدويةالطبية األخطاء من والتقليل المريض ثقافة

• Make sure your doctor knows about any allergies and adverse reactions you have had to medicines.

أي عن علم لديهم والممرض الطبيب أن تأكد. قبل من له تعرضت قد دوائي تحسس

This can help you to avoid getting a medicine that could harm you

• When your doctor writes a prescription for you, make sure you can read it.

. الوصفة كتابة في الطبيب خط وضوح من تأكد

If you cannot read your doctor's handwriting, your pharmacist might not be able to either.

• Ask for information about your medicines in terms you can understand—both when your medicines are prescribed and when you get them:– What is the medicine for?– How am I supposed to take it and for how long?– What side effects are likely? What do I do if they occur?– Is this medicine safe to take with other medicines or dietary

supplements I am taking?– What food, drink, or activities should I avoid while taking this

medicine?

واستخداماتها – بالدواء الخاصة األسئلة جميع اسأل. والجرعة الجانبية وأعراضها

• When you pick up your medicine from the pharmacy, ask: Is this the medicine that my doctor prescribed?

هو • لك الموصوف الدواء أن تأكد. لك تسليمه تم الذي

• If you have any questions about the directions on your medicine labels, ask.

Medicine labels can be hard to understand. For example, ask if "four times daily" means taking a dose every 6 hours around the clock or just during regular waking hours.

•. الدواء على الصيدلي بكتابات معرفتك من تأكد

• Ask your pharmacist for the best device to measure your liquid medicine.For example, many people use household teaspoons, which often do not hold a true teaspoon of liquid.

• Special devices, like marked syringes, help people measure the right dose.

الجرعة • لقياس طريقة أحسن عن الصيدلي اسألالسائلة.

•Ask for written information about the side effects your medicine could cause.

. فاكتبها خطيرة أعراض يسبب الدواء كان إذا

If you know what might happen, you will be better prepared if it does or if something unexpected happens.

•. فاكتبها خطيرة أعراض يسبب الدواء كان إذا

•If you are in a hospital, consider asking all health care workers who will touch

you whether they have washed their hands.

قبل اليدين بغسل قام الطبي الطاقم أن تأكد. عليك الطبي الفحص

Handwashing can prevent the spread of infections in hospitals

التنويم Hospital Stays :اثناءالطبية األخطاء من والتقليل المريض ثقافة

• When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will follow at home.

. والمتابعات العالجية الخطة عن طبيبك اسأل• This includes learning about your new medicines.• making sure you know when to schedule follow-up

appointments.• finding out when you can get back to your regular

activities.

• It is important to know whether or not you should keep taking the medicines you were taking before your hospital stay.

اللتي • االدوية على االستمرار امكانية من تأكدالتنويم قبل تستخدمها كنت

• Getting clear instructions may help prevent an unexpected return trip to the hospital.

الجراحي التنويم :أثناءSurgery

• If you are having surgery, make sure that you, your doctor, and your surgeon all agree on exactly what will be done.

الجراح • مع الطبيب توافق من تأكد

• The good news is that wrong-site surgery is 100 percent preventable.

قبل • العملية مكان على الجراح يوقع ان توقعللعمليات دخولك

• Surgeons are expected to sign their initials directly on the site to be operated on before the surgery.

• If you have a choice, choose a hospital where many patients have had the procedure or surgery you need.الجراحية العملية في المختص المستشفى أخترالمعنية

Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.

أخرى Other Steps :خطوات

• Speak up if you have questions or concerns.

بفعالية • شاركYou have a right to question anyone who is

involved with your care.

• Make sure that someone, such as your primary care doctor, coordinates your care.تنسيق عن مسئول طبيب وجود من تأكد

الطبية .رعايتك

This is especially important if you have many health problems or are in the hospital.

• Make sure that all your doctors have your important health information.الخاصة الصحية المعلومات جميع توفر من تأكد.بك

Do not assume that everyone has all the information they need.

• Ask a family member or friend to go to appointments with you.

بعض حضور الحضور أقاربك أحد من إطلبمعك .المواعيد

Even if you do not need help now, you might need it later.

• Know that "more" is not always better.

•. مطلوبة بالضرورة ليست الزيادة أن تفهمIt is a good idea to find out why a test or

treatment is needed and how it can help you. You could be better off without it.

• If you have a test, do not assume that no news is good news.

•. النتيجة متابعة فيجب فحص عملت إذا

Ask how and when you will get the results.

• Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources.

على • واطلع الطبي الطاقم حالتك عن إسأل. الموثوقة الطبية المصادر

•. الحاالت قبول وتأخير المواد قلة

• Access difficulties

• Delays in transfers or referrals to specialists.

الطبية واألخطاء الطرفية المستشفياتRural Hospital

• The availability of resources,

whether healthcare human resources, equipment, or facilities……

الطبية والمعدات البشرية الموارد قلةوالتجهيزات.

• One of the main issues is accommodating their patient population within the constraints created by time, distance, and resources.

المريض • نقل عند ) وتحديدا الموارد قلة مع المريض عالج. الخطورة العالي

• Transferring a critically ill patient to a tertiary care centre can be challenging.

Distance, travel, and resourcesوالموارد, السفر المسافة

• Physicians practicing in a rural setting should continue to provide care to the best of their ability, and initiate the transfer process.

يمكن • ما أقصى حسب الخدمة تقديم الطبيب على. المستمرة الطبية باالستشارات ويقوم

• While awaiting transfer, the physician may wish to access consultation services over the telephone to obtain advice regarding concurrent treatments.

الطبية واألخطاء الطرفية المستشفياتRural HospitalDistance, travel, and resources

والموارد, السفر المسافة

• All efforts in obtaining the transfer and phone consultation should be documented in the patient's medical record.

التي • االتصاالت جميع توثيق الطبيب على. المريض نقل أجل من يعملها

• The copy of relevant information should be provided as part of the transfer, ensuring receiving centre can initiate prompt treatment.

مع • ترفق الطبية االتصاالت بينت التي األوراق جميع. التحويل أثناء المريض

• Having pre-established protocols

. مسبقة وآليات بروتوكوالت وجود يجب

• The use of telemedicine to deliver healthcare

• Physicians should first consider the patient's condition.

•. المريض حالة مع وعالقته بعد عن العالج

Telemedicine

. المريض حالة مع وعالقته بعد عن العالج

• In some circumstances however, where there is an unusually high level of risk or a hands-on physical examination of the patient is more suitable, physicians should consider whether telemedicine is the best option.

Telemedicine

كان إذا تقييم الطبيب على يجبطريق عن المريض معالجة باإلمكان

بعد عن .العالج

• Telemedicine also carries medico-legal challenges that physicians should be aware of, including licensing requirements.

كالتصريح • القانونية اإلشكاليات بعض يحمل بعد عن العالج. المريض وخصوصية

• Keep patient information private and secure.

Telemedicine

• Extended hours.

• The availability of other healthcare providers.

•. المناسبة الطواقم وتواجد الدوام ساعات طول

Healthcare human resources in rural settings الفرعية والمستشفيات العاملة القوى

Need for:

• Proper planning, professional development, and retention strategies.

• Appropriate management of human resources will help reduce medico-legal risk.

األخطاء • يقلل المناسب الوظيفي التخطيطالطبية.

الطبية واألخطاء الطرفية المستشفياتRural HospitalHealthcare human resources in rural settings

الفرعية والمستشفيات العاملة القوى

االعياء • إلى يؤدي النفسي والجهد النفسي القلقالجسمانيه • بقدراته الطبيب معرفة يتوقع النظام

والنفسية• Courts generally expect physicians to be aware of

their capacity and fitness to provide competent clinical care.

والنفسية الجسمانيه بقدراته الطبيب معرفة يتوقع النظام

Stressful conditions may give rise to a physician's personal fatigue or other health conditions.

• Coordination and communication are key to smooth transitions, referrals, and follow-up.

• Transferring care to a locum or other professional, attention to detail is required in communicating and documenting patient care, particularly for those patients who have specific or more urgent medical needs.

النقل • في األساسية الركائز من التواصل وفن المعلومات نقلللمريض الجسماني

• Detailed information about the case, history of the patient, and most recent medical condition and observations should be included in the documentation.

للطبيب • ومقروء واضح بخط الحالة عن كاملة تفاصيل. الحالة مستقبل

. الحالة مستقبل للطبيب ومقروء واضح بخط الحالة عن كاملة تفاصيل

. والذاتي العلمي للتطوير فرص وجود

Opportunities for professional development for all staff.

• Attending conferences periodically• online learning activities. • Peer-to-peer learning between rural physicians should be

encouraged

• Interprofessional care brings many benefits, including giving patients greater access to a range of skills and knowledge.

• It also, however, places greater emphasis on the need for effective, clear, and timely communication between physicians and other healthcare professionals.

والمؤسسات • األشخاص بين الداخلية العالقات. متميز ألداء مهمة ركيزة

. األمن لتفعيل مهمة ركيزة والمؤسسات األشخاص بين الداخلية العالقات

In some remote communities, regional electronic networks can be set up to facilitate the exchange of patient information, allowing rural physicians and their team members to examine diagnostic imaging studies transmitted electronically.

Medical records can be digitized to facilitate transfer between satellite offices.

Communication between physicians and team membersالطبي الفريق وأعضاء الطبيب بين التواصل

مشاكل من كثير حل في سيساعد اإللكتروني النظام. والكتابي الشفهي اإلتصال

• Anticipating the information that members of the healthcare team may require is paramount to proper coordination, timely intervention, and follow-up related to patient care.

يطلبها التي المهمه المعلومات تصور. األهمية غاية في اآلخر الطرف

• Practising in a rural setting, given the distance, patient caseload, and need for referrals or transfers, places additional emphasis and value on clear documentation.

التوثيق أهمية على ضغط تضع الدعم وقلة المسافه .بعد

• Poor communication can lead to disruptions in continuity of care, delayed diagnoses, and unnecessary testing — not to mention frustrated patients.

تؤدي الفعال واالتصال التوثيق قلةوتدهورها الحالة سوء .إلى

• Familiarizing locum physicians with systems and providing briefing notes and face-to-face updates if possible on particular cases, including any anticipated problems and how to generally manage these

ايجابا. • ينعكس بالنظام الزائرين األطباء معرفة. األداء على

الطبية واألخطاء الطرفية المستشفياتRural HospitalCommunication between physicians and team members

الطبي الفريق وأعضاء الطبيب بين التواصل

Points to consider تؤخذ أن يجب نقاط باإلعتبار

Clear and detailed documentation

والمفصل الواضح التثبيت

• Communication between all providers should be clear, comprehensive, and timely.

وفي • وشامل واضح يكون أن بد ال الجميع بين التواصل. المناسب وقته

• Using structured communication techniques to reaffirm key messages and confirm comprehension.

•. المعلومة وصول من التأكد طريقة إستخدام

الطبية واألخطاء الطرفية المستشفياتRural HospitalPoints to consider تؤخذ أن يجب نقاط

باإلعتبار

Whether referrals, transfers, or handovers of care, such conditions demand attention to detail.

القرار اتخذ ومتى التحويل يتم لماذالتحويل سيتم ومتى

As well, given the issue of travel and distance, detailing why and when a decision has been made by the physician to transfer a patient to another facility or to a consultant for further diagnostic tests or treatment should be well documented in the medical record.

والنقل Referrals and .التحويلtransfers

At times it is not possible for a rural physician to promptly transfer a patient to a tertiary facility.

إتخاذ من فالبد سبب ألي التحويل على القدرة عدم عند. المريض سالمة لضمان الالزمه اإلجراءت جميع

In these circumstances, appropriate temporary measures should be determined by the referring and receiving physicians until transfer take place.

• In some jurisdictions, protocols have been established which facilitate the timely transfer of patients.

الجميع • حق تحفظ برتوكوالت وجود

• Medical orders should be written in a clear and legible manner and progress notes or other suitable medical history should be available on the record or should be updated to accurately reflect a patient's condition.

والتاريخ • واضح يكون أن البد الطبي األمرالتحاليل وجميع والفحص المريض

• Referring physicians should be aware of the core elements of a good referral including

التحويل • بأساسيات ملم يكون المحول الطبيب– information about the problem– clinical question to be answered– patient details– results of relevant investigations– treatments already provided.

التحويل • بأساسيات ملم يكون المحول الطبيب

• Using templates for referral forms

عليها • ومتعارف معتمدة نماذج إستخدام

• Referring physicians should communicate to the receiving physician's office staff any urgency or particular time frame required for a scheduled appointment.

وقابل • المحول بين الموعد تحديد يتم أن البدالحالة

• With this information, staff can determine if the timing is cause for significant concern.

Should the clinical condition of the patient necessitate an earlier appointment, the physician should attempt to negotiate an earlier appointment.

ذلك عرض فيجب التأخير تتحمل ال الحالة كانت إذاالحالة سيقبل الذي الطبيب على

If this is not possible, referring the patient elsewhere should be considered.

• Physicians should inform patients who are waiting for a scheduled appointment about the signs or symptoms for which the patient should immediately seek further medical care.

األعراض • عن المريض تثقيف الطبيب على يجب. القبول تأخر عند القلق تستدعي التي

• Communicate to the consulting physician any significant changes in the condition of the patient.

الطاقم • أو الطبيب مع مستجدات أي عرض. للحالة القابل

• If a lack of beds is preventing a transfer or referral, the referring physician should provide sufficient clinical information so the receiving physician can form a professional opinion and give appropriate direction.

للمستشفى • المريض عن واضحة صورة إيصال يجبقبول سرعة في النظر إعادة في يقرر حتى المرجعي

.الحالة

Strategies and points to consider in dealing with boundary issues:

يجب • استراتيجيات: عليها المحافظة

المهنية.•العدل.•السرية.•الموضوعية.•االفتراضيات • قلة

: عليها المحافظة يجب استراتيجياتالمهنية.•العدل.•السرية.•الموضوعية.•5. االفتراضيات. قلة

Physicians have a duty to provide •Equal access and care to all patients. •Professionalism •Confidentiality•Objectivity•Avoiding assumptions when caring for patients.

• Separating professional work from personal or social events is important.

•. الشخصية والعالقات المهنية بين الفصل

• For example, during social events, if a physician is asked questions regarding medical conditions or medical opinion, the physician should state politely, but clearly, that an appointment during office hours would be more appropriate.

• Living and practicing medicine in a rural community can present unique challenges for physicians.

• ) دائما النائية المناطق في الطبية الرعاية تقديم. التحديات بعض مع يتزامن

Reflecting on the differences between urban and rural practice can be a good way of anticipating situations and building workable and professional strategies that help reduce medico-legal risk.

النائية المناطق في اإلمكانيات بين الفرق تفهم. الطبية األخطاء خطورة من يخفف المتقدمة والمناطق

References

• Society of Rural Physicians of Canada website home page, www.srpc.ca. Retrieved June 25 2012 from:http://www.srpc.ca/index.html

• This issue is discussed in greater detail in the article "Limited healthcare resources: The difficult balancing act."

References

• Canadian HealthcareNetwork.ca, "EMR success story: Sustainable rural care built from the ground up," January 2012. Retrieved on January 22 2013 from: http://blog.canadianemr.ca/canadianemr/2012/02/building-an-emr-from-scratch-a-saskatchewan-success-story.html

References

• Chauban, T., Jong, M., Buske, L., "Recruitment trumps retention: results of the 2008/09 CMA Rural Practice Survey,'Canadian Journal of Rural Medicine (2010) Vol. 15, no.3 p.101

zohair al aseri. md, fcem (uk). frcpc (em&ccm). consultant, departments of emergency medicine...

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