The Danish National Board of Health Patient Safety

The Danish National Board of Health - Patient Safety Anne Mette Dons, MD Head of Department Supervision and Patient Safety

The Danish Population § 5. 4 million inhabitants § 1 million younger than 17 years 1 million over 60 years 9 th of February

The Health Act: On the basis of respect for the individual and his or her integrity, the citizens shall have: § 1) Easy and equal access to health services § 2) Treatment of high quality § 3) Coherent health services § 4) The freedom of choice § 5) Easy access to information § 6) A transparent Health service § 7) Short waiting time 9 th of February

Structure of the Health Service § Ministry of Health and Prevention § Political prioritisation, financial frame, legislation § The National Board of Health: § The health professional knowledge. The highest health authority. Delivers Independent Advise and Supervision. Monitoring health Care § The Regions: § Run the Hospitals, psychiatry, GP’s and specialised healthcare. § The Municipalities: § Prevention, rehabilitation, nursing and dependency treatment 9 th of February

5 regions and 98 municipalities 9 th of February

The Danish authorities on Patient Safety Ministry of the Interior- and Health National Agency The National Board of Health for Patients' Rights and Complaints Supervision Regional Medical Officers 9 th of February

National Board of Health: Mission og vision § Mission: § We work to promote health for the citizens § Vision § Healthy citizens and safe, high quality health care ) 9 th of February

Main obligations of The National Board of Health (The Health Act) § Surveillance § Counseling § Supervision 9 th of February

The legal protection of the patient The Patient National Agency The Patient for Patients' Insurance Rights and Complaints Association The National Board of Health 9 th of February The employer

Target areas in Patient Safety at the NBH § General Surveillance § Identification and management of risk areas § Identification and management of the professional misconduct § Publication of binding Guidance to Health Personnel 9 th of February

Surveillance and Supervision Patient safety Supervision of health personnel Professional misconduct Abuse/illness fitness to practice General surveillance Failure in Organization Risk areas

Incidence Investigation NBH decides if there is to be an investigation Can be on the basis of complaints § Often in writing, response is mandatory § Unannounced inspection possible § Together with the local public health officers 9 th of February

Organization Is the incident due to the organization and not the individual? Working conditions § Local manuals § Collaboration within the hospital § 9 th of February

What can the National Board of Health do? § Recommend a different way of organizing the work § Recommend local manuals/instructions § Recommend use of other procedures 9 th of February

Supervision of health personnel § Personal inability to practice (fitness to practice) § Deficient professional performance 9 th of February

General Surveillance § Psychiatry (e. g. measures of constraint) § Prescription of medication (dependency potent) § New Patient Safety areas 9 th of February

Planned Supervision § Nursery homes § Registration and inspection of all premises, where doctors preform Cosmetic treatments § Registration and inspection of all premises, where doctors preform private medical treatment from 1. 1. 2012 9 th of February

Focused inspections § Yearly subjects, chosen from complaints, insurance, incidents, adverse events. § Examples: § Patients rights, Safe medication, documentation in medical records, hygiene, use of antipsychotic medicine 9 th of February

Quality and supervision Quality Good Quality Acceptable medical standard Bad Quality Supervision

Information National Agency for Patients' Surveillance Rights and Complaints The Patient Insurance Association Guidance Medicines Agency National Board Sundhedsstyrelsen Adverse Events of Health Supervision Dentist complaint system Supervision National patient diagnoses and treatment registrar The scientific societies 9 th of February

Act on Patient Safety § Since 1 st of January 2004 § Background: § Danish and international adverse events studies § Objective: § to improve patient safety in the health care system

Method § Collecting and Analysing knowledge of adverse events § Advising the health care system on patient safety

Characterization of the reporting system § Mandatory § Confidential § Sanction-free § Learning orientated

Interaction of authorities The local unit Implementation of locale initiatives The regional unit Coordination and advising The centrale unit Advising the Danish Health Care System

The Reporting System at National Agency for Patients' Rights and Complaints § Since 2011 § Gather knowledge from: § The Reporting System § The Patient Insurance Association § Patient Complaints 9 th of February

Number of events in the Reporting system § 98. 669 reported adverse events in 2011 § 78. 036 finished cases on AE 9 th of February

Publications from the National Board of Health § Newsletters § Alerts § Reports § Annual report

§ Der er i alt rapporteret 98. 669 utilsigtede hændelser til Dansk Patientsikkerheds Database i 2011. Samme år er 78. 036 hændelser færdigsagsbehandlet samt afsluttet og videresendt til Patientombuddets læringsenhed 9 th of February

Range of Reactions from National Board of Health Risk Areas Guidelines Professional regulations Risk Organization Recommendations of change Risk personnel Pursuit of persons with repeated deficient professional performance 9 th of February

The Whole Bunch… At NBH Risk Areas Risk personnel 9 th of February Risk Organisations

Goal and Method § The purpose § Maximum patient safety § Acceptable professional performance § The method § Professional guidelines § Rules and regulations § Inspection 9 th of February