10 years of the National Patient Safety Program: progress, obstacles and Nursing protagonism

Although research and actions to improve patient safety globally have strongly increased since the late 1990s, the issue is still an important public health problem that persists to the present day. This is evidenced by the emblematic value of 10% of adverse events in healthcare over the total cases of provided care1.

There have certainly been progress, but only in specific areas such as hospital infection control and medication administration, mainly focused on hospital care, while there has been no global progress in improving patient safety at all levels of healthcare neither in enhancing all healthcare-related processes1.

Based on the need to improve patient safety, the World Health Organization (WHO) launched the Global Action Plan in 2021 to eliminate avoidable harm in healthcare assistance by 2030 and redefined the concept of patient safety from a more systemic and comprehensive perspective: it was considered a structure of organized activities that creates cultures, processes, procedures, behaviors, technologies and environments in healthcare, consistently and sustainably reducing risks, minimizing avoidable harm and mistakes, and reducing harm impact whenever it does occur2.

Based on this new concept, it is clear that improving safety means going beyond the search for adverse events, or the identification of risks; rather than that, it requires strategies that change behaviors and consider human factors and the role of leaders as variables that impact successful decision-making, considering that many features in patient safety programs require more the commitment of individuals towards a safe practice than specific financial resources1.

With regards to the engagement of healthcare professionals in safety improvement programs, the role of nurses in Brazil and throughout the word should be highlighted. There is no doubt that the advances made in the country so far have been largely brought about by nurses' work in healthcare services as leaders for the implementation of institutional policies, protocols and patient safety centers. The creation of the Brazilian Network of Nursing and Patient Safety in 2008 stands out as a pioneering action of nurses, raising the awareness of professionals and institutions, fostering discussions and proposing actionable solutions.

As important as that is the need of political coordination by governments, establishing policies that strengthen and regulate actions to improve safety in healthcare systems and services around the world.

In that regard, the Brazilian Ministry of Health established a National Patient Safety Program (PNSP) in 2013, which established important guidelines to be followed by healthcare and health education institutions in the country. Those guidelines included the mandatory establishment of internal systems for reporting adverse events in institutions; the creation of Patient Safety Centers; the elaboration of Institutional Patient Safety Plans; the establishment of care protocols in health services; and fostering the inclusion of patient safety topics in the curricula and in research carried out by teaching and research institutions in the country3.

The National Health Regulatory Agency (ANVISA), with a view to the systematic implementation of surveillance and monitoring of incidents, created a system so that institutions could report adverse events and record the actions taken when severe events occur. Another guideline of the PNSP was related to stimulating and creating spaces for patient involvement in their own safety3, which still constitutes an important gap towards reaching safe care.

Although this is a robust legislation that indicates many actions to be adopted by healthcare services to improve safety, in harmony with all WHO regulations, there is still a long way to go in Brazil. Despite the gradual increase in notifications in the ANVISA system observed since its implementation, figures still point to underreporting, since approximately 292,000 incidents were reported in 2022 by the registered healthcare institutions4.

With regard to patient safety centers, there are about 5,000 of them; in hospitals alone, the country has more than 7,000 institutions, i.e., the number of centers is still far below expectations5. There is still little evidence of the effective actions of these centers and their impact on the management of institutions’ healthcare safety.

As far as education is concerned, it is essential that the inclusion of patient safety in the national curriculum guidelines and in the curriculum of undergraduate healthcare courses -especially in Nursing- be effectively implemented, thus reaffirming commitments based on the PNSP and WHO recommendations.

A review study that analyzed research studies with innovations for the teaching of patient safety in Nursing courses could not find any research study in the Brazilian context. That points to the need to fostering graduate programs to offer courses and conduct studies that can develop methodologies for teaching Patient Safety6.

Despite it is possible to see some progress in healthcare and Nursing research studies on the subject, these focus more on measuring harm and analyzing its causes, since they still do not present potential impacts of innovations and strategies adopted to improve safety. We need to go deeper in our current approach to safety and create a truly balanced and significantly more differentiated approach to safety, requiring Nursing to develop professional and intersectoral partnerships for a leap forward in the quality and safety of care.

REFERENCES

• 1. Patient Safety Movement Foundation. Patient Safety Movement Foundation. Irvine: Patient Safety Movement; 2018 2023 Sep 7. Available from: https://patientsafetymovement.org/
  » https://patientsafetymovement.org/
• 2. World Health Organization. Global patient safety action plan 2021-2030: towards eliminating avoidable harm in health care. World Health Organization. Geneva: WHO; 2021 2023 Sep 7. Available from: https://www.who.int/teams/integrated-health-services/patient-safety/policy/global-patient-safety-action-plan
  » https://www.who.int/teams/integrated-health-services/patient-safety/policy/global-patient-safety-action-plan
• 3. Ministério da Saúde (BR). Gabinete do Ministro. Portaria MS/GM nº 529, de 1° de abril de 2013. Institui o Programa Nacional de Segurança do Paciente (PNSP). Diário Oficial União. 2013 abr 1. Brasília, DF: Ministério da Saúde; 2013 2023 Sep 7;150(62 Seção 1):43-4. Available from: https://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=02/04/2013&jornal=1&pagina=43&totalArquivos=120
  » https://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=02/04/2013&jornal=1&pagina=43&totalArquivos=120
• 4. Ministério da Saúde (BR). Agência Nacional de Vigilância Sanitária. Incidentes relacionados à assistência à saúde: resultados das notificações realizadas no Notivisa- Brasil, janeiro a dezembro de 2022. Ministério da Saúde. Brasília, DF: Ministério da Saúde; 2023 2023 Sep 7. Available from: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/relatorios-de-notificacao-dos-estados/eventos-adversos/relatorios-atuais-de-eventos-adversos-dos-estados/brasil
  » https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/relatorios-de-notificacao-dos-estados/eventos-adversos/relatorios-atuais-de-eventos-adversos-dos-estados/brasil
• 5. Ministério da Saúde (BR). Datasus: cadastro nacional de estabelecimentos de saúde. Brasília, DF: Ministério da Saúde; 2023 2023 Sep 7. Available from: http://cnes.datasus.gov.br/
  » http://cnes.datasus.gov.br/
• 6. Gomes ATL, Salvador PTCO, Goulart CF, Cecilio SG, Bethony MFG. Innovative methodologies to teach patient safety in undergraduate nursing: scoping review. Aquichan. 2020;20:e2018. doi: https://doi.org/10.5294/aqui.2020.20.1.8
  » https://doi.org/10.5294/aqui.2020.20.1.8

Edited by

Editor-chefe:

João Lucas Campos de Oliveira

Publication Dates

• Publication in this collection
  13 Nov 2023
• Date of issue
  2023