Clinical FeaturesPharmacy

Lessons learned in Patient Safety: My observations and reflections while working within the healthcare system in the UAE

Over my professional career, I amassed 20 years of practical experience in healthcare as a pharmacist and a quality healthcare advocate. As a healthcare professional practicing pharmacy in UAE, I have always been enthusiastic about improving the quality of care. My belief that Patient Safety is a paramount concern and a top priority in healthcare started in 2009 when I completed my MSc in Quality and Safety in Healthcare Management from RCSI Dubai, a branch campus of the Royal College of Surgeons in Ireland (RCSI) in the United Arab Emirates. Since then, as a healthcare professional, I have been seeing and reflecting on the development of patient safety awareness and science in healthcare. In this article, I would like to share a few insights and experiences on this fundamental principle in healthcare.

The global landscape of health care is changing, with health systems working in increasingly complex environments, patient safety is a big and growing global public health challenge and an international healthcare goal. The United Arab Emirates (UAE) is part of this global community striving for excellence in healthcare and has made significant strides to improve patient safety in its
healthcare system.

In UAE healthcare system, the Ministry of Health and Prevention (MoHaP) oversees the national healthcare regulations. The emirates have regional healthcare authorities’ departments, like the Department of Health (DOH) in Abu Dhabi and the Dubai Health Authority (DHA) in Dubai, to regulate each region’s medical sectors. The Departments of Health shape the regulatory framework for the health system, inspects against regulations, enforces standards, and encourages the adoption of world–class best practices and performance targets by all healthcare service providers in
the Emirate.

In this article, I want to highlight three main facts, that in my opinion, have contributed to the advancement of the quality of care while nurturing patient safety approaches in the healthcare system in the UAE.

First of all, the ‘vision’ to provide world-class health and social care services must exist before any sort of implementation. The UAE does not only have a ‘vision’ but also stringent regulations governing the clinical practices in all healthcare settings to support it. Healthcare providers should adhere to strict guidelines in all process of clinical pathways, including but not limited to best practice clinical guidelines, correct diagnosis, updated best practice guidelines of medication management, verifying prescriptions, safe medication administration procedures, providing clear instructions to patients, and verifying the authenticity of the medications.

The department of health (DoH) implemented standards, policies, and initiatives to promote healthcare quality, implementing a total quality management system to ensure the safe and effective
use of medications. JAWDA, which is the Arabic translation of ‘Quality,’ is a program that was launched in 2014. It supplies a framework designed to assess the quality performance of health
providers in Abu Dhabi based on a set of quality outcome indicators under main areas like safety, effectiveness of care, timeliness of service delivery, and patient-centric delivery of care.

The Department of Health (DoH) has signed an agreement with the Emirates Classification Society (TASNEEF) to Certify Healthcare Providers in the Emirate of Abu Dhabi for JAWDA Data Certification. JAWDA Data Certification (JDC) is a process to improve the quality and accuracy of health data and clinical coding in the Emirate of Abu Dhabi. It is an initiative of the Department of Health (DoH) to enhance the transparency and trust between healthcare providers, payers, patients, and regulators. JDC involves auditing the claims and coding processes of healthcare facilities, as well as validating the data submission of key performance indicators (KPIs) for quality measurement. The objective of JDC is to ensure that the health data reflects the actual services
provided and the outcomes achieved, and to support the improvement of patient safety, clinical effectiveness, and patient experience. JDC is based on a set of standards and guidelines that
are aligned with international best practices.

In 2023, The Department of Health – Abu Dhabi announced its accreditation by the prestigious International Society for Quality in Health Care External Evaluation Association (ISQua EEA). DoH
received this accreditation for its commitment to quality and patient safety in health and social care. The accreditation recognizes DoH’s adherence to international standards in healthcare services, ensuring continuous improvement and excellence in service delivery.

Another key strategic initiative is the effective integration of technology to improve patient safety. Malaffi is the first health information exchange platform in Abu Dhabi. Malaffi, which means “my file” in Arabic, aims to improve healthcare delivery quality, safety. It has a mobile app that allows patients to access their health information and manage their appointments, prescriptions, and referrals.

By providing instant access to the patient’s medical file, Malaffi empowers healthcare professionals to make better clinical decisions, enhances coordination and avoids unnecessary duplication of
tests and procedures. It is one of the most advanced health Information exchange platforms in the world, providing patient’s health information from a routine checkup, consultation or emergency treatment to laboratory tests or radiology images, all are now collated in their personal file, with their medical history safely and securely stored and instantly accessible when needed.

Malaffi is integrated with the National Unified Medical Record (NUMR) program Riayati and Nabidh, the Dubai Health Authority platforms for the secure exchange of reliable healthcare information among licensed health facilities in Dubai, a step that further supports the delivery of an integrated health system for citizens across the UAE. This initiative not only reduces healthcare costs, but also primarily contributes to patient engagement, reduces the risk of medical error, improves medications safety, supports patient empowerment to aid self-care, informed decisionmaking, enhanced medical compliance, and improved trust between patients and medical professionals.

Adding to this, I believe the different initiatives and collaboration between pharmacovigilance authorities and healthcare providers, plays an important role in the advancement of providing quality care, an example of this is, healthcare facilities having assigned pharmacovigilance focal points who are tasked with specific responsibilities that include:

  • Following up with healthcare professionals within the facility for reporting Medication Errors and send any clarification to DOH when required.
  • Identifying and implementing practices to improve the Pharmacovigilance reporting to DOH.
  • Educating healthcare professionals on the importance and methods of Medication Errors (ME) to the Pharmacovigilance program.
  • Receiving emails of safety alerts and recall circulars and disseminating them to healthcare professionals within the facility.
  • Becoming a member of the Abu Dhabi pharmacovigilance networking (ADPVN) and participates proactively in its activities. The ADPVN members meet in comprehensive workshops and advanced training days activities to enhance medication safety and encourage safe patient care practices.

As a pharmacovigilance focal point of my healthcare organization, I have been following and participating in these initiatives and campaigns and observing their positive impact on improving
patient safety and quality of care in different settings and contexts. It is also a great learning opportunity from the inspiring stories, best practices of leading experts and peers worldwide committed to making health care safer and better for everyone. Such activities lead to reframing the relationship between healthcare providers and regulators, resulting in effective communications and positive outcomes.

The standard on reporting medication errors, aims to ensuring system thinking and just culture. It ensures that reported errors are studied, reviewed and that procedures are established to prevent them from reoccurring. The standard also requires that healthcare facilities must develop long-term monitoring plans to ensure that changes come into effect after the medication errors
occur. The standard adopts the “Culture of Safety”, designed to promote the development and implementation of the Continuous Quality Improvement system.

Finally, another important contributing reason to the advancement of quality of care, is the role played by Quality and Patient Safety leaders. Health organisation leaders consider patient safety as a strategic goal as they are aware that patient safety is everyone’s responsibility; it is not a one-time event, it is not a theme, it is not about accreditation, but it is a culture, a continuous process
of improvement and learning. It is how we do things in our organizations daily.

As a pharmacovigilance focal point of my organization and a quality and patient safety function lead of my pharmacy department, I was supported by my leadership to walk the safety talk at an
organizational level. Adding to my responsibilities as the organizations’ pharmacovigilance focal point, my role is to:

  1. Encourage and collect adverse events, errors and near misses reporting data.
  2. Review and analyse the collected data of medications errors, clinical interventions and near misses.
  3. Study reported data, highlight systems gaps, show examples as lessons learned.
  4. Prepare monthly slides for discussion at the medication management committee,
  5. Discuss and recommend corrective actions that can prevent recurrence.
  6. Follow up corrective actions’ implementation and monitoring.
  7. Slides then will be circulated to all clinical departments for sharing the good practices and learning from mistakes and near misses.
  8. Spread the quality and safety talks, meet with the department colleagues on weekly huddles, and with organizational staff on regular virtual events, discussing Principles of patient safety, quality in healthcare, patient education and engagement, system thinking in analysing medication errors or adverse events, just cultures, medications reconciliations, WHO world patients’ safety campaigns.
  9. Mentor other quality champions at different department to disseminate the quality and safety talk.
  10. Support improvement projects, continuous educations, and patient safety initiatives.

Patient safety practices have come a long way, with valuable lessons. The way forward is for healthcare providers to focus on investments in advanced technologies like artificial intelligence, machine learning, proactive risks management and preventative mitigation strategies. On the other hand, in recent years, a notable surge in collaborative initiatives between higher education
institutions and healthcare providers has appeared, marking a transformative approach to addressing patient safety challenges. As a dedicated safety pharmacist, I keenly see this trend as I explore the evolving healthcare landscape. The constructive collaboration between academia and healthcare fosters innovative solutions that enhance patient safety protocols and bridge
the gap between theory and practical application. This dynamic partnership promises to advance pharmaceutical practices and cultivate a culture of continuous improvement in the quest for the
best patient care in the UAE.

To conclude, I would like to add that the drive for excellence, be it in any aspect, must come from ‘within’. Personally speaking, my unwavering commitment to pharmacy extends beyond the confines of dispensing medications. As a pharmacist, I am impassioned to pursue quality and patient safety excellence. It is not merely a professional obligation but a personal mission to ensure everyone receives the highest standard of care. Through continuous education, rigorous adherence to protocols, and a relentless dedication to staying informed about advancements in the field, I strive to contribute to a healthcare environment where patient well-being is paramount. In a world where precision and compassion intersect, I find fulfilment knowing that my role extends far beyond the counter —it reaches into the hearts and lives of those entrusting me with their health.

Written by Linda Asaad Ghazal, Pharmacist II, Quality and Patient Safety – BCPS, Msc.QSHM, CPHQ,CPPS – Imperial College London Diabetes Centre

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