All systems in place to up patient safety
Healthy competition including a first on medication safety among wards and units at Kalubowila Hospital
Organised and systematic, even for non-health personnel like us, it is easy to spot the colour-coded and clearly labelled equipment and medicines without confusion or delay.
We are in a popular state hospital that has traversed a pathway that would take overall patient safety to a different level.
Others have looked at and improved productivity in some areas. However, the Colombo South Teaching Hospital (CSTH), Kalubowila, has gone that extra mile not just to fine-tune its productivity but also its processes – all for the benefit of its patients and to ensure medication safety.
“Such improvements can be used as a strong tool in administration, to enhance teamwork and efficiency and motivate dedication and commitment,” reiterated Director Dr. Sagari Kiriwandeniya, going onto explain that the final outcome of all these organizing and systemchanges is patient safety.
With a bed strength of 1,249, the ‘catchment’ area of the CSTH is wide, from Dehiwala, Mount Lavania, Ratmalana and Moratuwa to Nugegoda, Maharagama, Pannipitiya and Kottawa to Piliyandala and Kesbewa. About 2,000 people access its Outpatients’ Department (OPD), around 2,000 more attend its clinics and around 500 seek admission each day.
The CSTH has 41 wards including the specialties of medical, surgical, paediatrics, obstetrics & gynaecology, cardiology, eye, earnose-throat, neurology, psychiatry, orthopaedic, rheumatology, urology, nephrology, gastroenterology, gastrointestinal surgery, oral & maxillofacial surgery and haematology.
The examples of the good outcomes of this systems-change flow forth without hesitation from Dr. Kiriwandeniya. Such organization would help any nurse working in any ward to be familiar with where all the important medicines and medical tools are. It also helps overcome medication errors with regard to look-alike and soundalike medicines.
“Everybody would know where the medicines are, which medicines would be marked clearly, where the other equipment such as those needed for blood transfusions is and also that they do not have to scramble because such equipment would be ready to use,” she says, explaining that if batteries are needed they would be available and if charging is needed that would have been done in advance.
This Director is happy that the staff would be on the ball and ready to face any emergency and would not have to check whether the drugs are outdated….when there is an emergency. All these measures
would minimize errors as well as wastage and maximize efficiency and use of resources.
She brings under the spotlight a project at the Cardiology Unit, how when patients are discharged, they do not have to queue up at the counter to get their medications. Instead, a pharmacist delivers the medicines to their bedside and explains why the medicine has been prescribed, how it should be taken and also the possible sideeffects so that they leave for home armed with knowledge.
“The patients are very happy and because they know about their medications and how to take them, there would be a reduction in wastage and improved medication
adherence. This is a ‘personalized’ approach to medication delivery and is likely to have a positive impact on patient outcomes and overall healthcare quality in the unit,” she smiles.
Looking back at the recent history of the CSTH, she says that her predecessors Dr. Anil Jasinghe followed by Dr. Asela Gunawardena had begun these processes for which this tertiary care teaching hospital had won many productive awards.
Then the unprecedented COVID19 pandemic hit and the world including hospitals were turned topsy-turvy. Within hospitals, all systems collapsed with surgical wards being converted to medical wards to face the massive influx of patients hit by this contagious respiratory disease.
“Everything went awry. Everything got messed up. Workplace organization in hospitals was disrupted,” says Dr. Kiriwandeniya, stressing that this went on for about three years.
Then followed the economic crisis, exacerbating the situation.
She points out that two batches of nurses as well as other staff were thrown into this new, notvery-productive culture, with the misconception that they were helpless because there was no money. This was while the economic crisis was also swelling the numbers of those seeking treatment at this state hospital as the middle class turned up for care and succour.
It was then that Dr. Kiriwandeniya spread the word that small actions at ground level could go a long way – in organizing resources and manpower as well as maximizing infrastructure and motivation.
……And so, focus was turned to reviving good management, starting in mid-2023 (last year), targeting six months and providing training in some aspects to the staff.
She is happy that all of the staff, from the Consultants through to the support staff, embraced these
suggestions, activating Work Improvement Teams (WIT), while training new staff.
The highlight, of course, was that the CSTH had an inter-ward and unit competition, with the component of medication safety being a first in a hospital in the country, at the end of last year.
The medication safety component had been overseen by a Steering Committee under the general guidance of the Director and included three Consultants, the Chief Pharmacist and the Medical Officer for Quality Management, with an extensive training being carried out for staff by the Department of Clinical Pharmacology of the Sri Jayewardenepura University’s Faculty of Medical Sciences.
The competition is over but the systems and mindset have come to stay – as is obvious when the Sunday Times walks around the CSTH, with thoughts that it could easily act as a strong role model for other hospitals around the country.