The Need to Improve Quality of Nursing care, Patient’s Safety and Evidence-Based Practice in Saudi Arabia Dr Abbas Al Mutair Ph.D, MN, BN, CCN Post Grad Dip, RN Mohammed Al Mana College for Health Sciences, KSA

Aim Outlines Quality of nursing care and the need for improvement This paper aims to discuss the need to improve quality of nursing care in Saudi Arabia in terms of: Quality of nursing care Patient safety Evidence based nursing practice. Quality of nursing care and the need for improvement Healthcare system in Saudi Arabia. Nursing workforce in Saudi Arabia Safety and performance improvement. Evidence-based nursing practice

Quality of nursing care and the need for improvement Quality improvement in Saudi Arabia has become a major focus within health care, especially in the areas of regulatory quality, quality assurance, quality improvement and patient safety. The issues and trends affecting nursing care today are increasingly complex and dynamic. There is a great need for nurses to improve the quality of health care delivery

Cont. A key policy in the Kingdom of Saudi Arabia being implemented as a part of the ninth development plan in KSA (2009-2014), with regard to health services, is the need to adopt methods to improve quality of care, and to apply these methods across all health sectors to ensure the appropriate levels of efficiency and quality care achieved.

Healthcare system in Saudi Arabia The health care system in Saudi Arabia has there sectors: No Health sector No of Hospitals No of Beds 1 Ministry of Health 244 (58.9%) 33277 (59.5%) 2 Other governmental health sectors 39 (9.5%) 10822 (19.5%) 3 Private Hospitals 125 (30.6%) 11833 (21%) Total 408 (100%) 55932 (100%)

Nursing workforce in Saudi Arabia. No Health sector Saudi Nurses Expatriates Total 1 Ministry of Health 31824 (50.2%) 31473 (50.8%) 63297(100%) 2 Other governmental health sectors 2883 (11.8%) 21370 (88.9%) 24253 (100%) 3 Private Hospitals 525 (5.5%) 8946 (94.5%) 9471 (100%)

Patient safety The need to improve patient safety for continuous quality improvement has been extensively recognized as a key priority in many countries over the entire world Nurses give lower significance to patient safety compared to other healthcare professionals in SA due to: Failures of leadership Absence of patient-safety culture A need for better management

Medical errors There are more than one definition of error in the literature. Medical error: The failure of a planned action to be completed as intended (an error of execution) or the use of a wrong plan to achieve an aim (an error of planning) ( Reason, 1990)

Type of “errors” Adverse event The Harvard Medical Practice study defines it as “an unintended injury that was caused by medical management and that resulted in measurable disability” Negligence was defined “as failure to meet the standard of care, reasonably expected of an average physician, qualified to take care of the patient in question”

Cont. Near Miss any event that could have had an adverse patient consequence but did not, and was indistinguishable From a full-fledged adverse event in all but outcome (Barach and Small, 2000).

Barriers in reporting medication administration errors by nurses Fear from being blamed (fear of punishment). Education Lack of policy Lack of interdisciplinary collaboration and communication. Lack of safety culture. (Aboshaiqah, 2013)

Recommendations to reduce medical errors Healthcare system should be designed to ensure patient safety possibly in the following three ways: By designing the system to prevent errors Designing procedures to make errors visible when they occur so that they may be rectified. By designing procedures for mitigating the adverse effects of errors when they are not detected and rectified.

International Patient safety goals Identify Patients Correctly. Improve Effective Communication . Improve the Safety of High-Alert Medications . Ensure Correct-Site, Correct-Procedure, Correct Patient Surgery. Reduce the Risk of Health Care-Associated Infections. Reduce the Risk of Patient Harm Resulting from Falls.

Evidence-based Practice EBP Education and research should be valued by nurses in Saudi Arabia and their participation must demonstrate pride and commitment to the nursing profession. Nurses are responsible and accountable for their practice and they should provide evidence of standards of the care they provide. Nurses are required to develop their knowledge and skills in line with the latest available evidence.

Cont. EBP Defined as “integrating individual clinical expertise with the commitment to being a leading source of knowledge and best available external clinical evidence from resources that foster evidence-based nursing practice systematic research (Sackett, Rosenberg & Gray, 1996).

Barriers to EBP utilization among nurses in Saudi Arabia Organization characteristics Lack of time Lack of nursing autonomy Lack of knowledge “feeling of not capable of evaluating the quality of research” Lack of research skills Lack of resources (database) Lack of computer facilities Lack of qualification

Conclusion This paper exemplifies the need for further improvement in the quality of nursing care. Many of the problems identified in this review could be monitored which could push for improvements in efficacy and quality of care. Nurses in Saudi Arabia should obligate to provide all patients a safe and caring environment and optimum nursing services. They are also required to demonstrate the highest quality of care supported by professional development. This should be collaborated with the other healthcare providers and supported by evidence based practice. Nurses must be empowered to continuously improve care and service for meeting quality of patient care

References Aboshaiqah, A. E. (2013). Barriers in Reporting Medication Administration Errors as Perceived by Nurses in Saudi Arabia”. Middle-East Journal of Scientific Research, 17(2), 130-136. Al-Mutair, A. (2015). Quality of nursing care in Saudi Arabia: needs for improvement. Journal of Nursing and Care, 4 (6), 1-3. Aljadhey, H., Mahmoud, M. A., Hassali, M. A., Alrasheedy, A., Alahmad, A., Saleem, F., ... & Bates, D. W. (2014). Challenges to and the future of medication safety in Saudi Arabia: A qualitative study. Saudi Pharmaceutical Journal, 22(4), 326-332. Elarab, H. S. E., El Salam, S. A., Behalik, S. G., & Eltayeb, H. E. (2012). Nurses, Practice, Knowledge and Attitude towards Evidence-Based Practice at Yanbu general hospital-kingdom of Saudi Arabia. LIFE SCIENCE JOURNAL-ACTA ZHENGZHOU UNIVERSITY OVERSEAS EDITION, 9(3), 1062-1071. Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. BMJ: British Medical Journal, 312(7023), 71. Salem, O. (2013). Evidence Based Nursing Practice Inside and Outside Middle East. World Applied Sciences Journal, 27(7), 803-810.

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