Patient Centered Care Dr Sylvia Cole MB;BS, DA, FRCA Consultant Anaesthetist/ Intensive Care Physician Paelon Memorial Clinic

Definition Providing care that is respectful and responsive to individual patient preferences, needs and values and ensuring that patient values guide all clinical decisions.

The UK experience

NICE(National Institute for Health and Care Excellence) UK Healthcare professionals should follow the department of health’s advice on consent. If someone does not have the capacity to make decisions, healthcare professionals should follow the the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safegaurds.

NICE Multifactorial risk assessment identifies the patients risk factors Cognitive impairment Continence problems Falls history Footwear Medication Syncope Visual impairment

Listened to Informed Respected Involved in their care Wishes are honored

Quality of personal, professional and organizational relationships Attributes Whole person care Coordination and communication Patient support and empowerment Ready access Reference Institute of Medicine

What can we do?

Nigerian Medical and Dental council Society for Quality in Health Care In Nigeria (SQHC) Medical professionals

MDCN (Medical and dental council of Nigeria) Hippocratic Oath The Hippocratic Oath is an oath historically taken by doctors swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, in Ionic Greek (late 5th century BC),[1] or by one of his students,[2] and is usually included in the Hippocratic Corpus. Classical scholar Ludwig Edelstein proposed that the oath was written by Pythagoreans, a theory that has been questioned due to the lack of evidence for a school of Pythagorean medicine.[3] Although mostly of historic and traditional value, the oath is considered a rite of passage for practitioners of medicine in some countries, although nowadays the modernized version of the text varies among the countries. The Hippocratic Oath (orkos) is one of the most widely known of Greek medical texts. It requires a new physician to swear upon a number of healing gods that he will uphold a number of professional ethical standards. Little is known about who wrote it or first used it, but it appears to be more strongly influenced by followers of Pythagoras than Hippocrates and is often estimated to have been written in the 4th century B.C.E Over the centuries, it has been rewritten often in order to suit the values of different cultures influenced by Greek medicine. Contrary to popular belief, the Hippocratic Oath is not required by most modern medical schools.

HIPPOCRATIC OATH : MODERN VERSION I swear to fulfill, to the best of my ability and judgment, this covenant: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery. I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God. I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help. —Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

Hippocrates oath original

Nice (National Institute for Health and Care Excellence) UK NICE has standards, produces guidelines based on evidence based medicine Treatment and care should take into account individual needs and preferences. Patients should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals nice.org.uk

International Conference on Patient Centered Care (America) Patient- centered care has now made it to center stage in discussions of quality. Enshrined by the Institute of Medicine Quality Chasm report 1-6 key elements of high quality care The Values and Value of Patient- Centered care. Ronald M Epstein, MD and Richard L. Street, Jr, PhD

Promoting Patient Centered Care SQHN Workshop 25 th June 2015 Today SQHN Society for Quality in Health Care In Nigeria

Dignity and respect Information sharing Participation Collaboration Partnership

Evidence based outcomes of patient and family engagement Improved Earlier discharges Patient safety/quality Patient satisfaction Patient/staff relationships Positive perceptions of workplace by staff Psychological adjustment of patients

Reduced Length of stay Medical errors Readmissions Staff vacancy and turnover Change in your prescriptions and treatment

What we do in Paelon

Patient rights Right to health care without regard to sex, culture, social status, education or religious background Right to have considerate and respectful care Right to know the physician who has primary responsibility for coordinating your care and also names and professional relationship of other caregiver(s) involved in your care Right to receive information about your illness, course of treatment and prospects of recovery in terms that you can understand Right to obtain information about any proposed procedure you may need in order to give consent(except in emergency situation) Right to participate actively in decision regarding your medical care Right to confidential treatment and confidential protection of your medical records Right to reasonable response on any request you may make for services received Right to refuse or accept to participate in research projects Right to know hospital rules and policy pertaining to you Right to know that vital error(s) made during care delivery will be reported to you expediently Right to explanation on your financial or medical bill Right to know the drug name, function and side effects of drugs you are given Right to have a choice of physician subject to availability

Provider rights Right to request patients to register at front desk before seeking medical care Right to request patients to cooperate with hospital caregivers Right to request patients to treat all hospital staff with respect and dignity Right to request patients to adhere with the agreed treatment Right to request patients to follow the health worker’s instructions diligently Right to request patients to take the necessary preventive measures in case of infectious disease per doctor’s instructions Right to request patients to be aware that health workers will endeavor to always act in their best interests, however, being human, are susceptible to infrequent errors Right to request patients to be aware that ALL procedures and treatment modalities carry varying levels of risk for which health workers are not liable Right to request patients to make payment for the treatment wherever applicable to the hospital promptly Right to request patients to respect the competence of health workers to make professional decisions on patients care Right to request patients to be punctual to attend the clinic/hospital for treatment at the given time Right to request patients to disclose all necessary information about himself/herself including all the treatment he/she has received before Right to request patients to inform the hospital of change of profile information (name/address/emergency contact/phone numbers etc.) Right to request patients to keep the hospital management informed, if change of doctors/hospital is desirable/desired

Questions?

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