Patient Safety in Complementary Medicine through the Application of Clinical Risk Management in the Public Health System

Abstract

Aim: To develop a systematic approach to detect and prevent clinical risks in complementary medicine (CM) and increase patient safety through the analysis of activities in homeopathy and acupuncture centres in the Tuscan region using a significant event audit (SEA) and failure modes and effects analysis (FMEA). Methods: SEA is the selected tool for studying adverse events (AE) and detecting the best solutions to prevent future incidents in our Regional Healthcare Service (RHS). This requires the active participation of all the actors and external experts to validate the analysis. FMEA is a proactive risk assessment tool involving the selection of the clinical process, the input of a multidisciplinary group of experts, description of the process, identification of the failure modes (FMs) for each step, estimates of the frequency, severity, and detectability of FMs, calculation of the risk priority number (RPN), and prioritized improvement actions to prevent FMs. Results: In homeopathy, the greatest risk depends on the decision to switch from allopathic to homeopathic therapy. In acupuncture, major problems can arise, mainly from delayed treatment and from the modalities of needle insertion. Conclusions: The combination of SEA and FMEA can reveal potential risks for patients and suggest actions for safer and more reliable services in CM.

Attitudes Underlying Reliance on Complementary and Alternative Medicine

“…In such situations, intervention is warranted to prevent needless incidents and mortality, and such intervention requires a thorough understanding of the determinants of dysfunctional CAM use. [17][18][19] The Cochrane Collaboration defines CAM as [a] broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health systems of a particular society or culture in a given historical period. 20 This definition acknowledges that CAM is not restricted to a specific service or product but encompasses a set of beliefs concerning health and illness as well, which may vary considerably among modalities, yet represent important factors in their use.…”

Use of Homeopathy in Integrative Oncology in Strasbourg, France: Multi-center Cross-Sectional Descriptive Study of Patients Undergoing Cancer Treatment

“…On the contrary, a recent study performed in Tuscany suggests that homeopathy, by attenuating side effects, makes it possible to improve adherence to oncological treatment and facilitates compliance. 19 Increasingly, the patients inform the doctor and oncologist of their using homeopathy treatment (87 and 82%, respectively), reflecting an improvement in communication and trust in the doctor-patient relationship. It is interesting to note that in 74.5% of the cases homeopathy was prescribed by doctors, a guarantee of supervision and safety.…”

Simulation: A Training Resource for Quality Care and Improving Patient Safety

“…The feedback loops are not in place; there is no testing of protocols; there is a lack of both guidelines for checking any of the above and reflection times for decision-making, which in our region are also part of a very hierarchical and compartmentalized cultural issue. All of this is known as the human factor, meaning the integration between the organization, work itself, and staff, which has been studied deeply by sociologists and ergonomists [34]. It is still today a subject that is rarely discussed by administrative staff and the managers of clinical institutions and integrated into the programs and curriculum of healthcare careers in most countries of the world.…”