The story so far: Former British nurse Lucy Letby was sentenced to life in prison earlier this week after being found guilty in the worst child serial killer case in the history of the U.K. Letby was convicted of murdering seven babies and trying to kill six others while working at the Countess of Chester Hospital between June 2015 and June 2016. She was first arrested in 2018. Letby killed infants by injecting them with air, others were force-fed milk and two were poisoned with insulin, court documents said as per news reports.
What are patient safety provisions in India?
Patient safety is a fundamental element of public healthcare and is defined as the freedom for a patient from unnecessary harm or potential harm associated with provision of healthcare, as per the Union Health Ministry document titled, ‘National Patient Safety Implementation Framework (2018-2025).’
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Patients in India are protected under multiple layers of law that are largely fragmented. The first idea of patient safety is enshrined in the Hippocratic Oath itself. Additionally, the Consumer Protection Act deals with medical negligence and deficiency of services; legal rights of the patients are set out in the Clinical Establishment Act, and the National Pharmaceutical Pricing Authority and Drugs Controller General of India have mechanisms to see that patients’ rights in terms of medication and devices are protected and that they are not overcharged, among other things.
How is neonatal safety maintained?
While there are no exclusive rules for neonatal care and safety, or protection against external harm in Indian hospitals, there are provisions and checks against issues like inadvertent mix-up of babies at birth and abduction. Dr. Ramesh Agarwal, professor in-charge of neonatal services in the paediatrics department of the All India Institute of Medical Sciences, New Delhi, says events where deliberate harm to patients is caused by care providers is extremely rare. “Such instances may involve people with complex psychiatric illnesses,” he points out.
He adds that in a country where 2.6 crore children are born annually, there could be human errors in terms of care, and lapses, but planned, deliberate harm is a rare occurrence. Healthcare systems are geared to prevent, detect, and manage human and operational errors, though the efficiency may vary, he explains.
There are a set of comprehensive provisions for the safety and wellbeing of neonates or newborn babies to minimise potential risks, says Dr. Sumit Chakravarty, senior consultant, Paediatrics and Neonatology, and head, NICU, Asian Hospital, Faridabad. The healthcare staff is also trained to counsel parents and provide emotional support, contributing to the safety and development of neonates.
He explains that adequate staffing ensures that trained healthcare providers can closely monitor each baby’s condition and respond swiftly to any concerns. “Proper equipment for respiratory support, temperature regulation, and monitoring vital signs are readily available. Neonates are typically kept in controlled environments to avoid exposure to external infections and temperature fluctuations. Parental involvement is encouraged but with precautions to prevent the spread of infections. Regular training and continuing medical education for healthcare staff are essential to maintain high-quality neonatal care and uphold safety standards,” he says.
What are some of the issues neonates face?
Although the global number of neonatal deaths declined from 5 million in 1990 to 2.4 million in 2019, children face the greatest risk of death in their first 28 days, according to the World Health Organization. Its data shows that in 2019, 47% of all under-five deaths occurred in the newborn period with about one third dying on the day of birth and close to three quarter dying within the first week of life.
The current infant mortality rate for India in 2023 is 26.6 deaths per 1,000 live births, a 3.89% decline from 2022. The infant mortality rate for India in 2022 was 27.6 deaths per 1,000 live births, a 3.74% decline from 2021. Children who die within the first 28 days of birth suffer from conditions and diseases associated with lack of quality care at birth or skilled care and treatment immediately after birth and in the first days of life.
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Pre-term birth, intrapartum-related complications (birth asphyxia or lack of breathing at birth), infections and birth defects cause most neonatal deaths.
Women who receive midwife-led continuity of care (MLCC) provided by professional midwives, educated, and regulated to internationals standards, are 16% less likely to lose their baby and 24% less likely to experience pre-term birth, it explained.
The global organisation has also advised families that prompt medical care should be sought in case of danger signs, including feeding problems, or if the newborn has reduced activity, difficult breathing, a fever, fits or convulsions, jaundice in the first 24 hours after birth, yellow palms and soles at any age, or if the baby feels cold. Families are also required to register the birth and bring the baby for timely vaccination, according to national schedules. “Some newborns require additional attention and care during hospitalisation and at home to minimise their health risks,” it says.