Pratique chirurgicale et sécurité du patient à l'hôpital régional et à l'hôpital protestant de Ngaoundéré

Introduction. La check-list (CL) a montré son efficacité pour réduire les complications chirurgicales dans plusieurs pays du monde où elle a été implémentée. Notre travail avait pour but d'étudier sa valeur à Ngaoundere et l'intérêt de son implémentation dans nos hôpitaux. Son objectif était d'identifier à l'aide de la CL les moyens de prévention et/ou de gestions des erreurs indésirables dans le cadre de la sécurité chirurgicale des patients. Matériels et méthodes. Nous avons mené une enquête descriptive rétrospective et prospective, en utilisant un questionnaire de type audit CL. Les paramètres évalués étaient les moyens de prévention utilisés, le type d'erreurs ou d'événement indésirable grave (EIG) observés et les raisons à l'origine de ces EIG dans un gran hôpital public de Ngaoundere et dans un grand hôpital privé de Ngaoundere. Résultats. 38 personnels ont participé à l'étude. 28,95% de ces personnels utilisaient comme moyen de prévention « la dénonciation » et 57,89% des personnels « l'archivage ». Le personnel a déclaré comme principaux EIG: les effets néfastes de l'administration des drogues, les hémorragies postopératoires, les pertes de fonction respiratoire, les infections postopératoires, et les allergies. Les principales raisons à l'origine de ces EIG étaient comme la communication défectueuse (67,47%), le manque d'outil de surveillance (25,52%) et la fatigue (12,38%). Conclusion. L'examen du type d'EIG et des raisons à l'origine de ces EIG laisse penser que la check-list opératoire, par sa facilitation de la standardisation du travail d'équipe peut améliorer la sécurité du patient chirurgical à Ngaoundere

Identifying medication errors in the neonatal intensive care unit and paediatric wards using a medication error checklist at a tertiary academic hospital in Gauteng, South Africa

Background. Paediatric patients are particularly prone to medication errors as they are classified as the most fragile population in ahospital setting. Paediatric medication errors in the South African healthcare setting are comparatively understudied.Objectives. To determine the incidence of medication errors in neonatal and paediatric inpatients, investigate the origin of medicationerrors that occurred and describe and categorise the types of medication errors made in both the neonatal intensive care unit (NICU) andpaediatric wards.Methods. The study followed a prospective, quantitative design with a descriptive approach. A prospective record review of inpatients'medication charts was undertaken to determine what was prescribed by the physician, dispensed by the pharmacy and administered bythe nurses. The researcher also directly observed the preparation and administration techniques as performed by the nurses. A medicationerror checklist was used to collect the data.Results. A total of 663 medication errors were detected in 227 patients over the study period of 16 weeks, of which 177 (78%) patients hadone or more error(s). There were 338 (51%) administration errors and 309 (47%) prescribing errors. Incorrect dosing was the most frequenttype of error (34%), followed by omission of medication (18.5%) and medication given at the incorrect time (12%). The causes of thesemedication errors were mostly due to miscalculation (26%), failure to monitor (15%) and procedures not followed (15%). Anti-infectives(43%) and analgesics (25%) had the most errors.In 118 (67%) patients the errors resulted in no harm to the patient, whereas in 59 (33%)patients the medication error resulted in some level of harm.Conclusion. The incidence of medication errors in the NICU and paediatric wards at the teaching hospital was higher than values reportedelsewhere globally. Most errors occur during prescribing and administration of medication. Dosing errors are a common problem inpaediatrics. Therefore, a formalised system to record these errors should be introduced alongside regular discussions on preventivemeasures among the multidisciplinary team

The impact of a modified World Health Organization surgical safety checklist on maternal outcomes in a South African setting: A stratified cluster-randomised controlled trial

Background. In South Africa (SA), the Saving Mothers Reports have shown an alarming increase in deaths during or after caesarean delivery.Objective. To improve maternal surgical safety in KwaZulu-Natal Province, SA, by implementing the modified World Health Organization surgical safety checklist for maternity care (MSSCL) in maternity operating theatres.Methods. The study was a stratified cluster-randomised controlled trial conducted from March to November 2013. Study sites were 18 hospitals offering maternal surgical services in the public health sector. Patients requiring maternal surgical intervention at the study sites were included. Pre-intervention surgical outcomes were assessed. Training of healthcare personnel took place over 1 month, after which the MSSCL was implemented. Post-intervention surgical outcomes were assessed and compared with the pre-intervention findings and the control arm. The main outcome measure was the mean incidence rate ratios (IRRs) of adverse incidents associated with surgery.Results. Significant improvements in the adverse incident rate per 1 000 procedures occurred with combined outcomes (IRR 0.805, 95% confidence interval (CI) 0.706 - 0.917), postoperative sepsis (IRR 0.619, 95% CI 0.451 - 0.849), referral to higher levels of care (IRR 1.409, 95% CI 1.066 - 1.862) and unscheduled return to the operating theatre (IRR 0.719, 95% CI 0.574 - 0.899) in the intervention arm. Subgroup analysis based on the quality of implementation demonstrated greater reductions in maternal mortality in hospitals that were good implementers of the MSSCL.Conclusions. Incorporation of the MSSCL into routine surgical practice has now been recommended for all public sector hospitals in SA, and emphasis should be placed on improving the quality of implementation

A meta-analysis of the efficacy of preoperative surgical safety checklists to improve perioperative outcomes

BACKGROUND:Meta-analyses of the implementation of a surgical safety checklist (SSC) in observational studies have shown a significant decrease in mortality and surgical complications.OBJECTIVE:To determine the efficacy of the SSC using data from randomised controlled trials (RCTs). METHODS:This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (CRD42015017546). A comprehensive search of six databases was conducted using the OvidSP search engine.RESULTS:Four hundred and sixty-four citations revealed three eligible trials conducted in tertiary hospitals and a community hospital; with a total of 6 060 patients. All trials had allocation concealment bias and a lack of blinding of participants and personnel. A single trial that contributed 5 295 of the 6 060 patients to the meta-analysis had no detection; attrition or reporting biases. The SSC was associated with significantly decreased mortality (risk ratio (RR) 0.59; 95% confidence interval (CI) 0.42 - 0.85; p=0.0004; I2=0%) and surgical complications (RR 0.64; 95% CI 0.57 - 0.71; petlt;0.00001; I2=0%). The efficacy of the SSC on specific surgical complications was as follows: respiratory complications RR 0.59; 95% CI 0.21 - 1.70; p=0.33; cardiac complications RR 0.74; 95% CI 0.28 - 1.95; p=0.54; infectious complications RR 0.61; 95% CI 0.29 - 1.27; p=0.18; and perioperative bleeding RR 0.36; 95% CI 0.23 - 0.56; petlt;0.00001.CONCLUSIONS:There is sufficient RCT evidence to suggest that SSCs decrease hospital mortality and surgical outcomes in tertiary and community hospitals. However; randomised evidence of the efficacy of the SSC at rural hospital level is absent

Systems-based Quality Improvement as a Tool to Implement the Surgical Safety Checklist in Rwanda

Objective: Effective strategies for implementation of the World Health Organization's Surgical Safety Checklist (SSCL) are not well characterized in resource-limited settings. Our objective was to utilize a systems-based quality improvement (QI) approach to initially implement a single; high-priority item from the SSCL. Setting: Butaro Hospital; a rural district hospital in northern Rwanda. Methods: A surgical service QI team was formed and trained with support of local leadership and expatriate staff trained in QI methodology. The team identified perioperative antibiotic administration as the first SSCL area for improvement. Baseline performance was measured by sampled chart review of Cesarean sections. Using systems-based QI methods and the Model for Improvement; a protocol for choice and timing of perioperative antibiotics was identified as the necessary intervention; developed; and then implemented. The impact on performance and spread of QI was measured. Results: At baseline; only 5.2 of Cesarean section patients received both correct choice and timing of a prophylactic antibiotic agent. After development of the protocol; appropriate choice and timing of antibiotic was observed in 61.7 of cases (p 0.001). This initial QI initiative stimulated additional projects to implement other components of the SSCL and to improve quality of surgical and anesthetic care. Conclusions: Implementing one component of the SSCL using QI methodology focused on stakeholder engagement; measurement; and team-based development of iterative systems of improvements facilitated a cultural change at Butaro Hospital. Training and support in QI methods can create an environment in which the SSCL and other efforts for quality in surgical and anesthetic care can be more readily implemented

Surgical Research; Surgical Audit and Safe Surgery

N. A.

Development and Use of Checklists for Assessment of Medical Students in Clinical Examinations on Real Patients: A Preliminary Study

Background Clinical performance examinations (CPE) are important methods for assessing medical students and postgraduate medical trainees. Unfortunately; assessment (scoring) in these exams as it is practiced in most medical schools is based mainly on the general impression and level of experience of the examiner. Hence; it has the disadvantage of being non-structured; subjective; and sometimes highly biased. The objective of this study was to develop objective structured tools (checklists); use them in the clinical examination; and to compare their scores to those given by the conventional way. Methods Case-specific checklists were developed for some common long and short clinical examination cases. These were tried in the final undergraduate surgery exam at Alazhari University; August 2008. Scores (marks) given to the same student; using the conventional and the checklist systems were compared using the chi square and correlation statistics. Questionnaires were filled by the examiners after using the checklists. Results Checklist and conventional scores were strongly correlated in the long case exams. A significant difference between the scores was; however; noted in the short case exams. Care should be taken in interpretation because of the small number of data. Evaluators felt that the checklist system was more objective and structured and hence fairer than the conventional method. Although checklist final scores took a bit longer time to calculate; that was not significant practically. examiners gave valuable feedback regarding the construction and the use of checklists. Conclusion The use of checklists in the clinical examination was more objective; more structured; and more accurate than the conventional method. The development of checklists requires hard team work and frequent updating and use to develop experience. We propose using checklists as alternative tools of assessment with many advantages over the conventional method; and to prepare the examination culture to adopt the OSCE