Antibiotic consumption history of patients in a referred laboratory in Yaounde

Background. Regulation of antibiotic prescription and consumption remain a major public health burden in low- and middle-income country. This study aimed to describe the antibiotic consumption of patients who had a positive antibiotic culture in a reference laboratory. Methods. A retrospective descriptive study was conducted among 113 participants with positive antibiogram with a documented history of antibiotics intake at the Yaoundé University Teaching Hospital (YUTH) in Cameroon between January 2016 to June 2021. Data were stored and analyzed using the Census and Survey Processing System (CSPro) version 7.3 and Statistical Package for Social Science (SPSS) version 25.0. Descriptive statistic was used to estimate the indicators. Results. Of the 113 patients enrolled, 105 had a history of drug use; 56 participants (53, 3%) had taken at least 2 antibiotics prior to sampling. Cephalosporins were the most consumed antibiotics (41, 0%), followed by nitroimidazols (28, 6%) and penicillins (28,6%). According to the WHO classification, 55 (52, 4%) took the major priority antibiotics. Conclusion. We are on the alert and there is an urging need to raise awareness among clinicians and patients alike by providing them with good clinical practice guidelines.

Patient safety culture at the unit level of a tertiary hospital in South Africa: a survey study

Background. Patient safety research is scarce in developing countries. Estimates of patient harm due to healthcare processes in resource-poor settings are thought to be greater than those in developed countries. Ideally, errors in healthcare should be seen as opportunities to improve the future quality of care. Objective. This study aimed to investigate patient safety culture within high-risk units of a tertiary hospital in South Africa. Methods. A quantitative, descriptive, cross-sectional methodology, using a survey questionnaire that measured 10 safety dimensions and one outcome measure among clinical and nursing staff, was employed. Results. Two hundred participants completed the survey questionnaire. Areas of strength identified by the participants included organizational learning (91.09%), staff attitudes (88.83%), and perceptions of patient safety (76.65%). Dimensions that have potential for improvement included awareness and training (74.04%), litigation (73.53%), feedback and communication about errors (70.77%), non-punitive response to error reporting (51.01%), size and tertiary level of the hospital (53.76%), and infrastructure and resources (58.07%). The only dimension identified as weak was teamwork and staffing (43.72%). In terms of the patient safety grade, respondents graded their own units highly but graded the hospital as a whole as having a poor patient safety grade. Conclusion. There are still significant gaps in the quality of care provided at this tertiary hospital. The current patient safety culture is perceived as punitive in nature with regard to reporting adverse events. It is advised that targeted patient safety improvements be made, followed by further investigation

Qualitative Analysis of One Primary Health Care per Ward in Ekiti State, Nigeria

The "One Primary Health Care (PHC) per Ward" policy is an important health care component for achieving health for all. This study assesses the functionality, successes and challenges in the implementation of 'one PHC per ward' policy in Ekiti State, Nigeria. In-depth and key informant interview guides serve as qualitative research instruments for data collection. Relevant information was sourced from different stakeholders, including the Executives of the State Primary Health Care Development Agency (SPHCDA), the Local Government Chairmen, the Heads of Departments in PHCs, Staff of PHCs and patients who visited PHC facilities, amounting to twenty-five in-depth and seven key informant interviews. Although all the wards assessed had at least one PHC facility, none of the PHC facilities visited met the minimum standards recommended by the National Primary Health Care Development Agency (NPHCDA). PHC facilities located in the rural areas had fewer infrastructural and human resources than those in the urban areas. Routine immunization exercises were improved across the PHC facilities as the Universal Drug Revolving Scheme adopted by the PHCs was successful, largely because of the re-investment of both principal and profit into the purchase of drugs. Results suggest that while routine immunization as an aspect of PHC services had received remarkable successes, the PHC facilities suffered from inadequate equipment and personnel. There is need for a political will and concerted actions that are designed to improve PHC facilities if PHCs are to realize the objectives for setting them up.

Analysis of patient safety incident reporting system as an indicator of quality nursing in critical care units in KwaZulu-Natal, South Africa

Background: Patient Safety Incidents occur frequently in critical care units, contribute to patient harm, compromise quality of patient care and increase healthcare costs. It is essential that Patient Safety Incidents in critical care units are continually measured to plan for quality improvement interventions.Aim: To analyse Patient Safety Incident reporting system, including the evidence of types, frequencies, and patient outcomes of reported incidents in critical care units.Setting: The study was conducted in the critical care units of ten hospitals of eThekwini district, in KwaZulu-Natal, South Africa.Methods: A quantitative approach using a descriptive cross sectional survey was adopted to collect data from the registered nurses working in critical care units of randomly selected hospitals. Self-administered questionnaires were distributed to 270 registered nurses of which 224 (83%) returned completed questionnaires. A descriptive statistical analysis was initially conducted, then the Pearson Chi-square test was performed between the participating hospitals.Findings: One thousand and seventeen (n = 1017) incidents in ten hospitals were self-reported. Of these incidents, 18% (n = 70) were insignificant, 35% (n = 90) minor, 25% (n = 75) moderate, 12% (n = 32) major and 10% (n = 26) catastrophic. Patient Safety Incidents were classified into six categories: (a) Hospital-related incidents (42% [n = 416]); (b) Patient care-related incidents (30% [n = 310]); (c) (Death 12% [n = 124]); (d) Medication-related incidents, (7% [n = 75]); (e) Blood product-related incidents (5% [n = 51]) and (f) Procedure-related incidents (4% [n = 41]).Conclusion: This study's findings indicating 1017 Patient Safety Incidents of predominantly serious nature, (47% considering moderate, major and catastrophic) are a cause for concern

Identifying quality indicators for prehospital emergency care services in the low to middle income setting: The South African perspective

Introduction : Historically, performance within the Prehospital Emergency Care (PEC) setting has been assessed primarily based on response times. While easy to measure and valued by the public, overall, response time targets are a poor predictor of quality of care and clinical outcomes. Over the last two decades however, significant progress has been made towards improving the assessment of PEC performance, largely in the form of the development of PEC-specific quality indicators (QIs). Despite this progress, there has been little to no development of similar systems within the low- to middle-income country setting. As a result, the aim of this study was to identify a set of QIs appropriate for use in the South African PEC setting. Methods : A three-round modified online Delphi study design was conducted to identify, refine and review a list of QIs for potential use in the South African PEC setting. Operational definitions, data components and criteria for use were developed for 210 QIs for inclusion into the study. Results : In total, 104 QIs reached consensus agreement including, 90 clinical QIs, across 15 subcategories, and 14 non-clinical QIs across two subcategories. Amongst the clinical category, airway management (n = 13 QIs; 14%); out-of-hospital cardiac arrest (n = 13 QIs; 14%); and acute coronary syndromes (n = 11 QIs; 12%) made up the majority. Within the non-clinical category, adverse events made up the significant majority with nine QIs (64%). Conclusion : Within the South Africa setting, there are a multitude of QIs that are relevant and appropriate for use in PEC. This was evident in the number, variety and type of QIs reaching consensus agreement in our study. Furthermore, both the methodology employed, and findings of this study may be used to inform the development of PEC specific QIs within other LMIC settings

Factors affecting patient safety: a qualitative content analysis

Background: Patient safety is one of the main components of good-quality health services. The main objective of this study is to explore the most effective factors relating to patient safety in Iran. Methods: This qualitative study was done using content analysis. Data were collected using semi-structured interviews. Through purposive sampling, 14 participants were selected by experts who were familiar with the patient safety friendly hospital program. Interviews were recorded and then analyzed by framework analysis using MAXQDA software. Results: Of 2,474 initial codes, 10 main themes and 53 sub-themes were identified, including importance of human resources; organization and management; interactions and teamwork; medication; equipment and physical environment; patient-related factors; patient safety and quality improvement; the importance of documentation; assessment and monitoring; medical errors; barriers and challenges. Conclusion: Factors affecting patient safety can be divided into two groups: facilitators and barriers. Hospitals can improve the implementation of patient safety standards, reduce the adverse events and enhance patient safety by strengthening facilitating factors, such as providing human resources, adequate medical equipment and facilities, increasing employee participation in quality improvement programs, improving staff training, communicating with patients and their families, and addressing the existing challenges and barriers

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

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

Évaluation des connaissances des praticiens sur la radioprotection des patients au Burkina Faso

Objectif : Évaluer les connaissances des praticiens sur la radioprotection des patients au Burkina Faso.Méthodes : Étude descriptive transversale multisites du 1er mars au 31 mai 2015 dans trois structures sanitaires auprès des prescripteurs chez qui un questionnaire comportant plusieurs items en rapport avec les connaissances sur la radioprotection a été administré.Résultats : Le questionnaire a été soumis à 164 médecins : 123 (75%) ont accepté de le remplir ; 82,9% prenaient en compte le rapport bénéfice-risque ; 60% informaient le patient sur les risques des rayonnements ionisants ; 26,9% avaient une bonne connaissance sur les objectifs de la radioprotection et 17,9% sur les principes de la radioprotection ; 83,7% étaient informée de l'existence du risque de cancer radio-induit ; 80% reconnaissaient l'exposition médicale comme source d'irradiation et 36,6% considéraient l'IRM comme une technique irradiante. Conclusion : Notre étude a montré une faible connaissance des principes, des objectifs de la radioprotection par les praticiens bien que l'existence du risque de cancer radio-induit lors de la réalisation de certains examens radiologiques n'était pas ignorée