ASSESSMENT ON THE EFFECTIVENESS OF THE SURGICAL SAFETY CHECKLIST IN CORRECTING MEDICAL ERRORS: A CASE STUDY OF GENERAL HOSPITAL KUBWA, ABJUA

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Worldwide, the safety of patients undergoing surgical procedures is a critical aspect of healthcare, with surgical errors being a major source of patient morbidity and mortality. In developed nations, studies have shown that medical errors, particularly in surgery, contribute substantially to patient morbidity and mortality. A study conducted by Makary and Daniel (2016) revealed that medical errors were the third leading cause of death in the United States, with surgical errors accounting for a large proportion of these cases. Surgical morbidity, including infections, bleeding, and complications from anesthesia, remains a prevalent issue, despite advances in technology and safety protocols (Weiser 2018). In Europe, the WHO estimates that up to 15% of hospitalized patients experience adverse events related to surgery, with surgical errors being a primary cause (WHO, 2019).

In Nigeria, the prevalence of surgical morbidity due to medical errors is significantly higher, largely due to systemic healthcare challenges such as inadequate staffing, poor infrastructure, and lack of adherence to safety protocols. Research indicates that many Nigerian hospitals face difficulties in implementing basic surgical safety measures, including the use of the WHO Surgical Safety Checklist (Okeke & Adewale, 2019). A study by Afolabi et al. (2017) found that surgical errors accounted for a significant proportion of post-operative complications in Nigerian hospitals, often resulting in extended hospital stays or death. These issues are exacerbated by poor reporting systems for medical errors and limited resources for training healthcare professionals on error prevention strategies. Even though surgical errors are preventable, yet they continue to contribute significantly to adverse outcomes in both developed and developing countries.

Apparently, in response to this global issue, the World Health Organization (WHO) introduced the Surgical Safety Checklist in 2008 as part of its "Safe Surgery Saves Lives" campaign to improve surgical safety outcomes and reduce the incidence of avoidable harm (WHO, 2009). This checklist has been widely adopted in various healthcare settings and has shown remarkable success in reducing surgical complications and mortality rates. According to Haynes & Nazi 2019), the Surgical Safety Checklist is a simple, standardized tool designed to ensure that critical safety steps are followed before, during, and after surgical procedures. It includes essential checks related to patient identity, the correct surgical site, and post-operative care protocols, among others. Studies by Leape, (2021) have demonstrated that the use of the checklist not only reduces errors but also improves communication and teamwork among surgical teams, leading to better outcomes. The checklist serves as a reminder for healthcare professionals to verify all important aspects of the surgery, thus minimizing human errors and enhancing patient safety. 

Similarly, Gawande, 2020 argued that the implementation of mandatory error reporting systems has been crucial in reducing medical errors and promoting patient surgical safety. This is because error reporting systems offer a mechanism for capturing and analyzing mistakes, thereby fostering a culture of transparency and continuous improvement in healthcare settings. However, Pronovost (2018) on the other hand argued that, it is not enough for guidelines to be implemented but the effectiveness of these systems largely depends on the willingness of healthcare providers to report errors, the existence of non-punitive reporting environments, and the institution’s commitment to analyzing and addressing reported errors.

1.2 Statement of the Problem

In recent times, medical errors during surgical procedures are a major concern in healthcare delivery globally, and Nigeria is no exception. Cursorily, the importance of understanding the effectiveness of the Surgical Safety Checklist in correcting medical errors cannot be overstated. Medical errors during surgery can lead to long-term disability or death, significantly affecting the quality of life of patients. In a resource-constrained environment like Nigeria, where healthcare systems are often overburdened and underfunded, it is crucial to assess whether the introduction of the checklist has led to measurable improvements in surgical safety. 

In Nigeria, the adoption of the Surgical Safety Checklist has gained traction in recent years, especially in tertiary hospitals. However, the extent of its effectiveness in reducing medical errors and improving surgical outcomes remains under-researched. The General Hospital Kubwa in Abuja is one such institution where the checklist has been implemented as part of its surgical safety protocols Existing literature supports the positive impact of the Surgical Safety Checklist on surgical outcomes in various healthcare settings around the world. For instance, a study by Weiser et al. (2010) found that hospitals that implemented the checklist saw a significant reduction in post-operative complications and mortality rates. Another study by Treadwell et al. (2014) reported that the checklist improved communication among surgical teams, leading to more coordinated and efficient surgical procedures. However, despite these successes, the effectiveness of the checklist in resource-limited settings like Nigeria has not been thoroughly explored, particularly in public hospitals such as the General Hospital Kubwa.

A study by Okeke and Adewale (2019) highlighted that while some Nigerian hospitals have adopted the checklist, its consistent and proper use remains a challenge due to factors such as staff resistance, lack of training, and insufficient resources. These challenges hinder the full potential of the checklist in reducing errors and improving patient outcomes. Similarly, Ogunsola (2021) opined that for low-resource settings like Nigeria, where healthcare infrastructure is limited, and adherence to safety protocols is often inconsistent surgical errors often go underreported or inadequately addressed This gap in the literature underscores the need for a focused investigation into the effectiveness of the checklist in reducing surgical errors at General Hospital Kubwa, Abuja. 

1.3 Objectives of the Study

The objective of this study is focused on assessment on the effectiveness of the surgical safety checklist in correcting medical errors: a case study of General Hospital Kubwa, Abuja. Specifically, the study seeks to:

assess the Surgical Safety Checklist aimed reducing surgical errors at General Hospital Kubwa, Abuja.

identify the challenges faced in the implementation of the checklist at General Hospital Kubwa.

determine the effectiveness of using Surgical Safety Checklist on improvement surgical outcomes.

examine the strategies can be implored to enhance implementation and utilization of Surgical Safety Checklist in General Hospital Kubwa?

Research Questions

What are the Surgical Safety Checklist aimed reducing surgical errors at General Hospital Kubwa, Abuja?

How effective is the use of Surgical Safety Checklist on improvement of surgical outcomes?

What are the challenges in implementing the checklist at General Hospital Kubwa?

What strategies can be implored to enhance implentatation and utilization of Surgical Safety Checklist in General Hospital Kubwa?

Research Hypotheses

Ho: The effective use of the Surgical Safety Checklist significantly does not reduce surgical errors and improves patient outcomes at General Hospital Kubwa, Abuja.

Hi: The effective use of the Surgical Safety Checklist significantly reduces surgical errors and improves patient outcomes at General Hospital Kubwa, Abuja.

1.6 Significance of the Study

 From a practical perspective, findings of the study will provide valuable insights into the effectiveness of the Surgical Safety Checklist in correcting medical errors to medical personnel in the case study (aGeneral Hospital Kubwa) and every other public hospitals in Abuja. The findings of this study will be beneficial to hospital administrators, policymakers, and healthcare practitioners in Nigeria as they seek to improve patient safety and reduce medical errors in surgical settings. The study will also provide recommendations for addressing the challenges encountered in implementing the checklist, thus contributing to the development of more effective safety protocols in the country’s healthcare system.

From a theoretical perspective, this study will contribute to the existing body of knowledge on surgical safety and error prevention in healthcare settings. By focusing on a Nigerian hospital, the study will provide a contextualized understanding of the challenges and benefits of using the Surgical Safety Checklist in a resource-limited setting. The research findings will also serve as a reference researchers and scholars  who wishes to conduct a research on the same topic and point for future studies on patient safety in similar healthcare environments, particularly in developing countries.

1.7 Scope of the Study

This study focuses on the effectiveness of the Surgical Safety Checklist in reducing medical errors at General Hospital Kubwa, Abuja. The content scope includes an examination of the checklist's impact on surgical outcomes, the challenges faced in its implementation and strategies to be adopted for possible improvment. The geographical scope is limited to General Hospital Kubwa, Abuja, a major public healthcare institution in Nigeria.

1.8 Limitations of the Study

Like it is with academic endeavor, one limitation of this study is the potential for incomplete or biased data from healthcare professionals, who may be reluctant to disclose errors or challenges related to the use of the checklist due to fear of repercussions. Additionally, the study is limited to a single institution, which may not fully represent the experiences of other hospitals in Nigeria. Another limitation is the potential lack of access to comprehensive hospital records, which may affect the accuracy of the data collected on surgical errors and outcomes.

Furthermore, the study is subject to limitations related to resource constraints in Nigeria's public healthcare system, such as inadequate staffing, lack of training, and inconsistent adherence to safety protocols. These factors may influence the effectiveness of the checklist and limit the generalizability of the study's findings to other hospitals with different levels of resources.

1.9 Definition of Terms

Surgical Safety Checklist: A standardized tool developed by the WHO to ensure that critical safety steps are followed before, during, and after surgical procedures to prevent medical errors.

Medical Error: A preventable adverse event or near miss that occurs during healthcare delivery, leading to patient harm or the potential for harm.

Patient Safety: The prevention of harm to patients during the delivery of healthcare, including efforts to reduce the risk of medical errors and adverse events.

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