Online Program

Adherence to universal protocol in developing nations: A west African study

Tuesday, November 5, 2013

Christina Hsu, University of Central Florida College of Medicine, Orlando, FL
Nader Moinfar, MD, MPH, University of Central Florida School of Medicine, Magruder Eye Institute, Orlando, FL
Introduction: Preventable surgical errors remain a global public health burden. Ophthalmology is associated with a high incidence of adverse events and relatively low adherence to preoperative site markings. In economically developed nations, noncompliance among ophthalmologists with surgical site markings has been reported to be only 50%, with poor adherence to preoperative checklist protocol as the most frequent contributing factor. Global rates and impact of wrong site surgery are largely unknown. Materials and Methods: A 7 question online survey was implemented to forty-six Ghanaian ophthalmologists, regarding their familiarity with and implementation of the Universal Protocol. Most common surgical and medical errors, in addition to largest contributing factors to errors were also assessed. Results: Although half of the Ghanaian ophthalmologists surveyed indicated familiarity with the Universal Protocol, 100% of the ophthalmologists stated that the Universal Protocol was not implemented before each surgery. The most frequent surgical and medical errors encountered dealt with wrong site surgery, with errors regarding nerve blocking, administering medicines, and lens implants. Time constraints (75%), the poor physician/patient ratio (50%), language/dialect barrier (50%), and scarcity of equipment and co-morbidities significantly contributed to medical and surgical errors. Monitoring for medical errors or adverse events in rural patients after surgery was professed to be difficult. Conclusion: Use of the WHO's Universal Protocol is proven effective interventional strategy in reducing surgical errors. The application of this strategy, however, appears widely disparate among different practice settings, and may be associated with the level of a nation's economic development and healthcare infrastructure.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Occupational health and safety

Learning Objectives:
Analyze the attitudes and preferences of West African ophthalmologists with regards to adherence to the WHO’s wrong-site surgery Universal Protocol Formulate novel conceptual frameworks and interventional strategies that can prevent surgical errors and increase adherence to the Universal Protocol in such developing economies. Identify proposed conceptual frameworks and interventional strategies in addressing the public health burden of preventable ophthalmological errors in developing economies.

Keyword(s): Safety, Vision Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conducted the study and am knowledgeable about its content. I am also supervised by a retinal surgeon, who is my co-author.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4276.1: Vision and eye health