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

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.