INVESTIGATION ON THE IMPACT OF CHECKLISTS AND ERROR REPORTING SYSTEMS IN ENHANCING PATIENT SAFETY IN NATIONAL HOSPITAL ABUJA

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Globally, patient safety has become a major focus in healthcare systems worldwide due to the increasing recognition of medical errors and their impact on healthcare delivery. Medical errors, which include adverse events, wrong diagnoses, and treatment mistakes, contribute significantly to morbidity and mortality rates in hospitals globally. According to Uranus & Stan (2021) medical errors are caused by personnel error and sometimes inevitable—particularly under stressful conditions. It has been demonstrated that levels of cognitive function are compromised as stress and fatigue levels increase, as is often the norm in certain complex, high-intensity fields of work. This can lead to increased errors in judgment, decreased compliance with standard procedures, and decreased proficiency. Areas such as healthcare in which safety and precision are paramount in accurate service delivery, have come to rely heavily on simple tools to aid in reducing human error. 

In response, healthcare systems have adopted various strategies aimed at reducing errors, with checklists and error reporting systems emerging as essential tools in this regard (World Health Organization, 2019). These tools are designed to streamline healthcare processes, promote transparency, and improve overall patient outcomes. Checklists, particularly in surgery and other high-risk clinical settings, have demonstrated their ability to enhance patient safety. Studies have shown that structured checklists not only reduce medical errors but also improve communication among healthcare teams. For instance, the World Health Organization (WHO) surgical safety checklist, implemented globally, has been linked to a significant reduction in postoperative complications and mortality rates (Haynes & Nazi 2019). These checklists serve as standardized protocols to ensure that healthcare providers adhere to specific steps during procedures, thereby minimizing human error. Conversely, error reporting systems complement the use of checklists by enabling healthcare professionals to document and report errors and near misses. These systems foster a culture of accountability and learning, allowing institutions to analyze errors and prevent future occurrences

In developed countries like the United States, the implementation of mandatory error reporting systems has been crucial in reducing medical errors and promoting patient safety (Leape, 2021). Checklists provide a structured approach to ensuring that healthcare professionals follow prescribed steps in medical procedures, reducing human errors (Gawande, 2020). Similarly, error reporting systems offer a mechanism for capturing and analyzing mistakes, thereby fostering a culture of transparency and continuous improvement in healthcare settings (Pronovost, 2018). However, 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.

In Nigeria, the healthcare system faces significant challenges, including underfunding, inadequate staffing, and a lack of standard safety protocols (Okeke et al., 2017). These challenges have contributed to the high rate of preventable medical errors in hospitals across the country. This has led to the adoption of patient safety practices such as checklists and error reporting systems, especially in tertiary healthcare facilities like the National Hospital Abuja.. The National Hospital Abuja, being one of the leading tertiary hospitals in the country, has initiated various patient safety protocols, including the use of checklists in surgical departments and the implementation of an internal error reporting system. The importance of implementing comprehensive safety systems cannot be overemphasized, especially as patient safety continues to be a global concern (Vincent, 2020). This study aims to investigate the impact of checklists and error reporting systems in enhancing patient safety in the National Hospital Abuja, thereby contributing to the body of knowledge on best practices for improving healthcare delivery in Nigeria.

1.2 Statement of the Problem

Patient safety is a critical issue in Nigeria's healthcare system, with medical errors posing significant risks to patients. Despite various efforts to improve healthcare delivery, Nigeria continues to grapple with high rates of adverse events in hospitals, many of which could be avoided with better safety protocols. Research by Ogundele (2018), Eze (2021) indicates that inadequate implementation of safety systems, such as checklists and error reporting mechanisms, contributes to these adverse events. For instance, a study by Olayemi and Olumide (2020) revealed that most healthcare facilities in Nigeria lack standardized safety protocols, leading to preventable errors that compromise patient safety.

At the National Hospital Abuja, the adoption of checklists and error reporting systems has been initiated as part of broader efforts to improve patient outcomes. However, there is a gap in understanding the extent to which these tools are effectively utilized and their overall impact on patient safety. Previous studies by Oguntunde (2019) focused primarily on the effectiveness of checklists in surgical settings globally but have not extensively explored their implementation in Nigerian hospitals. While error reporting systems are recognized as critical in promoting accountability, there is limited research on their effectiveness in Nigerian healthcare institutions. Additionally, the existing literature by  Afolabi & Omisore (2023) also highlights a reluctance among healthcare workers to report errors due to fear of punitive consequences. This culture of silence inhibits the effectiveness of error reporting systems and limits the opportunities for learning from mistakes. Thus, there is a need to explore how error reporting is managed in the National Hospital Abuja and the barriers healthcare workers face in utilizing these systems.

Given the above, this research seeks to fill the gap by investigating the impact of checklists and error reporting systems in enhancing patient safety in the National Hospital Abuja. The study will evaluate the current practices, challenges, and effectiveness of these tools, with the aim of proposing recommendations for improving patient safety outcomes.

1.3 Objectives of the Study

The objective of this study is focused on investigating the impact of checklists and error reporting systems in enhancing patient safety in the National Hospital Abuja. Specifically, the study seeks to: 

examine the extent of checklist usage in healthcare practices at the National Hospital Abuja.

assess the effectiveness of error reporting systems in promoting patient safety in the National Hospital Abuja.

identify the challenges faced by healthcare workers in implementing checklists and error reporting systems.

evaluate the overall impact of checklists and error reporting systems on patient outcomes at the National Hospital Abuja.

Research Questions

How extensively are checklists used in healthcare practices at the National Hospital Abuja?

How effective are error reporting systems in promoting patient safety at the National Hospital Abuja?

What challenges do healthcare workers face in implementing checklists and error reporting systems?

What is the overall impact of checklists and error reporting systems on patient outcomes at the National Hospital Abuja?

1.5 Research Hypotheses

Ho: The use of checklists and error reporting systems has not significantly enhanced patient safety at the National Hospital Abuja.

Hi: The use of checklists and error reporting systems has significantly enhanced patient safety at the National Hospital Abuja.

1.6 Significance of the Study

Practically, it will contribute to improving healthcare delivery in Nigeria by providing insights into the effectiveness of checklists and error reporting systems in enhancing patient safety. The findings of this study will be useful for healthcare policymakers, hospital administrators, and medical practitioners in Nigeria, as it will provide evidence-based recommendations for reducing medical errors and promoting a culture of safety in hospitals.

Theoretically, this study will contribute to the existing body of knowledge on patient safety in low-resource healthcare settings. By exploring the impact of checklists and error reporting systems in Nigeria, the study will fill a critical gap in the literature on patient safety interventions in developing countries. The research findings will also serve as a reference point for future studies on healthcare safety in similar contexts.

1.7 Scope of the Study

This study focuses on the impact of checklists and error reporting systems in enhancing patient safety at the National Hospital Abuja. The content scope includes an examination of how these tools are implemented, their effectiveness, and the challenges associated with their use. The geographical scope is limited to the National Hospital Abuja, a leading tertiary healthcare institution in Nigeria.

1.8 Limitations of the Study

Like it is with every academic endeavor, one of the limitations of this study is the potential for limited access to comprehensive data on medical errors and patient safety incidents, as hospitals in Nigeria often lack adequate record-keeping practices. Another limitation is the potential reluctance of healthcare professionals to openly discuss errors or challenges related to the implementation of checklists and error reporting systems due to fear of reprisal or legal consequences.

Additionally, the study will be limited by its focus on a single institution, the National Hospital Abuja. While the hospital is one of the leading healthcare institutions in Nigeria, its practices may not be fully representative of other hospitals in the country. Nevertheless, the findings from this case study can provide valuable insights into broader trends in patient safety interventions in Nigeria.

1.9 Definition of Terms

Checklist: A structured tool used by healthcare professionals to ensure that essential safety procedures and steps are followed during medical treatment or surgery.

Error Reporting System: A formal mechanism for healthcare professionals to report medical errors and near misses, with the aim of identifying trends and preventing future errors.

Patient Safety: The prevention of errors and adverse effects to patients associated with healthcare, and the promotion of measures that protect patients from harm.

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