Experiences of frontline nurses with adverse medical events in a regional referral hospital in northern Ghana: a cross-sectional study

Abstract

Background Adverse medical events (AMEs) are threats to delivery of quality healthcare services, particularly in resource-poor settings such as Ghana. In sub-Saharan Africa, 30% of deaths are attributed to AMEs and a significant proportion of these events are not reported. This study explored personal experiences of nurses with AMEs and the constraints to reporting them. Methods This is a descriptive cross-sectional study among professional ( n = 133) and auxiliary ( n = 88) nurses in a regional referral hospital in northern Ghana. A test for differences in experiences of professional and auxiliary nurses was done using Wilcoxon Mann-Whitney test. Ordered logistic regression analysis (proportional odds ratio models) and probit regression were used to ascertain the determinants of staff’s knowledge on AMEs and the odds of exposure, respectively. Results Overall, knowledge and awareness level on AMEs was average (mean = 3.1 out of the five-point Likert scale of 1 = “Very poor” to 5 = “Excellent”). Knowledge levels among professional nurses (mean = 3.2) were relatively higher than those among auxiliary nurses (mean = 3.0), ( p = 0.006). The predominant type of AME experienced was wrongful documentation ( n = 144), and the least experienced type was wrong transfusion of blood and/or intravenous fluids (IVF) ( n = 40). Male staff had higher odds of experiencing medical errors relative to female staff, OR = 2.39 (95% confidence interval (CI), 1.34–4.26). Inadequate logistics was the most perceived cause of AMEs. Knowledge on types of AMEs was significantly associated with gender of the respondents, OR = 1.76 (95% CI, 1.05–2.94); moreover, male staff had higher odds of knowing AME post-exposure action than female staff, OR = 1.75 (95% CI, 1.04–2.93). Conclusion Knowledge levels of nursing staff on AMEs were generally low, and even though exposures were high they were not reported. There is the need to integrate AME modules into the pre-service and in-service training curricula for nurses to enhance their knowledge on AMEs; reporting registers for AMEs should be made available in clinical sites and staff incentives given to those who report AMEs. Lastly, protocols on AMEs should form part of the quality assurance value chain for health facilities to promote compliance.

Implementation of the policy on standard protocol for care of septic and aseptic wounds in selected public health facilities in Ghana: an analytic case study

“…Indeed, increasing years of work experience had a negative association with adherence likelihood. This observation is contrary to similar studies where years of work associated with better professional practices by nurses and other clinical personnel [12,26,32]. Perhaps, the differences in methodology, cadre of respondents and clinical settings could explain these variances in findings.…”

“…In line with findings in some of the reviewed literature, it was found that even though over two thirds of the staff demonstrated knowledge of standard policy protocols, similar to findings by [7,12,26,27], there was an incommensurate application of the knowledge in real practice of their duties.…”

“…Sadly, adherence to these policy protocols to the latter remains a mirage in many healthcare facilities, especially those owned by government. Beyond the financial, infrastructural limitations confronting many of these health facilities, several empirical studies have also pointed to wanton nonadherence to these professional guidelines on the part of clinicians, particularly nursing staff who turn to perform these clinical roles [12,26].…”

Implementation of the policy protocol for management of surgical and non-surgical wounds in selected public health facilities in Ghana: An analytic case study

“…protocols of nursing care. In line with findings in some of the reviewed literature, it was found that even though more than two thirds of the staff demonstrated knowledge of standard policy protocols, similar to previous studies [7,12,25,27], this knowledge did not translate into practice in terms of executing their duties. Alhassan et al [12] made similar observations when they discovered that even though nurses knew of the NMC policy guidelines for nasogastric tube feeding, majority of them, regrettably, did not apply this knowledge in the execution of their duties when independently observed.…”

“…Sadly, adherence to these policy protocols to the latter remains a mirage in many healthcare facilities, especially those owned by government. Beyond the financial and infrastructural limitations confronting many of these health facilities, several empirical studies have pointed to wanton nonadherence to these professional guidelines on the part of clinicians, particularly nursing staff who turn to perform more of these clinical roles [12,25]. Obs.…”