Advocating for safer surgery and Patient safety in Zambia

Health incidences that require surgical intervention continue to increase around the world and Zambia is no exception.

 In most cases, surgery is the only option if permanent disabilities and risk of death could be avoided or reduced. Conditions that require surgical intervention such as cancers, cardiovascular diseases, congenital defects and traumatic injuries especially due to accidents especially traffic and industrial are ever-increasing putting more pressure on the country’s already burdened surgical theatres.

 The modern medical environment has seen many advances that have greatly benefited the surgical environment worldwide. However, research shows that although surgical procedures are intended to save lives, substantial harm can occur due to unsafe surgical care. Secondary Infections and even death have resulted from technical and human error in the operating theatre due to unsafe surgical practices that include wrong surgical site, retained surgical instruments inside patient’s cavities, wrong patient identification, and poor workmanship due to faulty or inadequate equipment.

The World Health Organisation (WHO) has observed that many deaths and complications that take place in the operating theatre are avoidable, placing surgical safety as a significant global public health concern.           

Various attempts have been made to address surgical safety globally. In 2008, WHO launched a second Global Patient Safety Challenge, ‘Safe Surgery Saves Lives’ in an effort to improve the safety of surgical care around the world. As part of this initiative the Surgical Safety Checklist was developed that could be applied in all WHO Member States.

 In Zambia, the Zambia Union of Nurses Organisation (ZUNO) working through its Interest Group, The   Zambia Operating Theatre Nursing Interest Group ( ZOTNIG)  in collaboration with the Royal College of Nursing (RCN)  from the United Kingdom is piloting the ‘Safe Surgery Saves Lives’ initiative .

The objective of the initiative is to shape policy and practice related to operating theatres working co-operatively with other professional associations and hospitals.   

The program focuses on the WHO Safe Surgery Checklist which identifies the five steps of surgical safety for any operation, aimed to adapt and practically implement the global safety standards. The Checklist does not prescribe a single approach but merely provides key elements are incorporated into the operating room routine.

Encouraging team work in the operating theatre at
Kabwe General Hospital in Central Province of Zambia©ZUNO

The five Steps to improve communication and teamwork must be completed for every patient undergoing a surgical procedure, including local anaesthesia in so doing reduce the potential for error or patient harm.

By engaging with the 5 Steps which are;

 1. Briefing 2. Sign In 3. Time Out 4. Sign Out and 5. Debriefing, one will identify glitches (system /process flaws and problems). These are recorded and trends identified over time enabling revision of practises and procedures through negotiation for improvement at the team level.

 

The program is being piloted in Lusaka and Kabwe at University Teaching Hospital, Kabwe General Hospital and Kabwe Mine Hospital after which an evaluation will be done before rolling it out to the rest of country.  Training has been conducted at the hospitals implementing the initiative covering a total of 278 members of the surgical teams.

ZUNO is using the initiative as a tool for advocacy for safer surgery and patient safety in Zambia. ZUNO and RCN working with other partners are investigating best ways to adapt and make it work for the country’s surgical environment. 

     The program will further support the empowerment of nurses to lead and influence change at different levels in health institutions and promote good practice.

Surgery is an essential component of health care and involves considerable planning and coordination.     Owing to the nature and volume of cases staff in operating theatres handle, it is without a doubt a stressful place to work. The means clinicians and other care teams need to work together by building strong team work and communicate effectively.

This demands that teams in the operating theatres depend on one another. Support is therefore required from policy makers and other coopering partners to ensure hospitals carrying out surgical care are equipped with the necessary tools and human resource so that Zambia’s journey towards Safe Surgery is successful.

 

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