Abstract:

Background: Health care is one of the most important services that every one desires to be of high quality and safety, but in real practice, this is not always the case. In the event of seeking health care, many patients are harmed and some get serious disabilities or even death. System failures and blame for errors committed are the ones that mostly promote occurrence of medical errors hence resulting into unsafe healthcare. Blame prevents health care providers from reporting errors for future prevention of re occurrence.

Patient safety, which is a component of quality healthcare, is defined as the absence of avoidable harm to patients during the process of health care, (Carmen A. n.d.). To achieve 100% absence of avoidable harm to patients is hard to realise as `to err is human` but efforts to avoid harm are of great importance. In developed countries, thousands of patients are reported to suffer serious harm and death in the event of receiving health care services. In 1999, Institute of Medicine in the USA estimated 44,000 to 98,000 preventable deaths annually due to medical errors in USA hospitals, (IOM 1999). In Uganda`s healthcare system, many patients are harmed and many even die during the event of seeking for healthcare but due to poor reporting systems there is limited information on the magnitude of preventable harmful medical errors.

The study to determine patient safety culture of Iganga, Kakira and Kamuli Mission in south eastern Uganda, had five objectives of; assessing the knowledge of health workers on patient safety, the role of the hospital management in promotion of patient safety culture, determine patient safety culture practices, point prevalence of common inpatient safety incidents, and causal pathways.

Methodology: The study was an observational, descriptive and cross-sectional survey. A sample of 144 health workers were interviewed using a questionnaire, three focus group discussions with hospital managers were conducted, and 169 inpatient records were reviewed. Data was entered in SPSS 16. 0 software then into Excel for further analysis and later presented in graphs.

Results: The study revealed that the knowledge of health workers on patient safety in the study hospitals was just above average at 55.8%. Under and over dosing of patients, dispensing of wrong drugs and poor infection control being the most common medical errors known, where as Uganda clinical guideline was found to be the most known guideline for patient safety. The study also showed that, the majority of health workers would not report errors due to ignorance and fear of blame. The study showed existence of team work and channels for communication of patient safety issues between management and staff. However, management role in promotion of patient safety is still demanding as there was limited availability of policies and guidelines, lack of patient safety incident record books and patient safety committees. There existed fairly good patient safety practices as communication, hand washing, dispensing and team work were all above average. However it was found out that poor reporting, fear of blame, under staffing and inadequate waste disposal practices did exist. Incidents of failure to monitor vital signs and delayed investigations were more prevalent in over 70% of all records studied. The majority of the surgical operations were done without pre-operative investigations and had inadequate post operative notes increasing the chances of harm to surgical patients. Causal pathways for medical incidents were mainly lack of guidelines and policies, poor monitoring of adherence to guidelines, limited skills and training of staff, understaffing, heavy workloads, lack of logistics and faultiness of equipments and lack of reporting procedures for patient safety.

Conclusion: In conclusion, the level of knowledge on patient safety culture is just average as awareness is still limited. There is a significant lack and limited availability of policies and guidelines, incident record books and committees that promote patient safety. The bad practices of fear to report incidents, under-staffing and fear of blame for errors committed need improvement. Failure to monitor vital signs, difficulty to access high skilled staff especially the medical officers and inadequate post operative notes also need serious attention as they are part of the causal pathways for patient safety incidents in the study hospitals. Provision of policies and guidelines, training of health worker, management leadership and effective communication and monitoring of patient safety in the study hospitals are highly recommended.

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