A COMPARATIVE STUDY ON REPORTING MEDICAL ERRORS FOR PATIENTS’ SAFETY AMONG PRACTICING PHYSICIANS AT GOVERNMENT SECONDARY AND TERTIARY HEALTH FACILITIES IN THE FEDERAL CAPITAL TERRITORY ABUJA

Abstract

Background: Prevention of medical error is very important in ensuring the quality of patient care and safety. However, the occurrence of these errors and the disclosure practices by physicians are not well documented. The objective of this study is to compare the occurrence of medical errors and their disclosure practices among physicians in government secondary and tertiary health facilities in Abuja, Nigeria.
Methodology: The focus group discussions were conducted among the various cadres of physicians, four each from the government secondary and tertiary health facilities. Various themes including medical error occurrences and disclosure practices were identified. This information obtained from both the FGDs and questionnaires were complemented by the results of the observational checklist on prescription writing errors. A cross sectional survey of physicians working in seven out of fourteen government hospitals was conducted. A cluster sampling technique of the hospitals as the clusters was employed to obtain the total sample size of 402 physicians, 201 for each level. A semi structured, self administered questionnaire was used to collect quantitative data on near misses, mistakes, slips or lapses, technical errors, drug omission errors and wrong drug route errors. Data was analysed using SPSS version 15.0 and summarised as proportions. Chi-square test was used to assess associations between variables at a significance level of 5%. Also logistic regression analyses were used to determine the significant predictors of medical error occurrences and disclosures.
Results: Some 255 physicians i.e. (52.6%) from the tertiary level and 230 (47.4%) from the secondary level were interviewed. From this survey, medical errors occurrences were generally higher at the secondary level. For example tertiary level versus secondary level errors occurrences were near misses (85.4% vs 85.7%), mistakes (73.3% vs 77.5%), slips or lapses (51.9% vs 65.5%), technical errors (70.6% vs 68.0%), drug omission errors (48.6% vs 45.4%) and wrong drug route errors (43.9% vs 55.2%); (p > 0.05 for all comparison groups). Taking these categories of errors from the survey together, the estimated overall error rates at the tertiary and the secondary levels were (62.2% vs 66.2%; p = > 0.05). The commonest prescription writing error at the tertiary and secondary levels was omission of patients’ age (33.3% vs 75.2%; p < 0.05.). At both the tertiary and the secondary levels, these error occurrences were largely attributed to poor communication
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(68.5% vs 64.3%, p = 0.333) and lack of medical equipments (67.4% vs 58.52%, p = 0.042). The knowledge on medical errors by the tertiary and the secondary levels were (57.65% vs 53.9%, p = 0.408). The secondary level however had a more positive attitude to medical error disclosure than the tertiary level (61.3% > 46.6%), p = 0.001). Both the tertiary and the secondary levels had very poor medical error disclosure practices with disclosure of errors that caused patient’s death or disability (3.9 vs 8.3%, p = 0.023); or disclosure of errors that caused discomfort or prolonged treatment to patients (33.2% vs 21.3%, p = 0.026). Major barriers to disclosure at the tertiary and the secondary levels were lack of malpractice insurance (69.4% vs 48.2%, p = 0.000); lack of policies for reporting errors (62.4% vs 55.4%, p = 0.119); and the fear of negative patient reactions (56.7% vs 51.3%, p = 0.233). The major motivations to disclosure were receiving a positive feedback from the institution (65.1% vs 56.3%, p = 0.048) and the support and understanding of colleagues (50.2% vs 48.7%, p = 0.74).
All the focus groups acknowledged that medical errors occur in their practice. The groups attributed the occurrence of these errors largely to lack of medical equipments, poor communication and working conditions. The groups at the secondary health facilities were more favourably disposed to medical error disclosure. The FGDs revealed that medical error disclosure practice was poor among physicians especially at the tertiary level. Lack of disclosure policy and malpractice insurance for physicians as well as the fear of lawsuits were among the barriers to disclosure identified. Some of the motivations to disclosure identified were positive responses from colleagues, the hospital authorities and the patients.
Conclusion: This study revealed a wide gap between the occurrence of medical errors and the disclosure practices. The study suggests that in this study setting, the development of institutional policies on disclosure will motivate physicians’ disclosure of medical errors and this should be encouraged. Such policies should include institutionally administered malpractice insurance for the doctors.

A COMPARATIVE STUDY ON REPORTING MEDICAL ERRORS FOR PATIENTS’ SAFETY AMONG PRACTICING PHYSICIANS AT GOVERNMENT SECONDARY AND TERTIARY HEALTH FACILITIES IN THE FEDERAL CAPITAL TERRITORY ABUJA