Medical error is not unique to Kenya

Health CS Sicily Kariuki addressing a press conference in Nairobi on March 8, alongside Medical Practitioners and Dentists Board Chairperson Prof George Magoha (right) and other ministry officials on KNH incident of brain surgery on a wrong patient. [David Njaaga/Standard]
Most Kenyans believe that patient safety standards in the country are a drastic far cry from global benchmarks, citing the case at Kenyatta National Hospital as well as several others in various public and private hospitals across the country. While it is tempting to believe this, the reality is that medical error is a global problem.

Countries such as the U.S. are also grappling with the issue. In a recent study, John Hopkins University Hospital patient safety experts estimated that medical error was the third highest cause of death in the US.

Their findings, which were published in the British Medical Journal in May 2016, further indicated that medical errors accounted for 10 per cent of all US deaths.

Not a Kenyan problem

It occurs elsewhere around the world as well, sometimes with greater prevalence and more dire consequences on human life. What makes the difference is how individual cases are handled and whether a culture of sharing information and addressing core issues, is promoted.

We need to create an environment in which health workers feel that they can share information about medical error without being unjustly victimized. Accurate and timely information empowers decision makers in the healthcare system to identify and address the root causes of preventable medical error.

In most cases of medical error, the root issue is usually human error. At KNH, some of the measures we have taken to address human error are tightening enforcement of standard operating procedures, improving patient-provider communications and increasing patient tagging.

In other cases of medical error, the challenge is a broader health systems issue, such as the shortage of health workers. The shortage of nurses in Kenya is particularly worrying and has a material effect on overall patient safety standards.

The Kenya Healthcare Workforce Report shows the current ratio of practicing nurses to the population is 8.3 per 10,000 against the World Health Organization (WHO) recommended limit of 25 nurses per 10,000.

The dire shortage of nurses against the backdrop of a huge number of patients contributes to fatigue and increases chances of human error. This points to the need to increase training of nurses and review recruitment processes to ensure that we have more nurses joining the workforce each year.

We also need to treat individual cases of medical error as a window into our health system. For instance, we need to ask ourselves why our referral hospitals are perpetually overcrowded, as evidences by the fact that bed occupancy at KNH sometimes hits 120 per cent.

It is no secret that primary healthcare has historically been given limited attention in Kenya. The result is that a patient who could have received basic malaria treatment at their local clinic ends up at KNH, leading to overcrowding and compromising patient safety standards.

These issues need to be addressed holistically if we are to reduce the prevalence of medical error in our hospitals.

At the same time, health practitioners need to be reminded of their commitment to not only deliver clinical excellence, but also treat patients with respect and empathy. This promotes a good patient-provider relationship, which makes it easier for patients to share information that would lead to better treatment and high patient safety standards.

Although most cases of medical error are caused by human error and broader health system challenges, a few are caused by reckless behavior among health practitioners who violate essential patient safety rules.

If this is suspected to be the case, commensurate displinary action should be taken, subject to proper investigations. In most cases around the world, state medical boards are charged with taking displinary action against medical malpractice. However, in some instances, cases are escalated to law courts.

A case in point is the highly publicized case involving Conrad Murray, who was Michael Jackson’s personal physician. In 2012, the American doctor was convicted of involuntary manslaughter in the death of the pop star and received a four-year sentence.

Dr Murray routinely administered Propofol as a sleeping remedy to Jackson at the comfort of the late musician’s home, despite the fact that any patient who receives the surgical anesthetic requires continuous monitoring of heart rate and breathing in an equipped medical facility.

Dr Okutoyi is the Head of Quality Healthcare Department at KNH.

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