Abstract
The disclosure of medical errors is very important in ensuring the quality of patient care and safety. However, the disclosure practices by physicians are not well documented in this setting. The objective of this study is to compare the disclosure practices as well as the motivations and barriers to disclosure of these errors among physicians in government secondary and tertiary health facilities in Abuja, Nigeria. A cross sectional survey of physicians working in six 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 and technical 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. Some 255 physicians i.e. (52.6%) from the tertiary level and 230 (47.4%) from the secondary level were interviewed. Both the tertiary and the secondary levels had very poor medical errors 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). The major barriers to error disclosures at the tertiary and the secondary health facilities were: lack of malpractice insurance (69.4% vs. 48.2%, p=0.000); lack of policies for disclosing 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 errors 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). This study suggests poor medical errors disclosure practices. 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 physicians.
Highlights
The Canadian Safety Institute defines an error as a failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. 1 An error often results to an adverse event to the patient
Overall the disclosure rate was higher at the secondary level than at the tertiary level (66.9%>53.3%)
This study revealed that medical error disclosure practices among physicians at both levels were poor
Summary
The Canadian Safety Institute defines an error as a failure of a planned action to be completed as intended (i.e., error of execution) or the use of a wrong plan to achieve an aim (i.e., error of planning). 1 An error often results to an adverse event to the patient. Adverse events are the injuries or harms that result from an error in the course of the management of the patient rather than the underlying condition of the patient; usually as an unintentional and unexpected occurrence. Medical errors are defined as preventable adverse medical events. “Mistakes” are errors in the planning of an Central African Journal of Public Health 2021; 7(2): 76-81 action. “Slips or lapses” are errors in the execution of an action that often occur as a result of distraction or momentary failure of concentration. “Technical errors” occur when there is a failure to carry out an action successfully even if the plan of action and technique are appropriate. [3,4,5]
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