Kenyatta hospital ignored global standards on patient identification

By Gatonye Gathura

Kenyatta National Hospital had earlier been warned of blatant disregard of proper patient identification procedures by its theatre personnel.

In a case that has shocked Kenyans, with the hospital owning to have operated on the wrong patient in a major surgery, the facility in 2016 had been warned such may be a routine occurrence at the hospital.

Alarmed at the high rate of surgical mistakes especially in Africa, the World Health Organisation (WHO) in 2008 had developed a safety checklist to be strictly followed in any major surgery.

The WHO surgical checklist which could have helped avoid the current case, forms part of KNH surgical procedure and is widely available including on the Internet.

However a recent study to assess the use of the checklist at KNH and other top hospitals in East Africa showed the manual is largely ignored leading to poor outcomes including fatalities.

The report published in 2016 in the journal BMC Anesthesiology showed only 25 per cent of surgical staff in the main hospitals in East Africa bothered to use the life-saving WHO checklist and only 19 per cent at Kenyatta National Hospital.

The study involved: Mulago Hospital in Uganda, CHU de Kamenge in Burundi, Muhimbili in Tanzania, Kenyatta in Kenya and CHU de Kigali in Rwanda.

While almost 60 per cent of the surgical team at KNH said they knew of the checklist most said it was not available at the hospital.

The response “It is not available” is perhaps a reflection of the culture and attitudes in these hospital rather than an indication of the actual availability,” said the study.

The authors including Dr Thomas Chokwe of the Department of Surgery at KNH and a lecturer at the University of Nairobi concluded what was lacking were not the checklists but enthusiasm among surgical staff.

“With the right motivation, anyone in the medical facility can print out from the Internet and pin up the checklist in theatres as a reminder to the surgical team to go through each of the components for every patient,” says the study.

Dr Chokwe and the team had recommended that the Ministry of Health issue and follow up directives for its implementation in all hospitals that conduct surgery in order to improve outcomes.

A study published in January showed the risk of dying from scheduled surgery in Africa is more than double the global average even when booked for minor surgeries.


What the WHO Checklist provides

The checklist has three mandatory sections that must be followed: Sign In .. Time Out … and Sign Out

Sign In

Before the patient is anesthetized a surgery coordinator will verbally review with the patient their identity, that the procedure and site are correct and that consent for surgery has been given. The coordinator will visually confirm that the operative site has been marked.

This may seem repetitive, the checklist says but it is ‘essential for ensuring that the team does not operate on the wrong patient or site or perform the wrong procedure.’

When confirmation by the patient is impossible, such as in the case of children or incapacitated patients, a guardian or family member can assume this role.

Time Out

Just before the surgeon makes the first skin incision, the coordinator will ask everyone in the operating room to stop and verbally confirm the name of the patient and the surgery to be performed. They will also confirm the site of surgery and the positioning of the patient in order to avoid operating on the wrong patient or the wrong site.

Sign Out

On completion the team will review together the operation that was performed, completion of sponge and instrument counts and the labeling of any surgical specimens obtained.

All these will be physically marked out in a checklist provided for the purpose. However evidence shows this is hardly happening at Kenya’s top referral at teaching hospital.

Last year in another publication Prof Nimrod JM Mwang’ombe of KNH and the University of Nairobi had called for the quick implementation of the WHO safety checklist.

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