Implementation Analysis of a Patient Safety Program in a Pediatric Perioperative Unit in Guatemala

Abstract

Background: Patient safety is critical to prevent medical errors and to improve clinical outcomes. The need to implement programs in patient safety is increasingly recognized as a prime component of healthcare delivery in low- and middle- income countries (LMICs). The goal for our study is to assess the implementation of a patient safety program in Guatemala.Methods: We used a mixed-methods approach to assess implementation of a patient safety program in the pediatric perioperative unit in Hospital Roosevelt, Guatemala. We collected data from unit staff respondents (n=16) using a qualitative de novo survey, the Evidence-Based Practice Attitude Scale-36 (EBPAS-36) survey, and a semi-structured interview. Interviews and surveys were conducted in Spanish, translated, and analyzed in English using NVivo v12. Quantitative data were analyzed to compare group means across survey domains. Data were triangulated, with final analysis guided by the Consolidated Framework for Implementation Research (CFIR). Data were collected over a 10-day period in July 2018.Results: Responses underscored several emergent thematic determinants representing the Inner Setting and Characteristics of Individuals CFIR domains, indicating a gap in knowledge of patient safety programs and attitude towards the use of evidence-based patient safety programs. Though respondents expressed an openness and willingness to adopt patient safety practices, few existing practices are in place to prevent medical errors.Conclusions: The main determinants which affect the implementation of an evidence-based patient safety program in the pediatric perioperative unit in Guatemala are related to the internal structure and culture of the unit, and not to external factors or the intervention itself. Positive attitudes and knowledge of patient safety practices are insufficient to overcome the challenges towards implementation. A framework for future implementation should include education and communication programs, adaptation of existing practices to increase leadership engagement, and use of tools to create a strong culture of safety.