Patient safety and error disclosure in developing country like Nepal

This blog is related to the understanding of seriousness of patient safety and error disclosure in developing countries like Nepal.

While reminiscing my work as a nurse in a small mission hospital at a countryside of Nepal, I realize that there were so many aspects that were simply unseen that could have impacted patient safety a lot. And I must admit that I was myself not very aware of the seriousness of this issue until I started to do research on this topic.

For instance, I have noticed student nurses administrating IV antibiotics to inpatients unsupervised, and the healthcare staff working there just enjoying the leisure time and considering it as a share of their high workload underestimating the risk posed for the patient. The reason behind these situations is staffing issues and high workload which is very prominent in context of Nepalese Healthcare System. It can be profusely seen at the government medical centers where the patients are not provided with all the details about the procedures they undergo and medications they are prescribed to treat their ailments. Therefore, one can easily assume regarding the situation of error disclosure in this kind of healthcare system where even the right to information of the patient is violated. This has led to several serious medication errors over the period and no efforts could be seen from the side of healthcare organizations and authorities to help reduce these incidents.

(Pic, James Wilshiere, 2021)

The attitudes of medical staff in Nepal regarding the disclosure and reporting of medical errors was not very positive before 7 years and I am not very hopeful that there might have been significant changes to it. Poor and underprivileged patients from the rural areas who often cannot advocate for themselves are stopped from talking about the error from which they are victimized. Healthcare staff cannot be solely blamed for such situations. Reporting of healthcare errors in Nepal is affected by so many factors. Healthcare staff in Nepal have the knowledge that admission of errors is important, but they struggle to decide how it should be done. Socio-legal climate of Nepal and the possible financial implications has made it difficult to be honest and disclose about the errors for medical staff (Kaldjian et al., 2006). Strong fears related to patient harm, violence from patients and their family members, damage to hospital’s reputation and to the reputation and loss of job for doctors and nurses have made the healthcare staff to hide and deny the errors. Fear of malpractice claims faced by healthcare staff lead to underreporting of errors, mistrust and skepticism towards the society and authorities (Hayes, 2008). This causes underestimation of the true incidence rate of medical errors.

Communication about errors is an important tool to convey medication safety information. There could be a huge difference regarding the comprehension of medication safety between a patient from a developed country and from a developing country. And it often prevails in developing countries like Nepal, where healthcare staff do not communicate enough to the patients related to the prescribed medication and ongoing medical procedures. And when the error happens, clear discussion with the patient and their family does not take place (Wilshiere, 2021).

It is essential for the healthcare staff and organization to disclose the true and complete nature of error before their patients as to how, why, where, and when it occurred and the necessary measures to be taken to avoid the same in the future (Kalra et al., 2013). However, in a country like Nepal, disclosure should be made in such a way so as to keep the cultural norms and values of the patient in mind. For example, efforts should be made to reduce language barriers and prevent the feeling of mistrust when the healthcare staff communicate with the victimized patients and their family members. Also, an environment where the healthcare staff are free of the fear of loss of autonomy and their professional credibility being challenged, should be fostered.

Blog writer:

Sanu Mahat
Doctoral researcher, MPH
Department of Nursing Science
University of Eastern Finland

References:

https://www.oneeducation.org.uk/communication-skills-in-healthcare/

Hayes, B. (2008). Medical errors–a hospital in Nepal searches for answers. Tropical doctor, 38(1), 45-48.

Kaldjian, L. C., Jones, E. W., & Rosenthal, G. E. (2006). Facilitating and impeding factors for physicians’ error disclosure: a structured literature review. The Joint Commission Journal on Quality and Patient Safety, 32(4), 188-198.

Kalra, J., Kalra, N., & Baniak, N. (2013). Medical error, disclosure and patient safety: A global view of quality care. Clinical biochemistry, 46(13-14), 1161-1169.