OPERATING ROOM MANAGEMENT ATTITUDES AND PATIENT SAFETY PRACTICES AMONG SURGICAL STAFF IN THE UNIVERSITY COLLEGE HOSPITAL IBADAN

Abstract

Operating room management attitudes like teamwork, good communication, cooperation, and coordination are vital to effective surgical care. Surgery is associated with a considerable risk of complications majority of which are avoidable. Hence, improving surgical safety has been identified as a public health priority by the World Health Organisation (WHO). Attitudes of members of surgical team about safety and teamwork in the operating theatre may play a role in patient safety. This study was therefore undertaken to investigate attitudes toward safety and teamwork among surgical staff at the University College Hospital, Ibadan. A questionnaire survey was conducted among 321 surgical staff in the University College Hospital, Ibadan. A customised version of the Operating Room Management Attitude Questionnaire (ORMAQ) was used. This measures attitudes to leadership, communication, teamwork, stress and fatigue, work values and organisational climate. Safety practices' were assessed using error and procedural compliance thematic structure. The sum of points of the attitudes on a Likert scale was computed to generate attitude score and the mean of the score was used to categorise attitude into poor or good attitude. The thematic structure for safety practices was similarly assessed. Data collected was analysed using descriptive statistics, Kruskal-Wallis analysis for comparison across professional groups and logistic regression to examine predictors of attitude to teamwork at 5% level of statistical significance. Results: Out of the 321 respondents, 73(22.7%) were surgeons and 111 (34.6%) surgical trainees, I 07(34.6%) operating room nurses and 30(8.1 %) anaesthetists. Respondents generally demonstrated positive attitudes to behaviors associated with effective teamwork and safety. Positive teamwork attitude was more pronounced among the consultants (64%), half of the trainees displayed good attitude and only 32% of nurses. Safety practices were poor across all the professional groups with 34(58.6%) of consultants, 104(68.4%) of residents and 68(61.3%) of nurses displaying poor safety practices. Eighty percent of nurses displayed poor attitude to stress and fatigue themes. There was a significant difference between consultants, resident doctors and nurses on information sharing, teamwork, work value and organizational climate, and stress and fatigue themes. Nurses were found to be 2.8 times less likely to have good teamwork attitude compared to surgeons (OR = 0.36; CI = 0.194-0.675) and those with 1-5 years of experience were 1.8 times less likely to have good teamwork attitude compared to those wi!h more than 6 years of experience (OR= 0.56; CI = 0.343 - 0.902). Overall, the surgeons and anaesthetists demonstrated positive attitudes towards teamwork and leadership. On the other hand, poor attitude to teamwork among nurses need to be addressed. Nurses were found to show attitudes suggesting invulnerability to the effects of stress and fatigue to a high degree. The negative attitude of nurses to teamwork which may be due to recurrent disharmony in the health sector in Nigeria needs to be further investigated. Training on teamwork and awareness of limitations when under stress is therefore recommended.