Ensuring Patient Safety: Addressing Critical Issues in Healthcare Facilities

/in /by

Ensuring Patient Safety: Addressing Critical Issues in Healthcare Facilities


Patient safety stands at the core of quality healthcare. To gain insight into the pressing safety concerns faced by healthcare professionals, we reached out to delegates attending our 10th Annual Conference for their perspectives on the main safety concerns at their workstations. The responses we received highlighted several critical areas that demand attention and improvement. This blog post delves into some of these concerns and explores how healthcare organizations can work toward fortifying patient safety.

 

Understaffing: The staff shortage in anesthesia, perioperative, and operating room (OR) settings is a significant concern. Understaffing can lead to overworked employees and a heightened risk of errors. Health facilities must address this issue by hiring additional personnel and implementing strategies to manage workloads effectively.

 

Inadequate Equipment: Monitoring patients during and after surgery is paramount. Insufficient monitoring equipment can lead to undetected complications. This situation is even worse for pediatric patients where available equipment is unsuitable for pediatric use. Missing critical equipment, such as defibrillators and laryngoscopes, can hinder a healthcare facility’s ability to respond effectively to emergencies. Facilities must invest in acquiring and maintaining basic equipment essential for patient safety. In addition, the provision of adequate biomedical support and a clean power supply ensures that medical equipment remains functional for a longer period. 

No Designated PACU: A designated post-anesthesia care unit (PACU) is indispensable for the safe recovery of surgical patients. The absence of a dedicated PACU can hinder patient recovery and necessitate immediate attention.

 

Slow Procurement Processes: Delays in procurement of essential equipment and drugs will impede anesthetists’ capacity to provide appropriate care. Streamlining procurement processes is essential to ensure that healthcare organizations can acquire the necessary equipment efficiently.

 

 

Patient safety is a collaborative endeavor involving healthcare professionals, administrators, and policymakers. Solutions call for joint efforts, allocation of adequate resources, and an unwavering commitment to continuous improvement. By taking concrete steps to mitigate these risks, healthcare facilities can establish a safer environment for patients and uphold their dedication to delivering quality healthcare. 

WORLD ANESTHETISTS DAY 2020

/2 Comments/in , , /by

One of the KRNA chapter responsibilities is to advocate for the welfare of its members. Comprised of license nurse anesthetists and associate student nurse anesthetists member, the KRNA chapter is registered under the National Nurses Association of Kenya. Between April and September 2020, the chapter collected data from its members. A Google form was created and sent to 200 known KRNAs practicing in Kenya. One hundred and ten (55%) of them responded representing 47% of the total number of the KRNAs trained in Kenya. Only 3% of the KRNAs remain unemployed. Among the unemployed are KRNA trainees who while have successfully completed their training, are yet to sit for the licensing exam postponed due to the COVID-19 pandemic.

While more than 70% indicated that they were either neutral or satisfied with their work, a significant percentage expressed dissatisfaction with their remuneration. Some concerns that have been raised that affect job satisfaction include workload, equipment, and supplies. While an ideal situation is to have at least 3 anesthetists per surgical bed to provide 24-hour coverage, many non-physician anesthetists work in under-resourced facilities with only one anesthetist per surgical bed leading to a huge workload. Kenya in general has a limited anesthesia workforce and the situation is more severe outside the capital city of Nairobi, where more than 80% of the anesthesiologists practice. Non-physician anesthetists working independently form the bulk of the anesthesia workforce for the underserved communities in Kenya. 

Another major issue is limited equipment; even basic tools like laryngoscopes are not readily available in some facilities and many of the anesthetists are forced to buy their own sets in order to make sure they have one when they need one. Monitoring tools like pulse oximeters are also limited and some facilities have outdated versions of the anesthesia machines that lack standard monitoring like capnography and ECG leads. Supplies of drugs and disposables also remains a challenge. Shortages of pain management drugs like morphine, spinal needles of appropriate sizes and difficult airway equipment including those for pediatrics are a common occurrence.

With regard to remuneration, only 56% of the graduates have been redesignated as nurse anesthetists. This lack of formal recognition of their specialized training locks them out of promotion opportunities. They have also been locked out of fair recruitment process with only a few counties setting aside slots for recruitment of KRNAs when hiring additional anesthesia workforce. The KRNAs have also being locked out of certain allowances including the call allowances despite handing calls in their practice. These challenges have a direct impact on their fair remuneration commensurate to the work done.

Nurse anesthetists are competent and skilled, trained to provide safe anesthesia in all forms of surgery including obstetrics, pediatrics, orthopedic, neurological, plastics, and general surgery. They can administer all forms of anesthesia including general anesthesia with additional skills in pain management, resuscitation and critical care. The KRNA chapter has strived to ensure that their members have members to not only CME opportunities but also create forums for engagement and mentorship as well as explore options for higher level of training. As we celebrate the World Anesthesia Day, we look forward to a future where the role nurse anesthetists play in the delivery of safe anesthesia will be recognized. Our work in bridging the gaps in access to safe surgery is unquestionable and the chapter will continue to advocate for its members to ensure they are well compensated, well trained, and perform their work to the highest possible standard


Investing in anesthesia workforce: a case for non-physician anesthetists

/in , , , /by
An anesthetist standing behind a surgical table curtain


Five billion people lack access to safe surgical and anesthesia services. In some parts of the world, this translates to more than 95% of the population without access to safe surgery. Surgery is described as the neglected step-child of Global Health. In the same breath, anesthesia is surgery’s ‘invisible sister’.

Continue reading

GOING GLOBAL: FUND MANAGEMENT FOR PANAC 2020

/in /by

Kenya Registered Nurse Anesthetists (KRNA) began formal training in Kenya in 2006.  This cadre has proved to be of value in training nurse anesthetists who primarily serve the rural facilities in the country. The success of the program caught the attention of colleagues across our borders, and some have traveled to Kenya to receive the training. South Sudan is one of the biggest beneficiaries of the KRNA training with more than 30 nurses trained as anesthetists in Kijabe College of Health Sciences. This work was supported by Hospital Support Organization (now known as African Mission Healthcare-Kenya or AMH-K). In 2019, AMH-K were the primary sponsors for the 8th Annual KRNA conference.

As the National KRNA chapter plans for the 1st Pan African Nurse Anesthetists Conference (PANAC) in June 2020, the chapter has asked for support from AMH-K in this activity. Given their expertise in management of donor funds, AMH-K will serve as the fund management agency for the PANAC 2020. This arrangement means that all monies received in form of grants, donations, delegate fees, and exhibition fees to support PANAC activities will go to AMH-K’s Special projects accounts. This will allow us flexibility to manage the funds in both US and Kenyan currencies. This will be the first time the KRNA chapter is handling funds from outside the country. We will use this first experience to learn from AMH-K what it takes to manage these resources in a manner that will ensure transparency and accountability. AMH-K will also provide an audit of the funds received and expended thus ensuring we remain accountable to the individuals and institutions that entrust us with resources to run this event.

LAUNCH OF THE OFFICIAL KRNA SCOPE OF PRACTICE

/in , /by

It has been three years in the making. The journey to develop a Scope of Practice for the Kenya Registered Nurse Anesthetists started during a meeting among a small group of practicing KRNAs. This document was something that every KRNA wanted to have so that the primary employer, the Government of Kenya, could formally adopt this cadre of practitioners into the health structure. The journey to have nurse anesthesia practice in Kenya started in the early 2000s. Some nurses left the country for certificate training programs available across our borders in countries like Tanzania. Others served as theatre nurses and were trained on the job to give anesthesia. At Kijabe, the sole anesthesiologist at the time-Dr. Mark Newton-started training his theatre nurses to give anesthesia. Having come from the US where a mix of physician and nurse anesthesia providers is standard practice in some setting, he knew that there was potential for this practice to be replicated here. Since formal accreditation in 2006, the numbers have grown to more than 200 practicing and student KRNAs


In Kenya, we face a huge gap in the number of anesthesia providers. This is one of the reasons non-physician anesthesia providers (NPAPs)-the clinical officers and nurses cadres- were approved and accredited. We still have a long way to go in terms of numbers. Such documents are a testament to the need to hold healthcare professionals to standards that will ensure patient safety above all.

Caption from speech prepared by chief guest

On 14th June the 1st Edition of the Scope of practice was formally launched during the 8th Annual KRNA conference held in Nyeri County. The document further cements the role of nurse anesthetists as a vital part of provision of safe anesthesia. Invited Guests representing various organizations including National and County Government, Nursing Council of Kenya, various nursing bodies including the NNAK, NACOA, and representatives of Center for Public Health and Development, joined us for the launch. These guests represent institutions that have supported the development of the KRNA Scope of Practice


This document that we are here to launch today is meant to serve as a guide to define who a nurse anesthetist is and what role they play in our health system. Anesthesia care is a critical need in a health system. It is said that there can be no surgery without anesthesia. I know that the under-served communities in rural Kenya, especially pregnant mothers,  are grateful for the services you provide.

Ms. Priscilla Emojong, Head of Nursing Education, Training and Research, Office of Director of Nursing, MoH

The KRNA Chapter appreciates all members, partners, donors, employers and colleagues who have supported us to ensure that this document becomes a reality.

With support from partners like ImPACT Africa and Center for Public Health and Development, the idea of an official Government document recognizing KRNAs has become a reality. This scope of practice will form the foundation for the development of a scheme of service that will allow the Human Resource system in both Government and private employers recruit and retain nurse anesthetists.

Samson Miriti, KRNA Chapter Chairman, 2017-To date