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Implementation of a colour-coded universal protocol safety initiative in Guatemala
  1. Brad M Taicher1,2,3,
  2. Shannon Tew1,
  3. Ligia Figueroa4,
  4. Fausto Hernandez5,
  5. Sherry S Ross6,
  6. Henry E Rice2,3,7
  1. 1Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
  2. 2Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
  3. 3Department of Global Health, Duke University Medical Center, Durham, North Carolina, USA
  4. 4Department of Pediatrics, Moore Pediatric Surgical Center, Guatemala City, Guatemala
  5. 5Department of Surgery, Moore Pediatric Surgical Center, Guatemala City, Guatemala
  6. 6Department of Urology, University of North Carolina, Chapel Hill, North Carolina, USA
  7. 7Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
  1. Correspondence to Dr Brad M Taicher, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA; brad.taicher{at}duke.edu

Abstract

Background Universal protocol implementation can be challenging in low-income or middle-income countries, particularly when providers work together across language barriers. The aim of this quality improvement initiative was to test the implementation of a colour-coded universal protocol in a Guatemalan hospital staffed by US and Guatemalan providers.

Methods From 2013 to 2016, a US and Guatemalan team implemented a universal protocol at a Guatemalan surgical centre for children undergoing general surgical or urologic procedures. The protocol was a two-step patient identification and documentation checklist, with the first step of all chart element verification in the preoperative area, after which a blue hat was placed on the patient as a visual cue that this was completed. The second step included checklist confirmation in the operating room prior to the procedure. We tested protocol implementation over three phases, identifying implementation barriers and modifying clinical workflow after each phase. We measured the error rate in documentation or other universal protocol steps at each phase and made modifications based on iterative analysis.

Results Over the course of programme implementation, we substantially decreased the rate of errors in documentation or other universal protocol elements. After the first phase, 30/51 patients (58.8%) had at least one error. By the third phase, only 2/43 patients (4.6%) had any errors. All errors were corrected prior to surgery with no adverse outcomes.

Conclusions Care teams of providers from different countries pose potential challenges with patient safety. Implementation of a colour-coded universal protocol in this setting can prevent and reduce errors that could potentially lead to patient harm.

  • paediatrics
  • surgery
  • patient safety
  • checklists
  • audit and feedback

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Footnotes

  • BMT and ST contributed equally.

  • Competing interests None declared.

  • Ethics approval IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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