Availability and utilization of medical devices in Jimma zone hospitals, Southwest Ethiopia: a case study

Exploring Missed Nursing Care in the NICU: Perspectives of NICU Nurses in Saudi Arabia's Eastern Health Cluster

(1) Background: Missed nursing care, an omission error characterized by delayed or omitted nursing interventions, poses significant risks to patients' safety and quality of car.; (2) Methods: This is a quantitative cross-sectional study on 151 nurses who work in NICUs in three main networks in the Eastern Health Province, Saudi Arabia: Dammam (n = 84), Qatif (n = 53), and Jubail (n = 14). The study uses a self-reported questionnaire (MISSCARE) and applies the 5-point Likert Scale. Statistical analysis data were analyzed using SPSS version 23.0. (3) Results: The primary reasons for missed care were shortage of nursing staff and unbalanced patient assignments. Missed nursing care negatively affects job satisfaction and was positively correlated with nurses' intentions to quit their jobs. Inadequate equipment, supplies, and breakdowns in communication between nurses and other healthcare professionals were also significant factors contributing to missed care. (4) Conclusions: Missed nursing care is associated with overwork, nursing shortages, and lower job satisfaction, impacting the quality of care provided in the NICU. Improving working conditions, nurse staffing, and patient assignment planning should be prioritized to address this issue effectively.

Efficiency of Medical Equipment Utilization and Its Associated Factors at Public Referral Hospitals in East Wollega Zone, Oromia Regional State, Ethiopia

Background

The significance of effectively using medical equipment has received widespread public attention. Due to its complex effects on healthcare costs and quality, the relationship between hospital features and medical equipment consumption has drawn increased attention. Therefore, the study aimed to evaluate the efficiency of medical equipment utilization and its associated factors.

Methods

The study was conducted at public referral hospitals in East Wollega, Oromia Regional National State, Ethiopia, in 2021. A cross-sectional study design was mixed with observation and document review. The study included approximately 192 pieces of equipment. Descriptive statistics and Pearson Chi-square (χ ²) were used to identify associations between each independent and dependent variable at p<0.05 to declare level of significance.

Results

Using 95% confidence interval (CI), the level of utilization coefficient was estimated to be 0.49 (0.44-0.55). As a result, 111 pieces of equipment (57.8%) were used efficiently, while 81 (42.2%) were underutilized. The form in which the hospitals received the equipment (χ ²=7.7.2; P=0.005), regular availability (χ ²=19.30; P=0.00), equipment breakdown (χ ²=11.57; P=0.001), the availability of trained staffs operating the equipment (χ ²=26.14; P=0.00), performing preventive maintenance (χ ²=91.54; P=0.00), the availability of spare parts (χ ²=32.36; P=0.00), and the availability of accessories (χ ²=43.91; P=0.00) were statistically significant factors affecting the medical equipment utilization.

Conclusion

On average, the utilization coefficient of medical equipment in the study hospitals was low compared to other study findings, which indicated that 2 out of 5 pieces of medical equipment were under-utilized, which could be significantly affected by the form in which the hospital received the equipment, its regular availability, equipment breakdown, availability of trained staff operating the equipment, performing preventive maintenance, and availability of adequate spare parts and accessories. Every hospital should develop an appropriate strategic framework to manage and utilize the available medical diagnostic equipment based on its level and demand.

Medical Equipment Management in General Hospitals: Experience of Tulu Bolo General Hospital, South West Shoa Zone, Central Ethiopia

Background

Medical equipment are vital items to deliver quality services in health facilities and the role of medical equipment is a well-founded reality. It is mainly used in many diverse settings in hospitals to diagnose, treat illnesses; support disabled and intervened acute and chronic cases. Effective maintenance and proper management are major utilization issues to provide quality services while saving scarce resources. However, managing medical equipment, especially, the utilization phase of medical equipment, was not well studied in this general hospital.

Objective

This study aims to assess the utilization of medical devices in Tulu Bolo General Hospital.

Methods

The study was conducted from December 25, 2021 to February 9, 2022. Data sources included health professionals and document archives in the hospital. Data collection method includes questionnaires and observations checklists. A census of 165 health workers was conducted, with a response rate 94.5%. Data was entered into epi-data; version 3.1, then analyzed by SPSS version 23 and presented using descriptive statistics.

Results

Procurement, storage, and utilization were found to be 53.47%, 56.57%, and 45.88%, respectively. Only 114 (57.3%) of the 199 pieces of medical equipment discovered were functional. Pearson correlation indicated that procurement and utilization of medical equipment are related to a higher proportion of non-functional devices (P = 0.000, B1 = 1.47, OR = 4.349, and CI 95% = 2.047-9.241) and nonfunctional medical equipment (B2 = 0.790, OR = 2.203, and CI 95% = 1.065-4.556) for procurement and utilization, respectively.

Conclusion

Procurement, storage, and utilization of available medical equipment in Tulu Bolo Hospital were low. While health sectors operating in a resource-limited were assumed to have a big shortage of medical technologies, procurement, storage, and utilization of the limited available medical equipment need the attention of health program managers.

Readiness of the primary health care units and associated factors for the management of hypertension and type II diabetes mellitus in Sidama, Ethiopia

Background

In low-income nations such as Ethiopia, noncommunicable diseases (NCDs) are becoming more common. The Ethiopian Ministry of Health has prioritized NCD prevention, early diagnosis, and management. However, research on the readiness of public health facilities to address NCDs, particularly hypertension and type II diabetes mellitus, is limited.

Methods

The study used a multistage cluster sampling method and a health facility-based cross-sectional study design. A total of 83 health facilities were evaluated based on WHO's Service Availability and Readiness Assessment (SARA) tool to investigate the availability of services and the readiness of the primary health care unit (PHCU) to manage type II diabetes and Hypertension. Trained data collectors interviewed with PHCU head or NCD focal persons. The study tried to investigate (1) the availability of basic amenities and the four domains: staff and guidelines, basic equipment, diagnostic materials, and essential medicines used to manage DM and HPN, (2) the readiness of the PHCU to manage DM and HPN. The data were processed by using SPSS version 24. Descriptive statistics, including frequency and percentage, inferential statistics like the chi-square test, and logistic regression models were used to analyze the data.

Results

Of the 82 health facilities, only 29% and 28% of the PHCU identified as ready to manage HPN and DM. Facility type, facility location, presence of guidelines, trained staff, groups of antihypertensive and antidiabetic medicines had a significant impact (P < 0.05) on the readiness of the PHCU to manage HPN and DM at a 0.05 level of significance. Facilities located in urban were 8.2 times more likely to be ready to manage HPN cases than facilities located in rural (AOR = 8.2, 95% CI [2.4-28.5]) and P < 0.05.

Conclusion and recommendation

The results identified comparatively poor and deprived readiness to offer HPN and DM services at lower-level health facilities(health centers). Equipping the lower-level health facilities with screening and diagnostic materials, essential medicines, and provision of basic training for the health care providers and NCD guidelines should be available, especially in the lower health care facilities.

Effect of deploying biomedical equipment technician on the functionality of medical equipment in the government hospitals of rural Nepal

BACKGROUND

Medical equipment plays a crucial role in the provision of quality healthcare services, despite this more than 50% of equipment in developing countries are non-functioning due to a lack of appropriate human resources to maintain. To address this problem some government hospitals of Nepal have deployed a mid-level technical cadre called 'Biomedical Equipment Technician' (BMET). This study aims to evaluate the effectiveness of deploying a BMET on the functionality of medical equipment in government hospitals of rural Nepal.

METHODS

We used a mixed-methods approach with a comparative research design. A comprehensive range of 2189 pieces of medical equipment at 22 hospitals with and without BMET were observed to assess their functional status. Medical equipment were stratified into 6 categories based on department and T tests were conducted. We collected qualitative data from 9 BMETs, 22 medical superintendents, and 22 health staff using semi-structured interviews and focus-group discussions. Thematic content analysis was conducted to explore how the BMET's work was perceived.

FINDINGS

The quantity of non-functional devices in hospitals without BMETs was double that of hospitals with BMETs (14% and 7% respectively, p < 0.005). Results were similar across all departments including General (16% versus 3%, p = 0.056), Lab (15% versus 7%, p < 0.005) and Operation Theater (14% versus 5%, p < 0.005). Hospitals with BMETs had fewer overall non-functional devices requiring simple or advanced repair compared to hospitals without BMETs [3% versus 7% (p < 0.005) simple; 4% versus 6% (p < 0.005) advanced]. In our qualitative analysis, we found that BMETs were highly appreciated by hospital staff. Hospital workers perceived that having a BMET on staff, rather than twice-yearly visits from central-level maintenance technicians, is an effective way to keep medical equipment functional. However, without a favorable working environment, the BMET alone cannot perform optimally.

CONCLUSIONS

Having a BMET at a rural government hospital has a substantial positive effect on the functional status of medical devices at the hospital. BMETs should be deployed at all rural hospitals to increase the functionality of medical devices, thereby improving the working environment and quality of health services provided.

‘Where is the ECG machine?’: a quality improvement project using WhatsApp to improve the efficiency in locating shared medical devices in an inpatient unit

Access to medical devices are vital to deliver safe patient care. In the context of constrained resources, however, clinical areas often have insufficient basic equipment, which tend to be shared among multiple clinical teams. This can result in delayed patient management and reduced institutional productivity. In our experience, in 2019, while working at Carseview Centre, an inpatient mental health unit in Dundee (National Health Service Tayside), there was only one functioning ECG machine shared between the five wards.

Using the work WhatsApp chat, we aimed to facilitate better sharing of the one machine. Plan, do, study, act (PDSA) 1 intervention introduced the project protocol, which encouraged doctors to post a photo of the device after use, captioned with its location. PDSA 2 involved printing a physical copy of the memorandum and attaching it to the machine to prompt further compliance. In PDSA 3, concise photo-posting guidelines were established and adherence was encouraged to mitigate concerns for potential confidential-data leaks.

A dynamic outcome measure, the overall effectiveness metric (OEM), was conceived to prospectively monitor the effectiveness of our interventions. An OEM ≥1 indicates engagement and thereby improvement, whereby <1 indicates no change compared with baseline.

The intervention in PDSA 1 was a success with an OEM of 3.5. Although no actual data leaks occurred, a potential for concern was raised by a senior doctor. This limited engagement with the protocol during PDSA 2 and 3, causing the OEM to decline to <1 towards the end of the project. Sixty percent reported that the protocol saved them time in locating the machine.

Individual factors, mainly frustration with the current situation, was a primary driver for the initial engagement among doctors. Although other factors such as senior doctor buy-in, may play a greater role in directing longevity of a technology-based quality improvement solution.

The role of medical equipment in the spread of nosocomial infections: a cross-sectional study in four tertiary public health facilities in Uganda

Background

With many medical equipment in hospitals coming in direct contact with healthcare workers, patients, technicians, cleaners and sometimes care givers, it is important to pay close attention to their capacity in harboring potentially harmful pathogens. The goal of this study was to assess the role that medical equipment may potentially play in hospital acquired infections in four public health facilities in Uganda.

Methods

A cross-sectional study was conducted from December 2017 to January 2018 in four public health facilities in Uganda. Each piece of equipment from the neonatal department, imaging department or operating theatre were swabbed at three distinct points: a location in contact with the patient, a location in contact with the user, and a remote location unlikely to be contacted by either the patient or the user. The swabs were analyzed for bacterial growth using standard microbiological methods. Seventeen bacterial isolates were randomly selected and tested for susceptibility/resistance to common antibiotics. The data collected analyzed in STATA version 14.

Results

A total of 192 locations on 65 equipment were swabbed, with 60.4% of these locations testing positive (116/192). Nearly nine of ten equipment (57/65) tested positive for contamination in at least one location, and two out of three equipment (67.7%) tested positive in two or more locations. Of the 116 contaminated locations 52.6% were positive for Bacillus Species, 14.7% were positive for coagulase negative staphylococcus, 12.9% (15/116) were positive for E. coli, while all other bacterial species had a pooled prevalence of 19.8%. Interestingly, 55% of the remote locations were contaminated compared to 66% of the user contacted locations and 60% of the patient contacted locations. Further, 5/17 samples were resistant to at least three of the classes of antibiotics tested including penicillin, glycylcycline, tetracycline, trimethoprim sulfamethoxazole and urinary anti-infectives.

Conclusion

These results provides strong support for strengthening overall disinfection/sterilization practices around medical equipment use in public health facilities in Uganda. There’s also need for further research to make a direct link to the bacterial isolates identified and cases of infections recorded among patients in similar settings.

Where is my infusion pump? Harnessing network dynamics for improved hospital equipment fleet management

OBJECTIVE

Timely availability of intravenous infusion pumps is critical for high-quality care delivery. Pumps are shared among hospital units, often without central management of their distribution. This study seeks to characterize unit-to-unit pump sharing and its impact on shortages, and to evaluate a system-control tool that balances inventory across all care areas, enabling increased availability of pumps.

MATERIALS AND METHODS

A retrospective study of 3832 pumps moving in a network of 5292 radiofrequency and infrared sensors from January to November 2017 at The Johns Hopkins Hospital in Baltimore, Maryland. We used network analysis to determine whether pump inventory in one unit was associated with inventory fluctuations in others. We used a quasi-experimental design and segmented regressions to evaluate the effect of the system-control tool on enabling safe inventory levels in all care areas.

RESULTS

We found 93 care areas connected through 67,111 pump transactions and 4 discernible clusters of pump sharing. Up to 17% (95% confidence interval, 7%-27%) of a unit's pump inventory was explained by the inventory of other units within its cluster. The network analysis supported design and deployment of a hospital-wide inventory balancing system, which resulted in a 44% (95% confidence interval, 36%-53%) increase in the number of care areas above safe inventory levels.

CONCLUSIONS

Network phenomena are essential inputs to hospital equipment fleet management. Consequently, benefits of improved inventory management in strategic unit(s) are capable of spreading safer inventory levels throughout the hospital.

Perceived organizational culture and its relationship with job satisfaction in primary hospitals of Jimma zone and Jimma town administration, correlational study

BACKGROUND

The concept of Organizational Culture (OC) which refers to the pattern of values, norms, beliefs, attitudes and assumptions may not be articulated through verbal language. However, it shapes the way people behave and the way things get done in an organization. The management of organizational culture is increasingly viewed as necessary part of health system reform. Major cultural transformation of an organization must be secured alongside structural and procedural changes in order to achieve desired quality and performances improvements in health systems. It is therefore essential to understand organizational culture, job satisfaction level of the health workers and the link between them.

METHODOLOGY

Facility based cross sectional study was conducted in four primary hospitals of Jimma zone and town administration. A self-administered questionnaire was used to collect the data. The collected data were checked for completeness, entered and documented into Epi-data version 3.1 and Exported to SPSS version 21 for analysis. Finally descriptive statistics, Paired t-test and multiple linear regression analysis were used to assess the relationship between organizational culture and job satisfaction and the results were presented using tables and charts.

RESULT

It was indicated from the finding that, the dominant existing organizational culture typology in the primary hospitals was Hierarchy culture (MS = 22.31, ±2.82).and the preferred organizational culture typology was Innovative culture (MS = 26.09, ±4.72). The health workers had low to medium level of job satisfaction where only (29.40%) of the health workers were very satisfied with their hospital physical working environment. Existing perceived clan culture had positive and significant correlation with health workers' satisfaction in relation to work relation dimension (r = .16, p < 0.002).

CONCLUSION

while acknowledging all limitation of observational study we reached to the conclusion that an employees of the respective primary hospitals would prefer to work in environment characterized by innovative and clan culture and their satisfaction level is medium so that the managers should undertake major cultural transformation and must work to improve the job satisfaction level of health workers within their respective hospitals.

Responding to maternal, neonatal and child health equipment needs in Kenya: a model for an innovation ecosystem leveraging on collaborations and partnerships

Background

Up to 70% of medical devices in low-income and middle-income countries are partially or completely non-functional, impairing service provision and patient outcomes. In Sub-Saharan Africa, medical devices not designed for local conditions, lack of well-trained biomedical engineers and diverse donated equipment have led to poor maintenance and non-repair. The Maker Project’s aim was to test the effectiveness of an innovative partnership ecosystem network, the ‘Maker Hub’, in reducing gaps in the supply of essential medical devices for maternal, newborn and child health. This paper describes the first phase of the project, the building of the Maker Hub.

Methods

Key activities in setting up the Maker Hub—a collaborative partnership between the University of Nairobi (UoN) and the Kenyatta National Hospital (KNH), catalysed by Concern Worldwide Kenya—are described using a product development partnership approach. Using a health systems approach, a needs assessment identified a medical equipment shortlist. Design thinking with a capacity building component was used by the UoN (innovators, public health specialists, engineers) working closely and with KNH nurses, physicians and biomedical engineers to develop the prototypes.

Results

To date, four medical device prototypes have been developed. Two have been evaluated by the National Bureau of Standards and one has undergone clinical testing.

Conclusions

We have demonstrated an innovative partnership ecosystem that has developed medical devices that have undergone national standards evaluation and clinical testing, a first in Sub-Saharan Africa. Promoting a robust innovation ecosystem for medical equipment requires investment in building trust in the innovation ecosystem.