ABSTRACT
The storing, retrieval, sharing, and utilisation of health care information, data, and knowledge for communication and decision-making are all aspects of health IT, an application of information processing including both computer hardware and software. The benefits of health information technology (IT) in the healthcare industry include enhancing drug safety, tracking, and reporting; boosting quality of treatment through optimised access to and adherence to standards; and enabling communication between healthcare providers. Data gathering is made possible by health IT systems for quality management, outcome reporting, and the tracking and reporting of public health diseases.
Establish the role of health information technology (HIT) in promoting patient safety at Mama Lucy Kibaki Hospital (MLKH), Nairobi City County, Kenya, was one of the objectives of the study, which assessed how well HIT was used in the hospital. Identifying HIT organisational variables, identifying HIT technological aspects, and characterising the distinct system components that affect how HIT is used to promote patient safety. The researcher used a descriptive cross-sectional study approach and purposefully chose a sample size of 147 participants.
The statistical package for social science (SPSS) version 22.0 and STRATA 12 software for Windows were used to code and analyse the qualitative data, while content analysis was used to analyse the quantitative data. Chi-square tests were used to compare the associations between the variables in the qualitative and quantitative analyses. 1) The majority of respondents—66 in total—felt that HIT was crucial to enhancing patient safety, according to the study’s findings. The hospital determined that the EMR, CPOE, and DSS were significant HITs helpful in ensuring patient safety. Following binary logistic regression, the study discovered enough data to suggest associations between effective patient safety promotions through HIT, including: similarity of access passwords (OR=1.2 [95% CI 1.075-1.600]); periodic trainings on HIT (OR =2 [95% CI 1.456-2.027]); involvement of HIT users (OR=1.5 [95% CI 1.180-1.654]); auto logout of users (OR=0.2 [95% CI 0.052-0.801]); knowledge The study suggested promoting and modifying HIT in the healthcare delivery at MLKH in order to continuously evaluate and monitor patient safety results.
CHAPTER ONE
INTRODUCTION
1.1 Background to the study
Innovative care delivery and health care reform projects both rely on health information technology (health IT). The avoidance, mitigation, and amelioration of unfavourable outcomes or injuries resulting from the procedures of providing healthcare is the subset of patient safety. According to Singh and Sittig (2015), health IT is broadly described as the hardware and software, including electronic information systems, used to generate, store, transmit, receive, and analyse health information. Electronic health records (EHRs), health information exchange (HIE), and telehealth are the three main parts of health IT. The widespread adoption of health IT can minimise medical mistakes, enhance patient care quality, and reduce costs through increased productivity (Claig, 2016). (IOM, 2012) defines health information technology as the use of a variety of technologies to collect, exchange, and analyse health data.HIT is crucial to the treatment we give our patients and helps to increase patient safety. The ability to quickly communicate patient information in a format that is readable, improved medication safety through increased legibility, which may reduce the risk of medication errors, and ease of retrieving patient information are all advantages of health information technology (IT).
One of the most crucial things medical practitioners can do for their patients is to keep them safe. However, research indicate that the rates of injury are higher in low- and middle-income nations, where it is estimated that 1 in 10 hospital patients suffer harm. According to the World Health Organisation (WHO), safety is a crucial component of high-quality medical treatment.
In health care systems all around the world, unsafe pharmaceutical practises and medication mistakes are a primary source of injury and preventable harm. According to WHO (2018), the yearly cost of drug mistakes is expected to be $42 billion USD worldwide. The purpose of HIE is to increase patient access to health information, which will enable patients to make better-informed treatment decisions that will enhance their health outcomes. The ease of access to clinical data, improved communication between hospitals, labs, pharmacies, doctor’s offices, and long-term care facilities, improved care coordination that reduces duplication of testing, and improved public health reporting and monitoring are just a few of the key advantages of HIE. Since the 1960s, Electronic Health Records (EHRs), a kind of health IT, have been hailed as having the ability to completely transform how healthcare systems operate. Health IT has the ability to enhance the overall quality, safety, and efficacy of healthcare delivery (Nieva & Sorra, 2003). EHRs have the potential to stop preventable medical mistakes when they are optimised. In reality, there has been significant discussion about how EHRs may change the routine operations of hospitals and other healthcare institutions to get the best outcomes.
The majority of government departments have been able to use IT systems in their operations. The financial industries have excelled in this area. Currently, online access to current financial service account information and transactions is accessible. According to Blumenthal (2009), introducing “an hour of coding classes for primary school pupils” is transforming them into more machine-like beings. He predicts that in the not-too-distant future, having knowledge of or proficiency in IT will become essential. Any perceived risks in the health industry that can be addressed by information technology are referred to as health IT risks.
The developed world is doing a fairly good job of putting the newest IT innovations in the healthcare industry into practise. For instance, the United States (US) built the National Grid System more than ten years ago, which connected places where health services are delivered across the country. According to later polls designed to gauge the effectiveness of such services, the result was a remarkable increase in both the speed of care delivery and patient satisfaction (Ballard, 2003). Additionally used in a variety of capacities are clinical decision support (CDS) and computerised physician order entry (CPOE). It has been extremely difficult to integrate IT systems in the health sector in underdeveloped nations. This difficulty is frequently linked to corruption, selfishness, or competing interests among policymakers and drivers, among other things. Patients and doctors alike have serious concerns about privacy, confidentiality, and security. The danger of data loss also contributes to the ongoing necessity for backups of all data held in information systems. In the context of patient safety, big data analytics, business intelligence, and cloud computing are additional technology tools that health IT may want to investigate (Dommering, 2012).
According to a research done in US hospitals, the probability of mistake on a prescription medicine order is reduced by 48% (95% CI: 41% to 55%) when processed through a CPOE system. Given this impact size and the extent of CPOE adoption and use in hospitals, it was anticipated that prescription mistakes would decrease by 12.5% in 2008, or over 17.4 million pharmaceutical errors would be avoided in the United States during that year (Radley et al., 2008).
drug mistakes can happen throughout the prescription, dispensing, and administration stages of drug management and entail giving the patient the incorrect medicine, dose, or route.
In Nairobi City County, Mama Lucy Kibaki Hospital (MLKH) is a level four hospital. According to Nyamasege (2015), the hospital is situated in a catchment that is heavily inhabited and has a population of almost two million people. The hospital has 137 beds, but on average, 800 outpatients are seen each day, exceeding the institution’s daily bed capacity. Obstetrics and Gynaecology, the Comprehensive Care Centre, male and female medical and surgical sections, and the outpatient unit are just a few of the departments that make up the hospital. Mama Lucy Kibaki Hospital was built by the Chinese government for a total of 544 million Kenyan Shillings. The plan’s main goal was to reduce the amount of traffic at Kenyatta National Hospital (Owuondo et al., 2015). Due to high demands, its location predisposes it to patient safety issues. According to Nairobi County statistics for 2015, MLKH had the highest number of negligence cases (3/300,000) (Nyamasege, 2015). This emphasises the necessity of doing the research at MLKH to comprehend how HIT will function in the context of preserving patient safety in order to minimise pharmaceutical mistakes, fatalities, and carelessness.
1.2 Statement of the Problem
Hospitals and doctors are still hesitant to deploy CPOE systems despite the well-documented capacity of health information technology to decrease medical mistakes and identify possible safety issues. However, organisations have drastically altered how they see patient safety due to persistent obstacles to the use of information technology, which the majority of payers and providers recognise as crucial. Poor handwriting or transcribing of pharmaceutical orders has increased mistakes due to non-use of the CPOE system (Kathini, 2012).
The standard of treatment has increased in Kenya’s health system throughout time, and hospital patient safety issues have decreased. However, patients continue to express unhappiness with several critical aspects of patient safety (WHO, 2014). Concerns about information privacy, confidentiality, and security, diagnostic and prescription errors, delays in drug delivery, and medication errors or negligence have increased (WHO, 2014). Medication errors or negligence were reported at a high of two (2) in every 100 patients, accounting for over half of the patient safety concerns. Compared to private health institutions, public health facilities had more serious concerns about patient safety. The majority of Kenyans frequently endure delays in receiving care or are unable to obtain it at all, which makes their situation much worse (Nyamasege, 2015). These safety problems can have a variety of negative effects, including needlessly prolonged illness, more difficult scenarios like paralysis from advanced illnesses, or even fatal outcomes on occasion (Nyamasege, 2015). The health sector in Kenya has been one of the slowest to embrace the promise of health IT and realise its full potential, despite the ability of IT to close health gaps and enhance patient safety. As a result, Kenya continues to see an increase in patient safety problems, the most of which have already been stated (Barnet et al., 2016). Risk management employees, safety staff, and IT workers have the chance to work together in the cross-cutting field of health IT safety. The identification, analysis, and mitigation of health IT safety issues benefit from the unique knowledge that each discipline perspective brings to the table (Rudin et al., 2014)..
1.3 Objective of the study
The main objective of the study is to determine the Health information Technology utilization in promoting patient safety among healthcare workers at mama Lucy kibaki hospital, Nairobi City County, Kenya
- To identify technological factors influencing utilization of HIT in promotion of patient safety at MLKH
- To determine HIT organizational factors influencing utilization of HIT in promotion of patient safety at MLKH
To describe individual system components influencing utilization of HIT in promotion of patient safety at MLKH
1.4 Research Questions
- What is the level of utilization of HIT in promoting Patient Safety at MLKH?
- Which organizational factors influence the utilization of HIT in promotion of patient safety at MLKH
- Which technological factors influence utilization of HIT in promotion of patient safety at MLKH
- Which individual system components influence utilization of HIT in promotion of patient safety at MLKH
1.5 Significance of the Study
The study’s findings are useful to the researcher since they supplement what is learned in school. The study is beneficial to aspiring Health IT researchers as well. The study’s suggested treatments spread knowledge about risk management. Finally, the study’s findings will empower the Ministry of Health (MOH) to take prompt action in response to the inadequacies in Health IT risk management..
1.6 Scope of the study
The main restriction was that only medical personnel, not patients, may be used. The participants were asked to offer solutions and ideas that would help both them and their clients in order to get past this.
1.7 Limitations of the study
Persuasion and written consents were utilised, if needed for secrecy, to gather sensitive information. The little local literature was another constraint on the investigation. To address this issue, a thorough analysis of the local literature that was accessible was conducted.
1.8 Definitions Of Terms
Challenges: Human-based difficulties to embracing the systems
Confidentiality: The ethical principle or legal right that a physician or other health professional will hold secret all information relating to a patient, unless the patient gives consent permitting disclosure.
E-iatrogenesis: Patient harm caused at least in part by the application of health information technology. Unintended errors from the intended design of healthcare information systems as users interact with systems differently than anticipated
Error: an occurrence where a planned sequence of mental or physical activities fails to achieve the intended outcome and when this failure cannot be attributed to some chance intervention or occurrence
Hardware Software Computing infrastructure used to support and operate clinical applications and devices
Health IT: The application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision-making.
Negligence: Failure to exercise appropriate and or ethical ruled care expected to be exercised amongst specified circumstances.
Optimal: Highest level or quality possible
1.9 Organization Of The Study
This research work is organized in five chapters, for easy understanding, as follows. Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study. Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature. Chapter three deals on the research design and methodology adopted in the study. Chapter four concentrate on the data collection and analysis and presentation of finding. Chapter five gives summary, conclusion, and recommendations made of the study.
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