Use this URL to cite or link to this record in EThOS:
Title: Adverse events associated with chemotherapy in a cancer centre in a developing country
Author: El-Mahdi, Alya Faysal
ISNI:       0000 0004 7656 3109
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2017
Availability of Full Text:
Access from EThOS:
Access from Institution:
Extensive international evidence has shown that a considerable number of patients are harmed by medication errors every year. This is the first study to investigate medication errors within cancer services in Sudan. The first aim of this study was to investigate patient safety culture in a large cancer centre in Khartoum, Sudan. Focus groups using the MaPSaF were conducted with staff from the medical, nursing and pharmacy teams. The findings revealed lack of knowledge regarding patient safety systems among research participant. Participants implied that the study hospital has a low priority for patient safety. The second aim of the study was to investigate the frequency, nature and potential causes of prescribing errors associated with chemotherapy. A mixed methods study was designed, composed of a quantitative prescription analysis followed by Critical Incident interviews and focus groups. During the study period, 10% of prescriptions contained at least one error, of which, nearly 90% of which had the potential to cause serious and life threatening harm. Errors were more likely with prescriptions containing cisplatin (chi-square test p < 0.001) or carboplatin (chi square test P < 0.05). Participants attributed errors to a culture where they were unable to ask questions, poor clinic organization, lack of knowledge and lack of essential equipment and resources. The third aim study was to identify the nature and frequency of errors associated with administration of chemotherapy to patients and to explore their potential causes. The study was composed of mixed methods, using observation and critical incident interviews. More than 300 intravenous doses were observed, none of which were correctly prepared and administered to patients. None of the nurses wore appropriate protective clothing or adhered to aseptic technique. More than one third of intravenous doses were calculated inaccurately and more than one fifth of the doses were withdrawn inaccurately. Nurses attributed the errors to lack of training, supervision and resources. In conclusion, findings show that patient safety is of a low priority at the study hospital which is leading to a high risk of harm to both patients and HCWs. A set of four interventions were recommended as a result of findings from the current work and mapped to the COM-B model of the Behaviour Change Wheel. The intervention aim to change healthcare worker behaviour, through centralisation of chemotherapy preparation, standardisation of chemotherapy prescribing, implementation of incident reporting systems and standardisation of care. These interventions are also aimed at creating legislation and guidance to regulate the practice of healthcare workers dealing with cytotoxic chemotherapy.
Supervisor: Whittlesea, Catherine Margaret Cecilia ; Davies, John Graham Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available