BACKROUND

Kamuzu Central Hospital (KCH) is a leading government institution forhealth care in Malawi. Since end of 2020 KCH started a partnership withthe University of applied Sciences Rhein Main (HSM), WiesbadenInstitute for Healthcare Economics and Patient Safety (WiHelP) anddeveloped a project to improve in patient safety.
Patient safety is a central aspect of patient care, aiming to preventpatient injuries and the resulting consequences for the patient, thehospital staff and the hospital. KCH is one of 8 hospitals in Malawiseeking accreditation according to the Council of Health ServiceAccreditation of Southern Africa (COHSASA) standards. The COHSASAstandards are measured with a scale from 1 to 100. If the adherence tothe standards is between 0 and 40, one is not compliant with thestandards. If the measured value is between 41 and 80, one is partiallycompliant with the standards. If the measured value is between 81 and100, one is compliant with the standards.

METHODS
Six Patient Safety Ambassadors (PSA) were trained in the operatingtheatre and surgery areas with the help of HSM. Several trainings of thestaff in the area of surgery and the OR were conducted by the PSAs,with the topics of documentation, safe surgery, safe patientidentification.
The Operation Theatre (OT) documentation was revised andstandardised. A tool to measure adherence to standard documentationwas developed. The quality of the documentation was measured over aperiod of 9 months. At the start of the project, an adherence of 16% wasmeasured and has increased to 74%.

Results

In December 2022, the third progress survey according to COHSASAstandards was conducted by Malawian auditors. In particular, thecategories of quality management (QM), risk management and theatrehave benefited from the Safe@KCH project.
In Qm (SE 7), the baseline score in 2018 was 13. In the 2019 ProgressSurvey, a score of 31 was achieved and in 2022, the score almostdoubled to 57.
In Risk Management (SE 5): a score of 17 was measured in the 2018Baseline Survey. In the Progress Survey of 2019 a value of 24 and in theProgress Survey of 2022 a value of 47.
In OT (SE 14) a value of 22 was measured in the Baseline Survey in 2018.In the 2019 Progress Survey a score of 30 and in the 2022 Survey a scoreof 66.
If nothing else, this had a major impact on the hospital's overall AverageScore. In 2018, the Average Score for the Hospital was 21, in the 2019Progress

DISCUSSION
The available data confirm that the project has led to significantimprovements in key areas of the hospital. The result adherence to thestandards, especially in the Operating Theatre, was more than doubled.As it turned out, with the focus on patient safety, there was also a veryfactual discussion about processes and safety in general. In our opinion,it makes sense to install Patient Safety Ambassadors in Hospitals inMalawi. We therefore recommend rolling out the programme to otherhospitals. It will then become clear whether the results can bereproduced there as well