Compliance with the WHO/WFSA standards for monitoring and associated factors during anaesthesia at Mulago National Referral Hospital

Abstract

Background: Access to safe anaesthesia, including proper intraoperative monitoring, is a fundamental human right. Monitoring does not directly prevent adverse incidents or accidents in the perioperative period. Still, it indirectly reduces the risks of incidents and accidents by giving an early warning that a patient's condition is deteriorating, allowing for timely intervention and making it an essential aspect of safe anaesthesia. Objective: To determine the availability of monitors, compliance with the WHO/WFSA standards for monitoring and the associated factors during anaesthesia at Mulago National Referral Hospital. Method: This was a sequential exploratory mixed-method study. Fifteen operating rooms were assessed for the availability of monitors, and intraoperative monitoring of 424 patients was observed from start to end of anaesthesia in a cross-sectional study. Following this, a qualitative study involving 24 anaesthesia and two key informants was conducted to determine factors associated with monitoring. Ethical approval was obtained for the study. Results: None of the rooms had all the monitors. Thermometers, ECG, and NIBP were mainly available (93.3% each). Most rooms had faulty oxygen analysers (80%) and Capnography (80%). Compliance with monitoring was only 41.5%, with not using carbon dioxide detection (67.2%) and no audio signal (23.3%) being the most significant contributor to the poor monitoring. ASA classification, Cadre of anaesthesia providers, and type of surgery were statistically significant for monitoring (P-value < 0.05). The factors affecting monitoring were faulty and lack of monitors and supplies, overworked, tired and reluctant anaesthesia providers, lack of funding to purchase accessories for and maintain anaesthesia equipment and poor anaesthesia charts. Conclusions and Recommendations: Compliance with standard monitoring at Mulago is poor, with faulty monitors, poor anaesthesia charts, lack of monitoring and tired, reluctant anaesthesia providers being the primary culprits. We recommend that the government improve funding for the purchase and maintenance of equipment, that the hospital improve the anaesthesia chart, and that anaesthesia providers maintain equipment and diligently adhere to standard practice.