Implementation of a colour-coded universal protocol safety initiative in Guatemala

Area of Science:

• Global Health
• Patient Safety
• Surgical Quality Improvement

Background:

• Universal protocol implementation faces challenges in low- and middle-income countries, especially with cross-language communication.
• A quality improvement initiative aimed to implement a color-coded universal protocol in a Guatemalan hospital with US and Guatemalan providers.

Purpose of the Study:

• To test the feasibility and effectiveness of a color-coded universal protocol in a diverse healthcare setting.
• To reduce errors in patient identification and documentation in a surgical center.

Main Methods:

• A two-step patient identification and documentation checklist was implemented over three phases (2013-2016).
• The protocol involved pre-operative chart verification and a visual cue (blue hat), followed by intraoperative confirmation.
• Iterative analysis of implementation barriers and workflow modifications were conducted after each phase.

Main Results:

• The rate of errors in documentation or universal protocol steps decreased significantly over the implementation phases.
• Initial error rate was 58.8% (30/51 patients), reduced to 4.6% (2/43 patients) by the third phase.
• All identified errors were corrected before surgery, with no adverse outcomes reported.

Conclusions:

• Cross-country care teams present patient safety challenges.
• A color-coded universal protocol can effectively prevent and reduce errors, enhancing patient safety in international healthcare collaborations.