Mulago looks to reduce surgical mishaps with WHO checklist
“We now have a built-in checklist on the computer. We are moving away from the old paper-based system."
Inyeong Park Health specialist KOFIH with a team of medics and IT at Mulago hospital. (Photos by Violet Nabatanzi)
________________
Mulago National Referral Hospital is set to improve surgical safety after adopting the World Health Organization (WHO) Surgical Safety Checklist.
The tool aims at eliminating errors during surgery.
The UN health agency developed several checklists to improve patient safety and health outcomes.
These tools are described as user-friendly, adaptable to various clinical settings, and designed to reduce complications and deaths during surgical procedures.
“With the new digital system, our services have become more efficient,” she said.
“We now have a built-in checklist on the computer. We are moving away from the old paper-based system."
Under a project funded by the Korea Foundation for International Healthcare (KOFIH), Mulago received $10,000 (sh37 million) to purchase computers for use in operating theatres.
These computers will be used to input patient data into the hospital system, improving surgical documentation and patient safety.
'No excuses'
Before surgery begins, the surgeon must go through the checklist to confirm critical information such as the patient’s identity, blood group, and the presence of the anaesthesiologist, ensuring that all requirements are in place for a safe procedure.
Dr Rosemary Byanyima, the Executive Director of Mulago Hospital and Inyeong Paik Health specialist KOFIH (C) posing for a picture with health workers after a meeting at Mulago hospital. 
During surgery, medical staff count and monitor instruments used, reducing the risk of leaving items inside patients’ bodies, a mistake that has happened in the past due to the lack of proper checklists.
“There is also a post-operative checklist which helps monitor the patient’s vitals and confirm that the procedure was completed correctly. This system minimizes risk throughout the surgical process,” said Byanyima.
She said that in the past, some patients returned with surgical instruments left inside them simply because the checklist wasn’t used.
“You know what that means. Any mistake puts the patient at serious risk."
Byanyima added that with the manual system, staff often lacked basic supplies like stationery.
“But with computers, there are no such excuses. We also plan to integrate the checklist into the hospital’s electronic medical records to enhance efficiency.”
She explained that digitizing Mulago’s systems is an ongoing process that will continue into the next financial year.
As part of the project, Mulago plans to begin installing computers in the lower Mulago theatres in the upcoming financial year, with plans to expand to upper Mulago later.
'Compliance has improved'
Diana Ainenomugisha, a nursing officer at the hospital and a laparoscopic nurse trained in South Korea, won the project in November 2024 to promote the use of the WHO Surgical Safety Checklist.
While WHO introduced the checklist in 2008, a study conducted at Mulago in 2012 showed a low compliance rate of just 10 percent.
“The checklist is crucial for patient safety,” said Ainenomugisha said.
“For instance, if a surgery starts with 20 instruments on the table, we count every item before and after to ensure nothing is left inside the patient. This process helps avoid serious surgical errors.”
Ainenomugisha said that in some cases both in Uganda and globally, patients have undergone the wrong surgeries, such as brain surgery instead of knee surgery, due to failure to use the checklist.
“The checklist ensures the surgical team verifies the patient's identity, the correct procedure, and the correct surgical site. Even if two patients have similar names, their unique identification numbers help prevent errors,” she explained.
“At the end of the project, we assessed our compliance rates. We found that theatre staff are now consistently entering data, and our compliance has improved to around 70 percent and 62 percent for the respective checklists.”