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Item Critical incidents in gynaecology: audit at Charlotte Maxeke, Johannesburg Academic Hospital(University of the Witwatersrand, Johannesburg, 2023-07) Chikwiri, Christopher; Chauke, LawrenceBackground: Critical incidents are among the ten leading causes of death and disability worldwide. Improving patient safety has become a global priority and one way to reach this goal is to report and analyse critical incidents. Objectives: To describe the epidemiology, patient outcomes and avoidable factors associated with critical incidents in gynaecology department at Charlotte Maxeke Johannesburg Academic Hospital (CJMAH). Methods: This research was a retrospective descriptive analysis of critical incidents in patients admitted to gynaecology wards at CMJAH from 1st January 2019 to 31st December 2019. All medical records of patients identified to have experienced critical incidents were reviewed and demographic information, timing of admission, critical incident markers and avoidable factors were extracted for analysis. Results: In total there were 257 critical incidents (CI) in 2082 gynaecology admissions during the one-year study period, which gives a critical incidence of 12.3%. A total of 158 patients experienced at least one or more critical incidents. The mean age (SD) of patients was 41.1 (14.8) years. The median (IQR) duration of admission was 6 days (3-10). Reasons for admission were emergencies 60 (38.0%), elective 54 (34.2%), oncology 44 (27.8%). Majority of the critical incident events were omission of procedures (n=45, 17.5%), deaths (n=34, 13.2%), massive transfusion (n=30, 11.7%), repeat laparotomies (n=29,11.3%) and fistula/organ damage (n=19, 7.4%). Avoidable critical incidents were (n=87, 55.1%). Most critical incidents were associated with no harmful outcomes to the patients (50, 31.5%), death (34, 22.8%) (mainly as a result on oncology admissions), moderate disability (29,17.9%), minimal disability (26, 16,1%), permanent/severe disability (14, 8.6%) and in (5,3.1%) harm could not be specified. Critical incidents forms were only filled out in 39 patients, that is a reporting rate of 24.7%. Conclusions: Critical incidents are a major cause of unnecessary harm in gynaecology at CMJAH. Half of these critical incidents are avoidable and therefore corrective measures can be undertaken to eliminate them in order to improve patient safety. Underreporting of critical incidents is still a major problem. There is need for precise definitions of critical incidents terms and modification of critical incident reporting system (including electronic) to promote patient safety culture in gynaecology.Item Awareness Factors Affecting Contraceptive Uptake in women attending the Gynaecology Out-Patients Department, at a Tertiary Hospital(University of the Witwatersrand, Johannesburg, 2023) Ndlovu, SineguguObjectives: The objectives of the study were to assess the knowledge and awareness of contraception in the women seen at Chris Hani Baragwanath Academic Hospital Gynaecology Out-patient department. We also looked at the efficiency of contraceptive counselling from the health care providers and assessed patient satisfaction. Study design: We conducted a prospective, descriptive, cross-sectional study. A survey of 100 women, of reproductive age attending the gynaecology out-patient department, was conducted using a questionnaire over a period of 3 months. Sample size was determined by use of The Survey System, Sample Size Calculator. The survey assessed the women’s knowledge regarding barrier methods as well as hormonal methods (in the form of combined oral contraceptives, injectables, the implant, the intrauterine device, emergency contraception) and permanent forms of contraception. Independent variables were age, level of education, employment, parity. Dependant variables were prevalence of contraceptive uptake, knowledge of available contraception. The association between the prevalence of contraceptive uptake and the knowledge regarding the available methods of contraception was assessed using the Chi square test, as well as the Mann Whitney U test. A p-value of 0.05 was decided upon for statistical significance an odds ratio and 95% confidence intervals were reported. Results: Overall Our study found that the total percentage of women using a method of contraception was 39.79 % while those that were not on any method of contraception was 60.20%. Our study also found that there were high rates of discontinuation of contraception. Overall,there was poor contraceptive awareness and knowledge. There was more awareness than there was intricate knowledge regarding the different forms of contraception. Contraceptive counselling increased the rate of contraceptive uptake; of the women that were initially counselled, and then offered contraception, 82.9% of them were agreeable. Conclusion: Awareness does not equal knowledge. All gynaecology out-patient visits should be seen as an opportunity for contraceptive counselling, regardless of the main complaint. The high rate of discontinuation of hormonal contraception should be further assessed, and women should be counselled prior to discontinuation, and preferably placed on another form of contraception which suits their needs