While the researchers did not employ any actual interventions, they do offer insightful recommendations. So how would you implement this as a practice change locally?

Please respond to Professor below
You nicely described some possible solutions for that particular medical community. However, one of the questions requiring a response for your discussion this week was omitted. Can you provide additional discussion about the explicit steps you would employ in the design phase and implementation phase of your future practice change project to instill implementation fidelity in the design, implementation, evaluation, and dissemination phases of your future practice change project? As I noted above, it is important to note that implementation fidelity requires that no aspect of the research study intervention can be altered. This includes implementation of the intervention, outcomes, and measures employed to determine outcomes. While the researchers did not employ any actual interventions, they do offer insightful recommendations. So how would you implement this as a practice change locally?

Initial response
The research by Ejekam et al. (2019) in Lagos sought to assess healthcare providers’ clinical experience, including knowledge, user experience, and perception of the effectiveness of Oxytocin. The study’s cross section approach used doctors and nurses, employed in public and private facilities and who offered obstetric and gynecology services.
The study reported a high failure rate of up to 74% ineffectiveness of Oxytocin in aiding medical procedures and being of help to the patient. WHO recommends using Oxytocin for reducing obstetric hemorrhage, especially postpartum (PPH), to help reduce maternal mortality. It is also helpful for induction, stimulation, and augmentation of labor when benefits outweigh the risks. However, practitioners (about 40% of the respondents) in Lagos used up to three times the recommended dosage to achieve effectiveness. WHO recommends 10IU, but there were records of up to 30IU to 60IU in Lagos hospitals. These practitioners did not also suspect the ineffectiveness of the medicines they were using. Another outcome from the study was on storage. A whooping 41-52% of the respondent did not know that the treatment required storage in refrigerators. This seem to couple the lack of temperature-time indicators in oxytocin vials that could ensure quality at the point of use, as is familiar with many vaccines. About 13% of the respondents have used ineffective Oxytocin in their practice. However, the inappropriate use and inconsistent use blocked the perception of the ineffectiveness of the medicine in Lagos facilities among the practitioners.
Therefore, the study brings to fore the state of consciousness of health practitioners on the ineffectiveness of medicines, especially Oxytocin, in Lagos hospitals. It also identifies gaps in pharmacovigilance concerning the application and use of medication, particularly Oxytocin. The levels of knowledge were also an issue regarding the use, application, procedure, and medicines protocol. Doctors went on to carry out surgical procedures (more than 50%) even when they realized the Oxytocin was not working. This was unethical and inconsiderate. It unearthed gaps in the conventional use of patient care guidelines and evidence-based procedure implementations in sub-Saharan Africa, particularly in Lagos, Nigeria.
Health and medical training and practices have laid out standards, procedures, and protocols for patient care, medication administration, and surveillance. There are also rules as to how often medical practitioners should upgrade and go for debriefings to keep abreast of changing and upcoming and emerging trends. The health practitioners in Lagos reveal a lack of consistency in following conventional practice in medicine. This counts as an omission on regulatory bodies in the country and a disregard in obligation for the facilities. In totality, the study results spell doom for the entire medical fraternity ranging from the massive investments in medicine, patients’ life and costs, and the proliferation of malpractices along the medicine chain due to disregard of legal and moral ethics checks.
Consequently, all stakeholders in the medical field in Nigeria need to be sensitized – medical licensing bodies, peer organizations, the authority, training institutes, and more importantly, the professional bodies, as appertains this wanton kind of professional lapse. Each of them needs to go back to the drawing board and check where and why the catastrophic medical lapse has occurred—each needs to tighten their grip on adherence to the rule of law and following procedures. Practitioners could adhere to updating and reference available data and information in the use and administration of medication. The patient interventions must rely on informed decisions in line with updated knowledge and faithfulness to professional and evidence-based nursing practice.

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