ISQUA18-2064Audit Analysis of Malpractice Litigation Cases in Nursing Practice in Private Health Care in South Africa to Improve Safe Quality Patient Care

Abstract

Objectives: Malpractice is compromising the quality and safety of patient care. In South Africa the underlying factors which result in adverse events causing extensive morbidity and mortality are not well understood. Many patients admitted to health establishments are subjected to malpractice negligence not related to their actual healthcare problem. Adverse events result from factors such as organizational, clinical management, human behaviour (Runciman et al., 2010:2-3). As lead researcher of a study investing malpractice in nursing practice in South Africa two independent research studies were completed in two of the wealthier provinces in South Africa, where the largest and most prominent private hospitals are based. The research question which gave guidance to the study was “What are the factors that contribute to malpractice litigation in nursing practice within the private healthcare sector in South Africa” The objectives included: 1. To complete an audit of the nursing process documents of a trial bundle of a litigated case. 2. Identifying the factors which contributed to the adverse events 3. 3 Categorising the adverse events according to principle type 4. Identifying the other members of the multi-disciplinary health team involved in the adverse event 5. Assessing the severity of the adverse event Methods: A quantitative, retrospective audit research design was applied. The target population was trial bundles of cases completed between 2011 and 2016. Trial bundles were provided by attorney firms who gave consent and consequently convenience sampling was applied, 41 trial bundles for Gauteng and 81 for the Western Cape provinces. Conceptual framework which gave guidance to the study included: The International Classification for patient safety (World Health Organisation, 2007:4-5), and the Safety Assessment Code (SAC), (New Zealand Incident Management System, 2008:1). Ethics approval was obtained for the study from Stellenbosch University (Ref N16/02/027 principle study, Gauteng S16/10/222; Western Cape S16/10/204).A waiver of consent to audit the trial bundles without the plaintiffs' permission. Ethical principles with specific reference to anonymity and confidentiality about attorney firms, hospitals, health professionals or plaintiffs were maintained An audit instrument was designed based on 42 trial bundles. Reliability was tested through a test-retest method through the audit of these trial bundles. A pilot study was completed on these trial bundles. Experts in the field of quality assurance and an expert witness of the court supported the validity. Trial bundles were audited with an audit instrument and analysed using the Statistical Package for Social Sciences (SPSS). Results: Results show that a variety of factors influence adverse events: lack of knowledge (75%), poor monitoring (69%), clinical manifestations not responded to (63%), not following guidelines (91%), behavioural (66%), lack of supervision (45%); 39% of the adverse events were severe, outcome of patients included disabled (25%), increase in hospital stay (79%), additional surgery (43%), quality of lives affected (69%) and 20% died; registered nurses involved (87%), nursing and medical (50,6%) Conclusion: Recommendations include the increase in training, improving monitoring of patients, supervision and adhering to guidelines to ensure safe quality patient care.