Medical Error dan Perilaku Klinis Petugas Kesehatan dalam Penatalaksanaan Malaria di RSU Gunung Sitoli Nias

Abstract

Background: Malaria is a major health problem in Nias. Inrecent, resistance to Choroquin has occurred in Nias. One ofthe potential factors is provider behaviour in diagnosing andtreating malaria cases. In Nias district hospital, malaria is oneof the ten most frequent diseases. This hospital functions asreferral for 18 health centres in the area.Objective: This study focused on malaria case managementand aimed to: (1) describe occurrence of diagnostic andtreatment errors; (2) describe occurrence of error of omissionand error of commission; (3) to explore provider behaviour inmanaging the disease; and (4) identify predisposing,enabling,and enforcing factors to medical errors.Method: A combination of quantitative and qualitative researchwas applied in this study. One hundred forty six (146) bloodslides available in May 2007 were re-examined in UniversitasGadjah Mada (UGM) laboratory to measure diagnosticagreement. In addition, all medical record of malaria caseswere used to identify diagnosis and treatment errors.Interviews were carried out with general practitioners,specialists, laboratory staff and nurses who dealt with malariacase management.Result: Kappa index was low (0.04). Among all patientsdiagnosed or treated as malaria (n=92), the occurrence ofmedical error was 1.87 per patient. Among these, this studyidentified 98 diagnostic errors, consisting of 16 cases of errorof ommission (17.39%) and 82 cases of error of commission(89.13%). Treatment errors occurred in 92 cases, i.e. 19 casesof error of ommission (20.65%) and 73 cases of error ofcommission (79.35%). Provider behaviour contributed tomedical errors. The behaviour was supported by lack oftraining on malaria for the hospital staff, absence of standardoperational procedure in managing malaria cases, incompetentlaboratory staff and lack of reward for good performance.Conclusion: The occurrence of medical error in casemanagement of malaria was high. Improvements in clinicalquality should be prioritized, taken into account the underlyingfactors.Keywords: medical errors, malaria case management, hospital,Nia