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. In
recent, resistance to Choroquin has occurred in Nias. One of
the potential factors is provider behaviour in diagnosing and
treating malaria cases. In Nias district hospital, malaria is one
of the ten most frequent diseases. This hospital functions as
referral for 18 health centres in the area.
Objective: This study focused on malaria case management
and aimed to: (1) describe occurrence of diagnostic and
treatment errors; (2) describe occurrence of error of omission
and error of commission; (3) to explore provider behaviour in
managing the disease; and (4) identify predisposing,
enabling,and enforcing factors to medical errors.
Method: A combination of quantitative and qualitative research
was applied in this study. One hundred forty six (146) blood
slides available in May 2007 were re-examined in Universitas
Gadjah Mada (UGM) laboratory to measure diagnostic
agreement. In addition, all medical record of malaria cases
were used to identify diagnosis and treatment errors.
Interviews were carried out with general practitioners,
specialists, laboratory staff and nurses who dealt with malaria
case management.
Result: Kappa index was low (0.04). Among all patients
diagnosed or treated as malaria (n=92), the occurrence of
medical error was 1.87 per patient. Among these, this study
identified 98 diagnostic errors, consisting of 16 cases of error
of ommission (17.39%) and 82 cases of error of commission
(89.13%). Treatment errors occurred in 92 cases, i.e. 19 cases
of error of ommission (20.65%) and 73 cases of error of
commission (79.35%). Provider behaviour contributed to
medical errors. The behaviour was supported by lack of
training on malaria for the hospital staff, absence of standard
operational procedure in managing malaria cases, incompetent
laboratory staff and lack of reward for good performance.
Conclusion: The occurrence of medical error in case
management of malaria was high. Improvements in clinical
quality should be prioritized, taken into account the underlying
factors.
Keywords: medical errors, malaria case management, hospital,
Nias