University of Cape Town, South Africa
Title: Exploring healthcare negligence: A nurse researcher’s journey in a developing country
Biography: Una Kyriacos
Statement of the Problem: In Cape Town, South Africa, little if any educational preparation is available for nurses embarking on the role of expert nurse witness in medical negligence lawsuits. Until recently litigation was prevalent in the private healthcare sector but recently healthcare consumers in the public sector are becoming litigious, with consequences for the national health budget.
The purpose of this paper is to describe a personal journey of research into patient safety with particular reference to the development and testing of an early warning scoring (EWS) vital signs observations chart for general medical and surgical wards for recognition of early signs of clinical deterioration. In some instances of reported healthcare negligence, exploration is best achieved using aspects of the Root Cause Analysis (RCA) approach.
Findings: The modified EWS (MEWS) designed for local use has provided a valid measuring tool to plot clinical and physiological deterioration. Our randomized controlled trials (RCTs) have shown that there was a significant difference in recording between trial arms for physiological parameters listed on the MEWS chart but omitted from the traditional/standard ward observations chart: respiration rate, oxygen saturation, level of consciousness and for clinical parameters omitted from the traditional/standard ward observations chart: skin colour (pallor/cyanosis), pain, sweating, wound oozing, pedal pulses, glucose, haemoglobin and 'looks unwell'. Improved reporting did not result in escalated calls for review of patients. In a case of successful patient suicide, use of a modified RCA approach was helpful in giving a written opinion.
Conclusion & Significance:
A validated local MEWS vital signs observations chart and a modified RCA approach are useful for structuring an expert nurse witness’ report in healthcare negligence lawsuits.
Nurse practitioners should receive instruction in recognition of early signs of deterioration and in the RCA approach to prevent adverse events and healthcare negligence lawsuits.