Judicialization of nursing malpractice in perioperative care, and delivery and birth assistance

Case	Malpractice description	Type of incident - Consequences for the victim	Legal outcome	Legal support for failure prevention
A	Gauze forgot, during thyroidectomy surgery, by the surgeon and team; and removed of a parathyroid gland by malpractice.	Event with damage - Hospital infection and deficit in the functioning of the parathyroid gland	Negligence Civil conviction of the institution	Perform counts and check surgical instruments, compresses and needles during the transoperative period and before surgical synthesis. Such a process should be carried out by the multi-professional team, which is composed of the nursing team, surgeon, instrumentalists, and anesthesiologists⁽¹⁴14 Steelman VM et al. Retained surgical sponges: a descriptive study of 319 occurrences and contributing factors from 2012 to 2017. Patient Saf Surg. 2018;12(20). https://doi.org/10.1186/s13037-018-0166-0 https://doi.org/10.1186/s13037-018-0166-... ^-¹⁵15 Ministério da Saúde (BR). Práticas seguras para prevenção de retenção não intencional de objetos após realização de procedimento cirúrgico em serviços de saúde. Nota técnica GVIMS/GGTES No 04/2017. [Internet]. 2017 [cited 2019 Sep 24]. Available from: http://portal.anvisa.gov.br/documents/33852/271855/Nota+T%C3%A9cnica+GVIMS-GGTES+n%C2%BA+04-2017/2bbdb035-4356-4512-841e-8ef5ddbdbc75 http://portal.anvisa.gov.br/documents/33... ⁾. Use radiopaque gauze and compresses for identification through radiography⁽¹⁴14 Steelman VM et al. Retained surgical sponges: a descriptive study of 319 occurrences and contributing factors from 2012 to 2017. Patient Saf Surg. 2018;12(20). https://doi.org/10.1186/s13037-018-0166-0 https://doi.org/10.1186/s13037-018-0166-... ^-¹⁵15 Ministério da Saúde (BR). Práticas seguras para prevenção de retenção não intencional de objetos após realização de procedimento cirúrgico em serviços de saúde. Nota técnica GVIMS/GGTES No 04/2017. [Internet]. 2017 [cited 2019 Sep 24]. Available from: http://portal.anvisa.gov.br/documents/33852/271855/Nota+T%C3%A9cnica+GVIMS-GGTES+n%C2%BA+04-2017/2bbdb035-4356-4512-841e-8ef5ddbdbc75 http://portal.anvisa.gov.br/documents/33... ⁾.
B	Lower limb burn by cautery plate-responsibility assigned to the nurse	Event with damage - Hardened lower limb injury, requiring chemical debridement and graft surgery	Negligence Civil conviction of the institution	Correctly position the patient on the operating table⁽¹⁶16 Bisinotto FMB, Dezena RA, Martins LB, Galvão MC, Sobrinho JM, Calçado MS. Burns related to electrosurgery: report of two cases. Rev Bras Anestesiol. 2017;67(5):527-34. https://doi.org/10.1016/j.bjan.2016.03.003 https://doi.org/10.1016/j.bjan.2016.03.0... ⁾. Use insulating devices on the table and armrests and legs support⁽¹⁶16 Bisinotto FMB, Dezena RA, Martins LB, Galvão MC, Sobrinho JM, Calçado MS. Burns related to electrosurgery: report of two cases. Rev Bras Anestesiol. 2017;67(5):527-34. https://doi.org/10.1016/j.bjan.2016.03.003 https://doi.org/10.1016/j.bjan.2016.03.0... ⁾. Use dry swabs between arms, torso, or legs to avoid current concentration in areas with fluid accumulation⁽¹⁶16 Bisinotto FMB, Dezena RA, Martins LB, Galvão MC, Sobrinho JM, Calçado MS. Burns related to electrosurgery: report of two cases. Rev Bras Anestesiol. 2017;67(5):527-34. https://doi.org/10.1016/j.bjan.2016.03.003 https://doi.org/10.1016/j.bjan.2016.03.0... ⁾. Do not leave the cautery plate in contact with tattoos⁽¹⁶16 Bisinotto FMB, Dezena RA, Martins LB, Galvão MC, Sobrinho JM, Calçado MS. Burns related to electrosurgery: report of two cases. Rev Bras Anestesiol. 2017;67(5):527-34. https://doi.org/10.1016/j.bjan.2016.03.003 https://doi.org/10.1016/j.bjan.2016.03.0... ⁾. Position the plate on clean and dry skin in a vascularized area with greater muscle mass⁽¹⁶16 Bisinotto FMB, Dezena RA, Martins LB, Galvão MC, Sobrinho JM, Calçado MS. Burns related to electrosurgery: report of two cases. Rev Bras Anestesiol. 2017;67(5):527-34. https://doi.org/10.1016/j.bjan.2016.03.003 https://doi.org/10.1016/j.bjan.2016.03.0... ⁾. Check that the patient is free of adornments⁽¹⁶16 Bisinotto FMB, Dezena RA, Martins LB, Galvão MC, Sobrinho JM, Calçado MS. Burns related to electrosurgery: report of two cases. Rev Bras Anestesiol. 2017;67(5):527-34. https://doi.org/10.1016/j.bjan.2016.03.003 https://doi.org/10.1016/j.bjan.2016.03.0... ⁾.
C	Chest burn by cautery plate positioning - Responsibility assigned to the nurse	Event with damage - Increased length of hospital stay	Negligence Civil conviction of the institution
D	Burn on the back of the thigh during surgical procedure. Nursing did not identify the burns in the postoperative period, despite the patient's complaint of pain.	Event with damage - Absence of walking for 30 days, causing depressive condition in need of therapy	Negligence Civil conviction of the institution

Case	Malpractice description	Type of incident - Consequences for the victim	Legal outcome	Legal support for failure prevention
E	Nursing staff neglected complaints of heavy bleeding, pain, and fetid odor in the vaginal canal for 42 hours postpartum. There were no records of the reports.	Event with damage - Perineal laceration and peritonitis. Patient undergoing restorative surgery.	Negligence Civil conviction of the institution	Observe, control and record vital signs, lochia, uterine involution, pallor, sweating, excessive bleeding, drowsiness, hematomas and/or edema in the operative wound, or episiorrhaphy, as well as the actions performed⁽¹⁷17 Silva AF, Nóbrega MML, Souto CMRM. Instrument for documentation of nursing process during Postpartum. Ciênc Cuid Saúde. 2015;14(3):1385-93. https://doi.org/10.4025/cienccuidsaude.v14i3.20227 https://doi.org/10.4025/cienccuidsaude.v... ⁾. Use a specific instrument to check postpartum care⁽¹⁷17 Silva AF, Nóbrega MML, Souto CMRM. Instrument for documentation of nursing process during Postpartum. Ciênc Cuid Saúde. 2015;14(3):1385-93. https://doi.org/10.4025/cienccuidsaude.v14i3.20227 https://doi.org/10.4025/cienccuidsaude.v... ⁾.
F	Nursing assistant diluted medicine in unidentified saline vial. Physiological serum with the possibility of containing remnants of fentanyl.	Event with damage - Death due to cardiorespiratory arrest	Negligence Civil conviction of the institution	Identify all syringes, vials, or pouches containing medications⁽¹⁸18 Instituto para Práticas Seguras no Uso de Medicamentos. Segurança no uso de medicamentos em cirurgia. [Internet]. 2018 [cited 2019 Sep 24]. Available from: https://www.ismp-brasil.org/site/wp-content/uploads/2018/05/boletim-seguranca-medicamentos-cirurgia.pdf https://www.ismp-brasil.org/site/wp-cont... ⁾. Never administer the contents into a syringe or pouch that is not clear, correct, and legibly identified⁽¹⁸18 Instituto para Práticas Seguras no Uso de Medicamentos. Segurança no uso de medicamentos em cirurgia. [Internet]. 2018 [cited 2019 Sep 24]. Available from: https://www.ismp-brasil.org/site/wp-content/uploads/2018/05/boletim-seguranca-medicamentos-cirurgia.pdf https://www.ismp-brasil.org/site/wp-cont... ⁾.
G	Bleeding for two hours during anesthetic effect in the postoperative period of vaginal hysterectomy, with no mention of the occurrence by nursing in medical records.	Event with damage - Laceration between the vaginal canal and perianal region. Patient undergoing restorative surgery.	Negligence Civil conviction of the institution	Review the care plan for the patient in the postoperative period, including the monitoring of the level of consciousness, vital signs, and aspect of the surgical dressing⁽¹⁷17 Silva AF, Nóbrega MML, Souto CMRM. Instrument for documentation of nursing process during Postpartum. Ciênc Cuid Saúde. 2015;14(3):1385-93. https://doi.org/10.4025/cienccuidsaude.v14i3.20227 https://doi.org/10.4025/cienccuidsaude.v... ⁾.
H	Nursing did not perform the correct water balance of the patient in the postoperative period. The record highlighted "good diuresis," while the patient was anuric.	Event with damage - Several surgical reoperations, culminating in nephrectomy for infected hydronephrosis.	Negligence Civil conviction of the institution	Accurately record the fluids administered intravenously and orally, and fluids excreted by the gastrointestinal and urinary tract; and monitor the water balance⁽¹⁹19 Aseni P, Orsenigo S, Storti E, Pulici M, Arlati S. Current concepts of perioperative monitoring in high-risk surgical patients: a review. Patient Saf Surg [Internet]. 2019;13 (32). https://doi.org/10.1186/s13037-019-0213-5 https://doi.org/10.1186/s13037-019-0213-... ⁾.

Case	Malpractice description	Type of incident - Consequence for the victim	Legal outcome	Legal support for failure prevention
I	Conducting delivery by nursing assistants, who communicated to the doctor only after a complication, even if he was present in the institution. Delivery was performed with the use of forceps.	Event with damage - Death of the NB. Urinary incontinence due to bladder injury in the postpartum period. Ineffective restorative surgeries.	Negligence Civil conviction of professionals	It is up to the nurse to assist the parturient, stimulate natural childbirth, identify dystocias, provide care to ensure the quality and safety of the mother and baby. In addition, in cases of identification of dystocia, the nurse should perform necessary assistance until the doctor's arrival⁽²⁰20 Conselho Federal de Enfermagem. Resolução nº 564, 18 de julho de 2017: código de ética de enfermagem [Internet]. 2017 [cited 2019 Sep 24]. Available from: http://www.cofen.gov.br/resolucao-cofen-no-5642017_59145.html http://www.cofen.gov.br/resolucao-cofen-... ⁾. The nursing assistant is responsible only for the execution of activities of medium level and repetitive nature, being vetted to conduct births⁽²⁰20 Conselho Federal de Enfermagem. Resolução nº 564, 18 de julho de 2017: código de ética de enfermagem [Internet]. 2017 [cited 2019 Sep 24]. Available from: http://www.cofen.gov.br/resolucao-cofen-no-5642017_59145.html http://www.cofen.gov.br/resolucao-cofen-... ⁾.
J	Childbirth conducted by nursing assistants	Event with damage - Neonatal hypoxia and deficit in cognitive and motor development	Malpractice Civil conviction of professionals
K	Brachial plexus injury in NB after delivery conducted by a nursing assistant	Event with damage - Right upper trunk brachial injury, with motor limitation	Malpractice Civil conviction of the institution
L	Childbirth with dystocia conducted by a nurse	Event with damage - Death of the NB by aspiration of amniotic content	Negligence Civil conviction of the institution
M	Exchange of NBs by nursing technician. Malpractice identified by mothers after 24 hours of birth.	Event with damage - Prolongation of the hospitalization for six days until the report of the DNA examination with the impediment of visits. The fact generated anguish and stress and, consequently, prevented the production of breast milk by one of the mothers.	Negligence Civil conviction of the institution	Daily check the identification bracelets of both the mother and the newborn⁽²¹21 Silva RSS, Rocha SS, Gouveia MTO, Dantas ALB, Santos JDM, Carvalho NAR. Wearing identification wristbands: implications for newborn safety in maternity hospitals. Esc Anna Nery. 2019;23(2). https://doi.org/10.1590/2177-9465-EAN-2018-0222 https://doi.org/10.1590/2177-9465-EAN-20... ^-²²22 López ES, Luna MS, Gracia SR, Fernández IB, Castellanos JLL, Muñuzuri AP, et al. Recommendations for the unequivocal identification of the newborn Recomendaciones para la identificación inequívoca del recién nacido. An Pediatr. 2017; 87(4). https://doi.org/10.1016/j.anpede.2017.03.008 https://doi.org/10.1016/j.anpede.2017.03... ⁾ Identify the mother and newborn immediately after delivery and confirm with the mother or legal guardian ⁽²¹21 Silva RSS, Rocha SS, Gouveia MTO, Dantas ALB, Santos JDM, Carvalho NAR. Wearing identification wristbands: implications for newborn safety in maternity hospitals. Esc Anna Nery. 2019;23(2). https://doi.org/10.1590/2177-9465-EAN-2018-0222 https://doi.org/10.1590/2177-9465-EAN-20... ^-²²22 López ES, Luna MS, Gracia SR, Fernández IB, Castellanos JLL, Muñuzuri AP, et al. Recommendations for the unequivocal identification of the newborn Recomendaciones para la identificación inequívoca del recién nacido. An Pediatr. 2017; 87(4). https://doi.org/10.1016/j.anpede.2017.03.008 https://doi.org/10.1016/j.anpede.2017.03... ⁾ Wear an identification bracelet with at least the mother's name and the newborn's medical record number ⁽²¹21 Silva RSS, Rocha SS, Gouveia MTO, Dantas ALB, Santos JDM, Carvalho NAR. Wearing identification wristbands: implications for newborn safety in maternity hospitals. Esc Anna Nery. 2019;23(2). https://doi.org/10.1590/2177-9465-EAN-2018-0222 https://doi.org/10.1590/2177-9465-EAN-20... ^-²²22 López ES, Luna MS, Gracia SR, Fernández IB, Castellanos JLL, Muñuzuri AP, et al. Recommendations for the unequivocal identification of the newborn Recomendaciones para la identificación inequívoca del recién nacido. An Pediatr. 2017; 87(4). https://doi.org/10.1016/j.anpede.2017.03.008 https://doi.org/10.1016/j.anpede.2017.03... ⁾

[1] Corresponding author: Gislene Aparecida Xavier dos Reis E-mail: gislenereis@ymail.com

Brasil

Brasil

Judicialization of nursing malpractice in perioperative care, and delivery and birth assistance

Judicialización del error de enfermería en la atención perioperativa y en la asistencia al parto y Nacimiento

ABSTRACT

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