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Veldman A, Krummer S, Schwabe D, Diefenbach M, Fischer D, Schmitt-Kästner S, Rohrbeck C, Pannu R. Safety and Feasibility of Long-Distance Aeromedical Transport of Neonates and Children in Fixed-Wing Air Ambulance. J Pediatr Intensive Care 2023; 12:235-242. [PMID: 37565016 PMCID: PMC10411161 DOI: 10.1055/s-0041-1731681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/27/2021] [Indexed: 08/12/2023] Open
Abstract
In cases of critical injury or illness abroad, fixed-wing air ambulance aircraft is employed to repatriate children to their home country. Air ambulance aircraft also transport children to foreign countries for treatment not locally available and newborns back home that have been born prematurely abroad. In this retrospective observational study, we investigated demographics, feasibility, and safety and outcomes of long-distance and international aeromedical transport of neonates and children. The study included 167 pediatric patients, 56 of those preterm neonates. A total of 41 patients were ventilated, 45 requiring oxygen prior to the transport, 57 transferred from an intensive care unit (ICU), and 48 to an ICU. Patients were transported by using Learjet 31A, Learjet 45, Learjet 55, and Bombardier Challenger 604, with a median transport distance of 1,008 nautical miles (NM), median transport time of 04:45 hours (median flight time = 03:00 hours), flight time ≥8 hours in 15 flights, and transport time ≥8 hours in 29 missions. All transports were accompanied by a pediatric physician/nurse team. An increase in FiO 2 during the transport was documented in 47/167 patients (28%). Therapy escalation (other than increased oxygen) was reported in 18 patients, and technical adverse events in 3 patients. No patient required CPR or died during the transport. Clinical transport outcome was rated by the accompanying physician as unchanged in 163 transports, improved in 4, and deteriorated in none. In summary, international, long-distance transport of neonatal and pediatric patients performed by experienced and well-equipped transport teams is feasible. Neither major adverse events nor physician-rated clinical deteriorations were observed in this group of patients.
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Affiliation(s)
- Alex Veldman
- Jetcall Air Ambulance, Idstein, Germany
- Department of Pediatrics, St. Vincenz Hospital, Limburg, Germany
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia
| | - Stefanie Krummer
- Jetcall Air Ambulance, Idstein, Germany
- Department of Pediatrics, St. Vincenz Hospital, Limburg, Germany
| | | | | | - Doris Fischer
- Jetcall Air Ambulance, Idstein, Germany
- Department of Pediatrics, St. Vincenz Hospital, Limburg, Germany
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Veldman A, Diefenbach M, Taymans L, Vadera B, Lelo J, Rouaud Y. Please get me out of here: The difficult decision making in fit-to-fly assessments for international fixed-wing air ambulance operations. Travel Med Infect Dis 2023; 54:102613. [PMID: 37331494 DOI: 10.1016/j.tmaid.2023.102613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/18/2023] [Accepted: 06/15/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION With international travel for leisure and business almost back to pre-pandemic levels, demand for repatriation due to illness and injury abroad is increasing [1,2]. In any repatriation, there is considerable pressure on all involved to organize a rapid transport back home. Delay in such action may be perceived by the patient, relatives, and the public as an attempt by the underwriter to hold off on an expensive air ambulance mission [3-5]. METHODS Review of the available literature and analysis of assistance and air ambulance Companies' infrastructure and processes to identify risk and benefit of executing or delaying aeromedical transport for international travellers. KEY FINDINGS While patients of almost any severity can be safely transported over great distances in modern air ambulance aircraft, immediate transport is not always in the patient's best interest. Each call for assistance requires a complex and dynamic risk-benefit analysis with multiple stakeholders involved to achieve an optimized outcome. Opportunities for risk mitigation within the assistance team include active case management with clearly assigned ownership, as well as medical and logistical experience with knowledge on local treatment opportunities and limitations. On the air ambulance side, modern equipment, experience, standards and procedures as well as accreditation can reduce risk. CONCLUSIONS Each patient evaluation remains a highly individual risk-benefit assessment. Optimal outcomes require a clear understanding of responsibilities, flawless communication and significant expertise among the key decision-makers. Negative outcomes are mostly associated with insufficient information, communication, inadequate experience or a lack of ownership/assigned responsibility.
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Affiliation(s)
- Alex Veldman
- UNICAIR, Idstein, Germany; Hudson Institute of Medical Research, Monash University, Melbourne, Australia.
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Schiller T, Musurlieva N, Dimitrova-Haruil M. Survey of the Opinions of the Graduated and Practicing Dentists in Bulgaria and Germany on the Topics of Patient Safety and Medical Error. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Patient safety and medical errors are issues that require research and strategies to deal with. The reasons for the occurrence of an adverse event should be sought among the quality of the received training, fatigue, ineffective communication, the culture of accusation, and the lack of an anonymous report register for training purposes.
AIM: The aim of the study is to survey and compare the opinion of the dentists in Bulgaria and Germany on topics related to patient safety and medical error.
MATERIALS AND METHODS: A survey with an anonymized questionnaire among dentists from randomly selected for the study purposes Regional Associations of settlements in the Republic of Bulgaria and Germany was used. Respondents answered 25 closed-ended questions divided into five panels: Demographic characteristics of the contingent, the role of study and postgraduate qualifications in acquiring knowledge of errors, willingness to share information about mistakes, factors of error, and culture of accusation. The obtained data were entered and processed with the statistical package IBM SPSS Statistics 20.0. The significance level of the null hypothesis is rejected at p < 0.05.
RESULTS: The largest relative share of respondents −72.37% ± 2.64%, is women, in the age range 25–35 years −48.60% ± 2.95%, and with work experience of 6–15 years −34.27% ± 2.81%. Statistically significant differences between the contingents were observed in terms of knowledge acquired during the study of the issue of patient safety (p = 0.005), and whether the study provided sufficient preparation to avoid medical error (p = 0.021). Differences were also found in the data from the issues related to the communication with the patient and the recognition of one’s own mistake (p = 0.034) or the mistake of their colleague (p = 0.004), as well as in terms of fatigue such as risk factor for an adverse event (p = 0.000). The exit data showed differences in the opinion of the two samples and on issues related to medical malpractice reporting and the role of professional organizations.
CONCLUSIONS: The majority of respondents believe that they were prepared during their training to identify the causes that could lead to medical errors and that the lack of regular breaks during work increases the risk of making a medical error. They would rather share with the patient an incident caused by themselves, but not one, caused by their colleagues. Respondents are of the opinion that the mistakes are not a sign of incompetence and the responsibility for the mistake lies with the dentist. Most respondents believe that an anonymous register of errors would be useful for their practice.
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Lee E, Kalisch BJ. Identification and comparison of missed nursing care in the United States of America and South Korea. J Clin Nurs 2021; 30:1596-1606. [PMID: 33590601 DOI: 10.1111/jocn.15712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to identify and compare missed nursing care types and reasons between South Korea and the United States of America. BACKGROUND Patient safety has become a significant task of the healthcare delivery systems worldwide. The omission of nursing care constitutes a growing concern because it threatens both patient safety and nursing care quality. DESIGN This study used a cross-sectional, descriptive and comparative design. METHODS Data were collected from registered nurses working in two university-affiliated tertiary hospitals and a general hospital in Korea and a Midwest United States tertiary hospital. In addition, the STROBE checklist was used in this study. RESULTS While substantial, the level of missed nursing care reported by Korean nurses was lower than that of United States nurses. Only three nursing care activities, setting up meals, patient assessment and skin/wound care, did not significantly differed between two countries. More basic nursing care types such as ambulation, feeding and mouth care were missed more than others in both countries. The reasons for missed care differed between two countries. However, both Korean and US nurses reported labour resource problems as reasons for missed care. CONCLUSIONS Although the types of missed nursing care differed significantly between countries, both Korean and US nurses reported labour resource problems for the top reasons for missed care. Thus, comparing missed nursing care could assist nursing administrators in developing strategies to improve care quality and patient safety. RELEVANCE TO CLINICAL PRACTICE The level and reasons for missed nursing care are very influential factors for patient outcomes and patient safety. Appropriate skill mix and staffing are needed to decrease extent of missed care, so that enhancing patient safety and quality of nursing care.
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Affiliation(s)
- Eunjoo Lee
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea
| | - Beatrice J Kalisch
- Innovation and Evaluation, University of Michigan School of Nursing, Ann Arbor, MI, USA
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Tlili MA, Aouicha W, Sahli J, Zedini C, Ben Dhiab M, Chelbi S, Mtiraoui A, Said Latiri H, Ajmi T, Ben Rejeb M, Mallouli M. A baseline assessment of patient safety culture and its associated factors from the perspective of critical care nurses: Results from 10 hospitals. Aust Crit Care 2020; 34:363-369. [PMID: 33121872 DOI: 10.1016/j.aucc.2020.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Critical care nurses are considered the key to patient safety improvement and play a vital role in enhancing quality of care in intensive care units (ICUs) where adverse events are frequent and have severe consequences. Moreover, there is recognition of the importance of the assessment and the development of patient safety culture (PSC) as a strategic focus for the improvement of patient safety and healthcare quality, notably in critical care settings. OBJECTIVES This study aimed to assess critical care nurses' perception of PSC and to determine its associated factors. METHODS This cross-sectional study was conducted among nurses working in the ICUs of the Tunisian centre (six Tunisian governorates). The study instrument was the French validated version of the Hospital Survey on Patient Safety Culture questionnaire, comprising 10 dimensions and a total of 50 items. RESULTS A total of 249 nurses from 18 ICUs participated in the study, with a participation rate of 87.36%. The dimensions scores ranged between 17.2% for the dimension "frequency of events reported" and 50.1% for the dimension "teamwork within units". Multivariable logistic regression indicated that respondents who worked in private hospitals were five times more likely to have a developed PSC (adjusted odds ratio [AOR]: 5.34; 95% confidence interval [CI], [2.28, 12.51]; p < 10-3). Similarly, participants who worked in a certified hospital were two times more likely to have a more developed PSC than respondents who work in noncertified hospitals (AOR: 2.51; 95% CI, [.92-6.82]; p = 0.041). In addition, an increased nurse-per-patient ratio (i.e., reduced workload) increased PSC (AOR: 1.10; 95% CI, [1.02-1.12]; p = 0.018). CONCLUSION This study has shown that the state of critical care nurses' PSC is critically low and these baseline results can help to form a plan of actions for improvements.
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Affiliation(s)
- Mohamed Ayoub Tlili
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle» - University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia.
| | - Wiem Aouicha
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle» - University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia
| | - Jihene Sahli
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Department of Community and Family Health, Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle», Tunisia
| | - Chekib Zedini
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Department of Community and Family Health, Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle», Tunisia
| | | | - Souad Chelbi
- University of Sousse, Faculty of Medicine of Sousse (Tunisia) - University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia
| | - Ali Mtiraoui
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Department of Community and Family Health, Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle», Tunisia
| | - Houyem Said Latiri
- University of Sousse, Faculty of Medicine of Sousse (Tunisia)- University Hospital Sahloul (Sousse,Tunisia), Department of Prevention and Safety Care, Tunisia
| | - Thouraya Ajmi
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Department of Community and Family Health, Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle», Tunisia
| | - Mohamed Ben Rejeb
- University of Sousse, Faculty of Medicine of Sousse (Tunisia)- University Hospital Sahloul (Sousse,Tunisia), Department of Prevention and Safety Care, Tunisia
| | - Manel Mallouli
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Department of Community and Family Health, Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle», Tunisia
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Mohan A, Manikandan S, Ravikumar TS, Batmanabane G. Decreasing medication errors in four intensive care units of a tertiary care teaching hospital in India using a sensitization programme. NATIONAL MEDICAL JOURNAL OF INDIA 2020; 32:207-212. [PMID: 32769240 DOI: 10.4103/0970-258x.291294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Medication errors have an adverse impact on the healthcare system by increasing patient morbidity and mortality. They are preventable, and educational or technology-based interventions are needed to reduce their prevalence and improve medication safety. We aimed to study the impact of a sensitization programme and a blame-free reporting tool for doctors and nurses on the prevalence and reporting of medication errors in the intensive care units (ICUs) of a tertiary care teaching hospital. Methods This prospective interventional study was conducted in the ICUs of cardiology, medicine, paediatrics and neonatology. Baseline medication errors were detected by prescription order review and direct observation of administration of medication for 30 days. A sensitization programme was conducted for doctors and nurses in these ICUs, the results were discussed, and a blame-free medication error reporting tool was introduced. Medication charts were modified to remove the transcription process in the cardiology and paediatrics ICUs. The follow-up study was conducted for 30 days in each ICU to monitor the impact of the sensitization programme. Results The prevalence of medication errors was found to be 334.1/1000 patient observation days. Prescription errors were the most common types of errors at 129.1/1000 patient observation days. The interventions significantly reduced the error rate in all four ICUs. The overall number of prescriptions with errors was reduced from 9.1% (177/1944) to 3.5% (48/1373) and no medication error was reported using the tool. Conclusion The sensitization programme on medication errors for doctors and nurses may be effective in improving medication safety. The impact was more pronounced in prescription errors. Reporting of medication errors did not improve in this study despite the introduction of a blame-free reporting tool.
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Affiliation(s)
- Anbarasan Mohan
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - S Manikandan
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - T S Ravikumar
- Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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Abstract
OBJECTIVE The objective of this study was to estimate the frequency and type of adverse events (AEs) among critically ill patients and identify patient and hospital factors associated with AEs and clinical and health care utilization consequences of AEs. MATERIALS AND METHODS This retrospective cohort study includes patients admitted to 30 intensive care units (ICUs) in Alberta, Canada from May 2014 to April 2017. The main outcome was AEs derived from validated ICD-10, Canadian code algorithms for 18 AEs. Estimates of the proportion and rate of AEs are presented. The association between documented AEs and patient (eg, age, sex, comorbidities) and hospital (eg, ICU site and type, length of stay, readmission) variables are described using regression methods. RESULTS Of 49,447 hospital admissions with admission to ICU, ≥1 AEs were documented in 12,549 (25%) admissions. The most common AEs were respiratory complications (10%) and hospital-acquired infections (9%). AEs were associated with having ≥2 comorbidities [odds ratio (OR)=1.4, 95% confidence interval (CI)=1.3-1.4], being admitted to the ICU from the operating room or another hospital ward (OR=1.8, 95% CI=1.7-2.0 and OR=2.7, 95% CI=2.5-3.0, respectively) and being readmitted to ICU during their hospital stay (OR=4.8, 95% CI=4.7-5.6). Patients with an AE stayed 5.4 days longer in ICU (95% CI=5.2-5.6 d, P<0.001), 18.2 days longer in hospital (95% CI=17.7-18.8 d, P<0.001) and had increased odds of hospital mortality (OR=1.5, 95% CI=1.4-1.6) than those without an AE. CONCLUSIONS AEs are common among critically ill patients and certain factors are associated with AEs. Documented AEs are associated with longer stays and increased mortality.
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Tlili MA, Aouicha W, Ben Rejeb M, Sahli J, Ben Dhiab M, Chelbi S, Mtiraoui A, Said Laatiri H, Ajmi T, Zedini C, Mallouli M. Assessing patient safety culture in 18 Tunisian adult intensive care units and determination of its associated factors: A multi-center study. J Crit Care 2020; 56:208-214. [PMID: 31952015 DOI: 10.1016/j.jcrc.2020.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/23/2019] [Accepted: 01/03/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aimed to assess patient safety culture (PSC) in intensive care units (ICUs) and to determine the factors affecting it. MATERIALS AND METHODS This is a cross-sectional study, conducted from October to November 2017 among professionals practicing in the ICUs of the Tunisian center. After obtaining institutional ethics committee's approval and administrative authorizations, an anonymous paper-based questionnaire was distributed to the participants after obtaining their consent to take part in the study. The measuring instrument used is the French validated version of the "Hospital Survey on Patient Safety Culture" questionnaire. RESULTS A total of 402 professionals, from 18 ICUs and 10 hospitals, participated in the study with a participation rate of 82.37%. All dimensions were to be improved. The most developed dimension was teamwork within the unit (47.87%) and the least developed dimension was the non-punitive response to error (18.6%). Seven dimensions were significantly more developed in private institutions than in public ones. Results also show that when workload is reduced, the PSC was significantly increased. CONCLUSION This study has shown that the PSC in ICUs needs improvement and provided a baseline results to get a clearer vision of the aspects of security that require special attention.
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Affiliation(s)
- Mohamed Ayoub Tlili
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia.
| | - Wiem Aouicha
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia
| | - Mohamed Ben Rejeb
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; University Hospital of Sahloul, Department of Prevention and Care Safety, Tunisia
| | - Jihene Sahli
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia; Department of Community and Family Health, Faculty of Medicine of Sousse, Tunisia
| | | | - Souad Chelbi
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia
| | - Ali Mtiraoui
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia; Department of Community and Family Health, Faculty of Medicine of Sousse, Tunisia
| | - Houyem Said Laatiri
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; University Hospital of Sahloul, Department of Prevention and Care Safety, Tunisia
| | - Thouraya Ajmi
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia; Department of Community and Family Health, Faculty of Medicine of Sousse, Tunisia
| | - Chekib Zedini
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia; Department of Community and Family Health, Faculty of Medicine of Sousse, Tunisia
| | - Manel Mallouli
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia; Department of Community and Family Health, Faculty of Medicine of Sousse, Tunisia
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Accidental removal of devices in intensive care unit: An eight-year observational study. Intensive Crit Care Nurs 2019; 54:34-38. [PMID: 31235215 DOI: 10.1016/j.iccn.2019.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/22/2019] [Accepted: 06/07/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND In the intensive care unit, invasive devices can be accidentally removed by the patient or by the operators, increasing workload, staff stress level and hospitalisation costs. OBJECTIVE to know the incidence of accidental removal of devices in critical patients, to identify their cause, when they occur and if they are repositioned. METHODS Retrospective observational study carried out in an academic, tertiary-level critical care department composed of three intensive care units. All adult patients recovered between 2011 and 2018 were enrolled. We calculated rates per 1000 device-years. RESULTS In the study period 10514 patients (194372 device-days) were admitted to the intensive care units and the number of reported accidental removal of devices was 451, corresponding to a rate of 2.3 episodes per 1000 device-days (95% confidence interval: 2.1-2-5). The overall rates of accidental removals were as follows: gastric tubes 10.2 (n = 270), intracranial devices 3.9 (n = 9), endotracheal tubes 2.4 (n = 27), central venous catheters and arterial catheters 1.5 (n = 92), peripheral intravenous catheters 1.2 (n = 25), surgical drains 0.5 (n = 15), urinary catheters 0.4 (n = 11), Extra Corporeal Membrane Oxygenation cannulas 0.4 (n = 1), tracheostomy cannulas 0.1 (n = 1). CONCLUSION Compared to the literature, this study shows fewer incidents of accidental removal of devices. The number of accidental removals could be an indicator of the quality and safety of the care.
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Wallis J, Fletcher D, Bentley A, Ludders J. Medical Errors Cause Harm in Veterinary Hospitals. Front Vet Sci 2019; 6:12. [PMID: 30805349 PMCID: PMC6370638 DOI: 10.3389/fvets.2019.00012] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/15/2019] [Indexed: 11/17/2022] Open
Abstract
Medical errors are a leading cause of mortality in human medicine. In contrast, errors in veterinary medicine are rarely discussed, and there is little known about their nature and frequency. This study aimed to evaluate the type and severity of medical errors reported in three veterinary hospitals. The voluntary online incident reporting systems of a small animal teaching hospital, large animal teaching hospital, and small animal multi-specialty practice were reviewed. Reports were included if they were entered between February 2015 and March 2018, and involved an incident pertaining to patient safety. The reporting systems classified errors into the following categories: drug, iatrogenic, system, communication, lab, oversight, staff, or equipment errors. In addition, all incidents were classified as resulting in either a near miss, harmless hit, adverse incident, or unsafe condition. Adverse incidents were further evaluated retrospectively for error severity. A total of 560 incident reports were included for analysis. Drug errors were the most frequently reported in all three hospitals, followed by failures of communication. Errors most commonly reached patients without causing harm (45%); however, 15% of all incidents resulted in patient harm. Eight percent of patients harmed suffered permanent morbidity or death. A higher proportion of adverse incidents were reported in the small animal teaching hospital than in the other two practice settings. This study demonstrates that medical errors have a substantial impact on veterinary patients. Establishing that drug and communication errors are most frequent in a variety of hospitals is the first step toward interventions to improve patient safety and outcomes in veterinary medicine.
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Affiliation(s)
- Jessica Wallis
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Daniel Fletcher
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Adrienne Bentley
- Cornell University Veterinary Specialists, Stamford, CT, United States
| | - John Ludders
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
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Laurent A, Chahraoui K, Bioy A, Quenot J, Capellier G. Vécu des situations à risque d’erreur en réanimation : une étude qualitative auprès des médecins et infirmiers. PSYCHOLOGIE FRANCAISE 2018. [DOI: 10.1016/j.psfr.2016.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Aggarwal S, Kheriaty A. Same behavior, different provider: American medical students' attitudes toward reporting risky behaviors committed by doctors, nurses, and classmates. AJOB Empir Bioeth 2017; 9:12-18. [PMID: 28985136 DOI: 10.1080/23294515.2017.1377780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The bioethics literature lacks findings about medical students' attitudes toward reporting risky behaviors that can cause error or reduce the perceived quality of health care. A survey was administered to 159 medical students to assess their likelihood to directly approach and to report various providers-a physician, nurse, or medical student-for three behaviors (poor hand hygiene, intoxication, or disrespect of patients). For the same behavior, medical students were significantly more likely to approach a classmate, followed by a nurse and then a doctor (p < .0001), to ask for behavioral modification. Across all three health care provider types, medical students were most likely to report intoxication (p < .0001). Medical students' willingness to approach or report a provider for a risky or unprofessional behavior is influenced by the type of health care provider in question. Medical schools should implement patient safety curricula that alleviate fears about reporting superiors and create anonymous reporting systems to improve reporting rates.
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Abstract
OBJECTIVES We hypothesized that intensivists unfamiliar with an ICU team and the context of that ICU would affect patient outcomes. We examined differences in mortality when ICU patients were admitted under intensivists routinely working in that ICU and compared with those admitted by intensivists familiar with an ICU elsewhere in the same hospital. DESIGN, SETTINGS, AND PATIENTS A 5-year natural experimental crossover study involving patients admitted to four ICUs in a large U.K. teaching hospital. INTERVENTIONS During a period of service reconfiguration, intensivists routinely rostered to work in one ICU worked in another of the hospital's four ICUs. "Home" intensivists were those who continued to work in their usual ICU; "visitor" intensivists were those who delivered care in an unfamiliar ICU. Patient data were obtained from electronic patient records to provide analysis on sex, age, admission Sequential Organ Failure Assessment score, date and time of admission, and admission type (elective, transfer, or unplanned). MEASUREMENTS AND MAIN RESULTS We analyzed 9,981 admissions to four separate ICUs over a 5-year period. In total, 34.5% of patients were admitted by intensivists working in nonfamiliar surroundings. Visitor intensivists admitted patients with similar age and gender distributions but with greater physiologic derangement (mean Sequential Organ Failure Assessment score, 4.1 ± 2.8 vs 3.9 ± 2.8; p < 0.001) than home intensivists. Overall ICU mortality rates were higher in visitor intensivists, albeit not significantly so (11.5% vs 10.2%; p = 0.052). However, when the ICUs were analyzed separately, visitor mortality rates were found to be significantly higher than for home intensivists in two of the four ICUs (p = 0.017, 0.006). A multivariable analysis adjusting for confounding factors and the clustering of consultants revealed that the overall mortality rate was significantly higher for visitors (odds ratio, 1.18; 95% CI, 1.02-1.37; p = 0.024). A significant interaction between the ICU and visitor status was also detected (p = 0.046), with the visitor effect remaining significant in the two ICUs identified previously (both p = 0.009). CONCLUSIONS Visitor intensivists in some ICUs were associated with higher mortality. The reasons are unknown but could relate to intensivists' practices, unfamiliarity with the patients, or the interaction with the interprofessional team.
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Error Detection and Reporting in the Intensive Care Unit: Progress, Barriers, and Future Direction. CURRENT ANESTHESIOLOGY REPORTS 2017. [DOI: 10.1007/s40140-017-0228-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Association of medication errors with drug classifications, clinical units, and consequence of errors: Are they related? Appl Nurs Res 2017; 33:180-185. [DOI: 10.1016/j.apnr.2016.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 11/20/2016] [Accepted: 12/02/2016] [Indexed: 11/23/2022]
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16
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Hs AS, Rashid A. The intention to disclose medical errors among doctors in a referral hospital in North Malaysia. BMC Med Ethics 2017; 18:3. [PMID: 28114911 PMCID: PMC5259943 DOI: 10.1186/s12910-016-0161-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 12/22/2016] [Indexed: 12/03/2022] Open
Abstract
Background In this study, medical errors are defined as unintentional patient harm caused by a doctor’s mistake. This topic, due to limited research, is poorly understood in Malaysia. The objective of this study was to determine the proportion of doctors intending to disclose medical errors, and their attitudes/perception pertaining to medical errors. Methods This cross-sectional study was conducted at a tertiary public hospital from July- December 2015 among 276 randomly selected doctors. Data was collected using a standardized and validated self-administered questionnaire intending to measure disclosure and attitudes/perceptions. The scale had four vignettes in total two medical and two surgical. Each vignette consisted of five questions and each question measured the disclosure. Disclosure was categorised as “No Disclosure”, “Partial Disclosure” or “Full Disclosure”. Data was keyed in and analysed using STATA v 13.0. Results Only 10.1% (n = 28) intended to disclose medical errors. Most respondents felt that they possessed an attitude/perception of adequately disclosing errors to patients. There was a statistically significant difference (p < 0.001) when comparing the intention of disclosure with perceived disclosures. Most respondents were in common agreement that disclosing an error would make them less likely to get sued, that minor errors should be reported and that they experienced relief from disclosing errors. Conclusion Most doctors in this study would not disclose medical errors although they perceived that the errors were serious and felt responsible for it. Poor disclosure could be due the fear of litigations and improper mechanisms/procedures available for disclosure.
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Affiliation(s)
- Arvinder-Singh Hs
- Masters in Health Research (RCSI, Hons), Penang Medical College, Georgetown, Pulau Pinang, Malaysia. .,Clinical Research Centre (Perak), 4th Floor Ambulatory Care Centre (ACC), Raja Permaisuri Bainun Hospital, Jalan Raja Ashman Shah, Ipoh, 30450, Perak, Malaysia.
| | - Abdul Rashid
- Department of Public Health, Penang Medical College, Georgetown, Pulau Pinang, Malaysia
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Nurses' experiences with errors in nursing. Nurs Outlook 2016; 64:566-574. [DOI: 10.1016/j.outlook.2016.05.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 05/16/2016] [Accepted: 05/31/2016] [Indexed: 01/17/2023]
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Fisher KA, Ahmad S, Jackson M, Mazor KM. Surrogate decision makers' perspectives on preventable breakdowns in care among critically ill patients: A qualitative study. PATIENT EDUCATION AND COUNSELING 2016; 99:1685-1693. [PMID: 27067065 DOI: 10.1016/j.pec.2016.03.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 03/07/2016] [Accepted: 03/25/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To describe surrogate decision makers' (SDMs) perspectives on preventable breakdowns in care among critically ill patients. METHODS We screened 70 SDMs of critically ill patients for those who identified a preventable breakdown in care, defined as an event where the SDM believes something "went wrong", that could have been prevented, and resulted in harm. In-depth interviews were conducted with SDMs who identified an eligible event. RESULTS 32 of 70 participants (46%) identified at least one preventable breakdown in care, with a total of 75 discrete events. Types of breakdowns involved medical care (n=52), communication (n=59), and both (n=40). Four additional breakdowns were related to problems with SDM bedside access to the patient. Adverse consequences of breakdowns included physical harm, need for additional medical care, emotional distress, pain, suffering, loss of trust, life disruption, impaired decision making, and financial expense. 28 of 32 SDMs raised their concerns with clinicians, yet only 25% were satisfactorily addressed. CONCLUSION SDMs of critically ill patients frequently identify preventable breakdowns in care which result in harm. PRACTICE IMPLICATIONS An in-depth understanding of the types of events SDMs find problematic and the associated harms is an important step towards improving the safety and patient-centeredness of healthcare.
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Affiliation(s)
- Kimberly A Fisher
- Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA; Meyers Primary Care Institute, 425 North Lake Avenue, Worcester, MA 01605, USA.
| | - Sumera Ahmad
- Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Madeline Jackson
- Meyers Primary Care Institute, 425 North Lake Avenue, Worcester, MA 01605, USA
| | - Kathleen M Mazor
- Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA; Meyers Primary Care Institute, 425 North Lake Avenue, Worcester, MA 01605, USA
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Nurse workload and inexperienced medical staff members are associated with seasonal peaks in severe adverse events in the adult medical intensive care unit: A seven-year prospective study. Int J Nurs Stud 2016; 62:60-70. [DOI: 10.1016/j.ijnurstu.2016.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 11/22/2022]
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Hewitt T, Chreim S, Forster A. Incident reporting systems: a comparative study of two hospital divisions. ACTA ACUST UNITED AC 2016; 74:34. [PMID: 27529024 PMCID: PMC4983791 DOI: 10.1186/s13690-016-0146-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/07/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Previous studies of incident reporting in health care organizations have largely focused on single cases, and have usually attended to earlier stages of reporting. This is a comparative case study of two hospital divisions' use of an incident reporting system, and considers the different stages in the process and the factors that help shape the process. METHOD The data was comprised of 85 semi-structured interviews of health care practitioners in general internal medicine, obstetrics and neonatology; thematic analysis of the transcribed interviews was undertaken. Inductive and deductive themes are reported. This work is part of a larger qualitative study found elsewhere in the literature. RESULTS The findings showed that there were major differences between the two divisions in terms of: a) what comprised a typical report (outcome based vs communication and near-miss based); b) how the reports were investigated (individual manager vs interdisciplinary team); c) learning from reporting (interventions having ambiguous linkages to the reporting system vs interventions having clear linkages to reported incidents); and d) feedback (limited feedback vs multiple feedback). CONCLUSIONS The differences between the two divisions can be explained in terms of: a) the influence of litigation on practice, b) the availability or lack of interprofessional training, and c) the introduction of the reporting system (top-down vs bottom-up approach). A model based on the findings portraying the influences on incident reporting and learning is provided. Implications for practice are addressed.
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Affiliation(s)
- Tanya Hewitt
- Population Health, University of Ottawa, 25 University Private, Ottawa, ON Canada K1N 7K4
| | - Samia Chreim
- Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, ON K1N 6N5 Canada
| | - Alan Forster
- Department of Medicine, Faculty of Medicine, University of Ottawa, Civic Campus, 1053 Carling Avenue, Box 684, Administrative Services Building, Ottawa, ON K1Y 4E9 Canada ; Ottawa Hospital Research Institute Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Box 684, Administrative Services Building, Ottawa, ON K1Y 4E9 Canada
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Review of crisis resource management (CRM) principles in the setting of intraoperative malignant hyperthermia. J Anesth 2015; 30:298-306. [DOI: 10.1007/s00540-015-2115-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 11/23/2015] [Indexed: 12/21/2022]
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Brunsveld-Reinders AH, Arbous MS, De Vos R, De Jonge E. Incident and error reporting systems in intensive care: a systematic review of the literature. Int J Qual Health Care 2015; 28:2-13. [DOI: 10.1093/intqhc/mzv100] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 01/19/2023] Open
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Okafor NG, Doshi PB, Miller SK, McCarthy JJ, Hoot NR, Darger BF, Benitez RC, Chathampally YG. Voluntary Medical Incident Reporting Tool to Improve Physician Reporting of Medical Errors in an Emergency Department. West J Emerg Med 2015; 16:1073-8. [PMID: 26759657 PMCID: PMC4703179 DOI: 10.5811/westjem.2015.8.27390] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/30/2015] [Accepted: 08/06/2015] [Indexed: 11/23/2022] Open
Abstract
Introduction Medical errors are frequently under-reported, yet their appropriate analysis, coupled with remediation, is essential for continuous quality improvement. The emergency department (ED) is recognized as a complex and chaotic environment prone to errors. In this paper, we describe the design and implementation of a web-based ED-specific incident reporting system using an iterative process. Methods A web-based, password-protected tool was developed by members of a quality assurance committee for ED providers to report incidents that they believe could impact patient safety. Results The utilization of this system in one residency program with two academic sites resulted in an increase from 81 reported incidents in 2009, the first year of use, to 561 reported incidents in 2012. This is an increase in rate of reported events from 0.07% of all ED visits to 0.44% of all ED visits. In 2012, faculty reported 60% of all incidents, while residents and midlevel providers reported 24% and 16% respectively. The most commonly reported incidents were delays in care and management concerns. Conclusion Error reporting frequency can be dramatically improved by using a web-based, user-friendly, voluntary, and non-punitive reporting system.
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Affiliation(s)
- Nnaemeka G Okafor
- University of Texas Health Science Center, Department of Emergency Medicine, Houston, Texas
| | - Pratik B Doshi
- University of Texas Health Science Center, Department of Emergency Medicine, Houston, Texas
| | - Sara K Miller
- University of Texas Health Science Center, Department of Emergency Medicine, Houston, Texas
| | - James J McCarthy
- University of Texas Health Science Center, Department of Emergency Medicine, Houston, Texas
| | - Nathan R Hoot
- University of Texas Health Science Center, Department of Emergency Medicine, Houston, Texas
| | - Bryan F Darger
- University of Texas Health Science Center, Department of Emergency Medicine, Houston, Texas
| | - Roberto C Benitez
- University of Texas Health Science Center, Department of Emergency Medicine, Houston, Texas
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Lighthall GK, Vazquez-Guillamet C. Understanding Decision Making in Critical Care. Clin Med Res 2015; 13:156-68. [PMID: 26387708 PMCID: PMC4720506 DOI: 10.3121/cmr.2015.1289] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 08/06/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Human decision making involves the deliberate formulation of hypotheses and plans as well as the use of subconscious means of judging probability, likely outcome, and proper action. RATIONALE There is a growing recognition that intuitive strategies such as use of heuristics and pattern recognition described in other industries are applicable to high-acuity environments in medicine. Despite the applicability of theories of cognition to the intensive care unit, a discussion of decision-making strategies is currently absent in the critical care literature. CONTENT This article provides an overview of known cognitive strategies, as well as a synthesis of their use in critical care. By understanding the ways by which humans formulate diagnoses and make critical decisions, we may be able to minimize errors in our own judgments as well as build training activities around known strengths and limitations of cognition.
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Affiliation(s)
- Geoffrey K Lighthall
- Associate Professor, Department of Anesthesia, Stanford University School of Medicine, Stanford, California USA
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Heavner JJ, Siner JM. Adverse Event Reporting and Quality Improvement in the Intensive Care Unit. Clin Chest Med 2015; 36:461-7. [PMID: 26304283 DOI: 10.1016/j.ccm.2015.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients in the intensive care unit are at high risk for experiencing adverse events and errors. The high-acuity health care needs of these vulnerable patients expose them to numerous medications, procedures, and health care providers. The occurrence of adverse events is associated with detriments to patient outcomes including increased mortality. Adverse event reporting is the most commonly used event-detection tool, but it should also be complimented with other tools such as trigger tools, chart review, and direct observation. Although adverse event reporting is essential for continuous improvement processes and is associated with improvements in safety culture, it remains significantly underutilized.
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Affiliation(s)
- Jason J Heavner
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Jonathan M Siner
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Lipshutz AKM, Caldwell JE, Robinowitz DL, Gropper MA. An analysis of near misses identified by anesthesia providers in the intensive care unit. BMC Anesthesiol 2015; 15:93. [PMID: 26082147 PMCID: PMC4468961 DOI: 10.1186/s12871-015-0075-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 06/09/2015] [Indexed: 11/23/2022] Open
Abstract
Background Learning from adverse events and near misses may reduce the incidence of preventable errors. Current literature on adverse events and near misses in the ICU focuses on errors reported by nurses and intensivists. ICU near misses identified by anesthesia providers may reveal critical events, causal mechanisms and system weaknesses not identified by other providers, and may differ in character and causality from near misses in other anesthesia locations. Methods We analyzed events reported to our anesthesia near miss reporting system from 2009 to 2011. We compared causative mechanisms of ICU near misses with near misses in other anesthesia locations. Results A total of 1,811 near misses were reported, of which 22 (1.2 %) originated in the ICU. Five causal mechanisms explained over half of ICU near misses. Compared to near misses from other locations, near misses from the ICU were more likely to occur while on call (45 % vs. 19 %, p = 0.001), and were more likely to be associated with airway management (50 % vs. 12 %, p < 0.001). ICU near misses were less likely to be associated with equipment issues (23 % vs. 48 %, p = 0.02). Conclusions A limited number of causal mechanisms explained the majority of ICU near misses, providing targets for quality improvement. Errors associated with airway management in the ICU may be underappreciated. Specialist consultants can identify systems weaknesses not identified by critical care providers, and should be engaged in the ICU patient safety movement.
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Affiliation(s)
- Angela K M Lipshutz
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - James E Caldwell
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - David L Robinowitz
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Michael A Gropper
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
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Hewitt TA, Chreim S. Fix and forget or fix and report: a qualitative study of tensions at the front line of incident reporting. BMJ Qual Saf 2015; 24:303-10. [PMID: 25749025 PMCID: PMC4413736 DOI: 10.1136/bmjqs-2014-003279] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 02/20/2015] [Indexed: 11/29/2022]
Abstract
Introduction Practitioners frequently encounter safety problems that they themselves can resolve on the spot. We ask: when faced with such a problem, do practitioners fix it in the moment and forget about it, or do they fix it in the moment and report it? We consider factors underlying these two approaches. Methods We used a qualitative case study design employing in-depth interviews with 40 healthcare practitioners in a tertiary care hospital in Ontario, Canada. We conducted a thematic analysis, and compared the findings with the literature. Results ‘Fixing and forgetting’ was the main choice that most practitioners made in situations where they faced problems that they themselves could resolve. These situations included (A) handling near misses, which were seen as unworthy of reporting since they did not result in actual harm to the patient, (B) prioritising solving individual patients’ safety problems, which were viewed as unique or one-time events and (C) encountering re-occurring safety problems, which were framed as inevitable, routine events. In only a few instances was ‘fixing and reporting’ mentioned as a way that the providers dealt with problems that they could resolve. Conclusions We found that generally healthcare providers do not prioritise reporting if a safety problem is fixed. We argue that fixing and forgetting patient safety problems encountered may not serve patient safety as well as fixing and reporting. The latter approach aligns with recent calls for patient safety to be more preventive. We consider implications for practice.
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Affiliation(s)
- Tanya Anne Hewitt
- Department of Population Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Samia Chreim
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
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Riga M, Vozikis A, Pollalis Y, Souliotis K. MERIS (Medical Error Reporting Information System) as an innovative patient safety intervention: a health policy perspective. Health Policy 2014; 119:539-48. [PMID: 25554702 DOI: 10.1016/j.healthpol.2014.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 10/24/2022]
Abstract
The economic crisis in Greece poses the necessity to resolve problems concerning both the spiralling cost and the quality assurance in the health system. The detection and the analysis of patient adverse events and medical errors are considered crucial elements of this course. The implementation of MERIS embodies a mandatory module, which adopts the trigger tool methodology for measuring adverse events and medical errors an intensive care unit [ICU] environment, and a voluntary one with web-based public reporting methodology. A pilot implementation of MERIS running in a public hospital identified 35 adverse events, with approx. 12 additional hospital days and an extra healthcare cost of €12,000 per adverse event or of about €312,000 per annum for ICU costs only. At the same time, the voluntary module unveiled 510 reports on adverse events submitted by citizens or patients. MERIS has been evaluated as a comprehensive and effective system; it succeeded in detecting the main factors that cause adverse events and discloses severe omissions of the Greek health system. MERIS may be incorporated and run efficiently nationally, adapted to the needs and peculiarities of each hospital or clinic.
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Affiliation(s)
- Marina Riga
- Health Economics, School of Economics, Business and International Studies, Department of Economics, University of Piraeus, 80, Karaoli & Dimitriou Street, 18534 Piraeus, Greece
| | - Athanassios Vozikis
- Health Economics and Information Systems, School of Economics, Business and International Studies, Department of Economics, University of Piraeus, 80, Karaoli & Dimitriou Street, 18534 Piraeus, Greece
| | - Yannis Pollalis
- Strategic Management and Policy, School of Economics, Business and International Studies, Department of Economics, University of Piraeus, 80, Karaoli & Dimitriou Street, 18534 Piraeus, Greece
| | - Kyriakos Souliotis
- Health Policy, Faculty of Social Sciences, Department of Social and Educational Policy, University of Peloponnese, Damaskinou & Kolokotroni Str., 20100 Corinth, Greece.
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Error in intensive care: psychological repercussions and defense mechanisms among health professionals. Crit Care Med 2014; 42:2370-8. [PMID: 25054673 DOI: 10.1097/ccm.0000000000000508] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To identify the psychological repercussions of an error on professionals in intensive care and to understand their evolution. To identify the psychological defense mechanisms used by professionals to cope with error. DESIGN Qualitative study with clinical interviews. We transcribed recordings and analysed the data using an interpretative phenomenological analysis. SETTING Two ICUs in the teaching hospitals of Besançon and Dijon (France). SUBJECTS Fourteen professionals in intensive care (20 physicians and 20 nurses). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We conducted 40 individual semistructured interviews. The participants were invited to speak about the experience of error in ICU. The interviews were transcribed and analyzed thematically by three experts. In the month following the error, the professionals described feelings of guilt (53.8%) and shame (42.5%). These feelings were associated with anxiety states with rumination (37.5%) and fear for the patient (23%); a loss of confidence (32.5%); an inability to verbalize one's error (22.5%); questioning oneself at a professional level (20%); and anger toward the team (15%). In the long term, the error remains fixed in memory for many of the subjects (80%); on one hand, for 72.5%, it was associated with an increase in vigilance and verifications in their professional practice, and on the other hand, for three professionals, it was associated with a loss of confidence. Finally, three professionals felt guilt which still persisted at the time of the interview. We also observed different defense mechanisms implemented by the professional to fight against the emotional load inherent in the error: verbalization (70%), developing skills and knowledge (43%), rejecting responsibility (32.5%), and avoidance (23%). We also observed a minimization (60%) of the error during the interviews. CONCLUSIONS It is important to take into account the psychological experience of error and the defense mechanisms developed following an error because they appear to determine the professional's capacity to acknowledge and disclose his/her error and to learn from it.
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Faisy C, Davagnar C, Marlet C, Seijo M, Guillou A, Fagon JY. Des RMM à la conception d’indicateurs de qualité et de sécurité : dix ans de travaux sur les RMM en réanimation. MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-015-1035-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Scott LD, Arslanian-Engoren C, Engoren MC. Association of sleep and fatigue with decision regret among critical care nurses. Am J Crit Care 2014; 23:13-23. [PMID: 24382613 DOI: 10.4037/ajcc2014191] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The effects of inadequate sleep on clinical decisions may be important for patients in critical care units, who are often more vulnerable than patients in other units. Fatigued nurses are more likely than well-rested nurses to make faulty decisions that lead to decision regret, a negative cognitive emotion that occurs when the actual outcome differs from the desired or expected outcome. OBJECTIVES To examine the association between selected sleep variables, impairment due to fatigue, and clinical-decision self-efficacy and regret among critical care nurses. Decision regret was the primary outcome variable. Methods A nonexperimental, descriptive design and extant measures were used to obtain data from a random sample of full-time nurses. Binary logistic regression models were used to examine the association between sleep variables, fatigue, and clinical-decision self-efficacy and regret. The discrimination of the models was compared with the C statistic, the area under the receiver operating characteristic curve. RESULTS A total of 605 nurses returned the questionnaires (17% response rate). Among these, decision regret was reported by 157 of 546 (29%). Nurses with decision regret reported more fatigue, more daytime sleepiness, less intershift recovery, and worse sleep quality than did nurses without decision regret. Being male, working a 12-hour shift, and clinical-decision satisfaction were significantly associated with decision regret (C statistic, 0.719; SE, 0.024). CONCLUSION Nurses who experience impairments due to fatigue, loss of sleep, and inability to recover between shifts are more likely than unimpaired nurses to report decision regret.
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Affiliation(s)
- Linda D. Scott
- Linda D. Scott is associate dean for academic affairs and an associate professor, Health Systems Sciences, University of Illinois at Chicago College of Nursing. Cynthia Arslanian-Engoren is an associate professor of nursing, School of Nursing, and Milo C. Engoren is a clinical professor, Department of Anesthesiology, University of Michigan, Ann Arbor
| | - Cynthia Arslanian-Engoren
- Linda D. Scott is associate dean for academic affairs and an associate professor, Health Systems Sciences, University of Illinois at Chicago College of Nursing. Cynthia Arslanian-Engoren is an associate professor of nursing, School of Nursing, and Milo C. Engoren is a clinical professor, Department of Anesthesiology, University of Michigan, Ann Arbor
| | - Milo C. Engoren
- Linda D. Scott is associate dean for academic affairs and an associate professor, Health Systems Sciences, University of Illinois at Chicago College of Nursing. Cynthia Arslanian-Engoren is an associate professor of nursing, School of Nursing, and Milo C. Engoren is a clinical professor, Department of Anesthesiology, University of Michigan, Ann Arbor
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Ahmed AH, Giri J, Kashyap R, Singh B, Dong Y, Kilickaya O, Erwin PJ, Murad MH, Pickering BW. Outcome of adverse events and medical errors in the intensive care unit: a systematic review and meta-analysis. Am J Med Qual 2013; 30:23-30. [PMID: 24357344 DOI: 10.1177/1062860613514770] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adverse events and medical errors (AEs/MEs) are more likely to occur in the intensive care unit (ICU). Information about the incidence and outcomes of such events is conflicting. A systematic review and meta-analysis were conducted to examine the effects of MEs/AEs on mortality and hospital and ICU lengths of stay among ICU patients. Potentially eligible studies were identified from 4 major databases. Of 902 studies screened, 12 met the inclusion criteria, 10 of which are included in the quantitative analysis. Patients with 1 or more MEs/AEs (vs no MEs/AEs) had a nonsignificant increase in mortality (odds ratio = 1.5; 95% confidence interval [CI] = 0.98-2.14) but significantly longer hospital and ICU stays; the mean difference (95% CI) was 8.9 (3.3-14.7) days for hospital stay and 6.8 (0.2-13.4) days for ICU. The ICU environment is associated with a substantial incidence of MEs/AEs, and patients with MEs/AEs have worse outcomes than those with no MEs/AEs.
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Impact of organizational culture on preventability assessment of selected adverse events in the ICU: evaluation of morbidity and mortality conferences. Intensive Care Med 2013; 39:1214-20. [DOI: 10.1007/s00134-013-2923-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 03/31/2013] [Indexed: 10/27/2022]
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Nurses’ disclosure of error scenarios in nursing homes. Nurs Outlook 2013; 61:43-50. [DOI: 10.1016/j.outlook.2012.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 05/06/2012] [Accepted: 05/29/2012] [Indexed: 11/17/2022]
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Adapa RM, Mani V, Murray LJ, Degnan BA, Ercole A, Cadman B, Williams CE, Gupta AK, Wheeler DW. Errors during the preparation of drug infusions: a randomized controlled trial. Br J Anaesth 2012; 109:729-34. [PMID: 22850220 DOI: 10.1093/bja/aes257] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We investigated the extent and frequency of dose errors and treatment delays made as a consequence of preparing drug infusions at the bedside, rather than using pre-filled syringes. METHODS Forty-eight nurses with critical care experience volunteered to take part in this randomized, blinded, controlled study conducted in the simulation centre of an urban hospital. They assisted in the management of a simulated patient with septic shock. Vasopressor infusions were prepared either by diluting concentrated drugs from ampoules or were provided in syringes pre-filled beforehand by an intensive care unit resident. RESULTS The time taken for the infusion to be started and the final concentration of the drugs were measured. We also measured the concentration of infusions prepared by a pharmacist and a pharmaceutical company. Nurses took 156 s to start infusions when using pre-filled syringes compared with 276 s when preparing them de novo, a mean delay of 106 s [95% confidence interval (CI) 73-140 s, P<0.0001]. One infusion prepared from ampoules contained one-fifth of the expected concentration of epinephrine; another contained none at all. Medication errors were 17.0 times less likely when pre-filled syringes were used (95% CI 5.2-55.5), and infusions prepared by pharmacy and industry were significantly more likely to contain the expected concentration (P<0.001 for norepinephrine and P=0.001 for epinephrine). CONCLUSIONS Providing drug infusions in syringes pre-filled by pharmacists or pharmaceutical companies would reduce medication errors and treatment delays, and improve patient safety. However, this approach would have substantial financial implications for healthcare providers, especially in less developed countries.
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Affiliation(s)
- R M Adapa
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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Nooryan K, Gasparyan K, Sharif F, Zoladl M. Controlling anxiety in physicians and nurses working in intensive care units using emotional intelligence items as an anxiety management tool in Iran. Int J Gen Med 2012; 5:5-10. [PMID: 22259255 PMCID: PMC3259021 DOI: 10.2147/ijgm.s25850] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Today, anxiety is one of the most common problems of mankind, to the extent that we could claim that it predisposes human to many physical illnesses, mental disorders, behavioral disturbances, and inappropriate reactions. The intensive care unit is a stressful environment for its staff, especially physicians and nurses. These stresses may have negative effects on the mental health and performance of the nurses and physicians. But the complications caused by this stress can be prevented by training emotional intelligence components. In this study, the impact of training emotional intelligence components on stress and anxiety in nurses and expert physicians is examined. METHODOLOGY A cross-interventional, pre- to post-, case and control group design was used and inferential study design was implemented. Our study included 150 registered hospitals physicians and nurses, who were widely distributed. In the study, a ten-question demographic questionnaire, a 20-question situational anxiety Berger (overt) questionnaire, and a 133-question Bar-on emotional intelligence questionnaire were used. RESULTS Research results indicate that average score for the situational anxiety of the case group in nurses was 47.20 before the intervention and it was reduced to 42.00 after the intervention, and in physicians was 40.46 before the intervention and it decreased to 33.66 after implementation of training items of emotional intelligence, which indicates the impact of training of emotional intelligence components on reduction of situational anxiety. The average score of situational anxiety of control group nurses was 46.73 before the intervention and it decreased to 45.70. In physicians, it was 38.33 before the intervention and it increased to 39.40 during post-test. However, t-test did not confirmed a statistically significant difference between the average score of situational anxiety of both case and control groups before the intervention, and there was a statistically significant difference between the average score of both case and control groups after training components of emotional intelligence (P = 0.000). CONCLUSION Training emotional intelligence components reduces situational anxiety of nurses and physicians working in intensive care units and their emotional intelligence score increased and situational anxiety score was significantly reduced.
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Chousterman B, Pirracchio R. [From iatrogenesis to medical errors: review of the literature and analytical approach]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2011; 30:914-922. [PMID: 22054716 DOI: 10.1016/j.annfar.2011.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 08/01/2011] [Indexed: 05/31/2023]
Abstract
Iatrogenesis and medical errors have been increasingly studied over the past years. Because of the lack of consensus concerning the definitions, it remains difficult to draw general conclusions from the published. Moreover, it is still likely to be underestimated because of underreporting. This review aims at evaluating the overall incidence of iatrogenesis and medical errors in anaesthesia and intensive care and at discussing the strategies to prevent these incidents, at the individual or systemic level.
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Affiliation(s)
- B Chousterman
- Département d'anesthésie-réanimation-Smur, hôpital Lariboisière, université Paris-7 Diderot, 2, rue Ambroise-Paré, 75010 Paris, France
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Physicians' Attitudes Toward Reporting Medical Errors-An Observational Study at a General Hospital in Saudi Arabia. J Patient Saf 2011; 7:144-7. [DOI: 10.1097/pts.0b013e31822c5a82] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Claro CM, Krocockz DVC, Toffolleto MC, Padilha KG. [Adverse events at the Intensive Care Unit: nurses' perception about the culture of no-punishment]. Rev Esc Enferm USP 2011; 45:167-72. [PMID: 21445504 DOI: 10.1590/s0080-62342011000100023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 05/15/2010] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED The safety culture of Intensive Care Units (ICU) recommends following the no-punishment approach when adverse events (AE) occur. It is, however, questionable if nurses perceive those AE. OBJECTIVES to characterize AE report systems; to verify AE frequency and consequences to the professionals; and to verify the nurses' level of confidence to report AE. This descriptive study involved 70 ICU nurses, who answered a questionnaire in 2007, followed by descriptive analyses. Most nurses (70.0%) reported the existence of an AE notification system at their place of work. The frequency of AE was reported as sometimes and several times by 51.4% and 28.6% of the sample, respectively. For 74.3% of nurses, punishment happens sometimes and always, mainly through verbal notice (49.0%). Most nurses (74.3%) reported feeling confident and completely confident to report AE. In conclusion, punishment still exists in the Units.
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Alonso-Ovies Á, Álvarez-Rodríguez J, del Mar García-Gálvez M, Velayos-Amo C, Balugo-Huertas S, Álvarez-Morales A. [Usefulness of failure mode and effects analysis to improve patient safety during the process of incorporating new nurses in an intensive care unit]. Med Clin (Barc) 2011; 135 Suppl 1:45-53. [PMID: 20875541 DOI: 10.1016/s0025-7753(10)70020-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyze proactively the process of incorporating new nurses in the intensive care unit (ICU) in order to detect risk areas and establish improvements that increase critical patient safety. MATERIAL AND METHODS Once the risk area was defined, the different phases of failure mode and effects analysis (FMEA) were applied: work team selection; process design; process phases definition; failure modes, possible causes and effects analysis; risk priority for each failure, and development of ameliorating and corrective actions. The proposed actions consisted of an orientation and training program (theoretical and practical) for new nurses, a supervision plan, a progressive responsibility program and ICU participation in personnel recruitment. RESULTS Twelve nurses began to work in the ICU during the first 18 months of the program's implementation. Of these, only one nurse had full experience in critical care and three had partial experience. Participation of the ICU in personnel recruitment was nil. All the nurses with no or partial experience followed the orientation program (nursing supervisor interview, test of previous knowledge, handing over of the employee handbook, etc.), the theoretical and practical training program (supervision and tutorship) and the progressive responsibility program. More than half (63.6%) of the new nurses had another nurse duplicating their jobs during the training period and 54.5% of the new nurses attended the critical care course for nurses. Nurses participating in the orientation and training program expressed a high level of satisfaction. These measures helped nurses to decrease their stress and anxiety, increase and consolidate their knowledge, and provide safer care to critical patients. CONCLUSIONS FMEA is a useful tool for improving ICU processes, even those involving human resources. The improvements implemented to decrease clinical risk related to the incorporation of new nurses in the ICU, based on previous training, will increase the safety of critical patient care by decreasing human errors due to inexperience.
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Affiliation(s)
- Ángela Alonso-Ovies
- Servicio de Medicina Intensiva, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain.
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Ilan R, Squires M, Panopoulos C, Day A. Increasing patient safety event reporting in 2 intensive care units: a prospective interventional study. J Crit Care 2010; 26:431.e11-8. [PMID: 21129913 DOI: 10.1016/j.jcrc.2010.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 09/13/2010] [Accepted: 10/03/2010] [Indexed: 11/19/2022]
Abstract
PURPOSE The aims of this study were to increase the reporting of patient safety events and to enhance report analysis and responsive action. MATERIALS AND METHODS A prospective, interventional study in 2 adult intensive care units (ICUs) in an academic center was used. A paper-based reporting system, adapted from a previously reported intervention, was introduced. A multifaceted approach, including education, reminders, regular updates, personal and group feedback, and weekly leadership rounds, was led by a patient safety committee. Committee members reviewed the reports and initiated solutions as required. RESULTS During the first year, a total of 332 safety events were reported using the new system, reflecting a significant increase in total reporting (10.3/1000 patient days preintervention to 34.5/1000 patient days postintervention; rate ratio, 3.35; 95% confidence interval, 2.23-5.04). Most reports were submitted by nurses (nurses, 75.3%; physicians, 10.5%; other workers, 7.8%). Overall reported events per 1000 patient days differed by unit (level 3 ICU, 44.1; level 2 ICU, 24.9; P < .001). Several system-based interventions were initiated in the ICUs to address reported safety hazards. CONCLUSIONS After the introduction of this new approach, reporting rates have increased significantly throughout the first year. Differences in reporting rates among workers and units may reveal priorities and barriers to reporting. The integrated approach facilitated prompt response to selected reports.
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Affiliation(s)
- Roy Ilan
- Department of Medicine, Queen's University, Kingston General Hospital, Kingston, ON, Canada K7L 3N6.
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Moreno-Millán E, Villegas-Del Ojo J, Prieto-Valderrey F, Nieto-Galeano J. [Adverse effects, intercommunication, management of knowledge and care strategies in intensive nursing]. Med Intensiva 2010; 35:3-5. [PMID: 21130536 DOI: 10.1016/j.medin.2010.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 09/19/2010] [Indexed: 11/25/2022]
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Klopotowska JE, Kuiper R, van Kan HJ, de Pont AC, Dijkgraaf MG, Lie-A-Huen L, Vroom MB, Smorenburg SM. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R174. [PMID: 20920322 PMCID: PMC3219276 DOI: 10.1186/cc9278] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 06/29/2010] [Accepted: 10/04/2010] [Indexed: 11/10/2022]
Abstract
Introduction Patients admitted to an intensive care unit (ICU) are at high risk for prescribing errors and related adverse drug events (ADEs). An effective intervention to decrease this risk, based on studies conducted mainly in North America, is on-ward participation of a clinical pharmacist in an ICU team. As the Dutch Healthcare System is organized differently and the on-ward role of hospital pharmacists in Dutch ICU teams is not well established, we conducted an intervention study to investigate whether participation of a hospital pharmacist can also be an effective approach in reducing prescribing errors and related patient harm (preventable ADEs) in this specific setting. Methods A prospective study compared a baseline period with an intervention period. During the intervention period, an ICU hospital pharmacist reviewed medication orders for patients admitted to the ICU, noted issues related to prescribing, formulated recommendations and discussed those during patient review meetings with the attending ICU physicians. Prescribing issues were scored as prescribing errors when consensus was reached between the ICU hospital pharmacist and ICU physicians. Results During the 8.5-month study period, medication orders for 1,173 patients were reviewed. The ICU hospital pharmacist made a total of 659 recommendations. During the intervention period, the rate of consensus between the ICU hospital pharmacist and ICU physicians was 74%. The incidence of prescribing errors during the intervention period was significantly lower than during the baseline period: 62.5 per 1,000 monitored patient-days versus 190.5 per 1,000 monitored patient-days, respectively (P < 0.001). Preventable ADEs (patient harm, National Coordinating Council for Medication Error Reporting and Prevention severity categories E and F) were reduced from 4.0 per 1,000 monitored patient-days during the baseline period to 1.0 per 1,000 monitored patient-days during the intervention period (P = 0.25). Per monitored patient-day, the intervention itself cost €3, but might have saved €26 to €40 by preventing ADEs. Conclusions On-ward participation of a hospital pharmacist in a Dutch ICU was associated with significant reductions in prescribing errors and related patient harm (preventable ADEs) at acceptable costs per monitored patient-day. Trial registration number ISRCTN92487665
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Affiliation(s)
- Joanna E Klopotowska
- Department of Hospital Pharmacy, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Adverse drug events in intensive care units: risk factors, impact, and the role of team care. Crit Care Med 2010; 38:S83-9. [PMID: 20502179 DOI: 10.1097/ccm.0b013e3181dd8364] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Advances in diagnostic tests, technological interventions, and pharmacotherapy have resulted in spectacular results for many intensive care unit (ICU) patients who, in earlier generations, would have succumbed to their critical illness. At the same time, the complexity and intensity of care required for ICU patients is also associated with greater risks for harm resulting from care. As in other inpatient areas, medications are the most common type of therapy in ICUs and are also associated with the most frequent type of ICU adverse events. Critically ill patients are at high risk for adverse drug events for many reasons, including the complexity of their disease that creates challenges in drug dosing, their vulnerability to rapid changes in pharmacotherapy, the intensive care environment providing ample distractions and opportunity for error, the administration of complex drug regimens, the numerous high-alert medications that they receive, and the mode of drug administration. The clinical outcomes of adverse drug events can result in end-organ damage and even death. The costs of an adverse drug event can be substantial to healthcare systems with an additional $6,000-$9,000 for each event. The multiprofessional patient care team is one approach to promoting patient safety in the ICU.
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Della Rocca G, De Flaviis A, Costa M, Chiarandini P, Pompei L, Venettoni S. Liver Transplant Quality and Safety Plan in Anesthesia and Intensive Care Medicine. Transplant Proc 2010; 42:2229-32. [DOI: 10.1016/j.transproceed.2010.05.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bion JF, Abrusci T, Hibbert P. Human factors in the management of the critically ill patient. Br J Anaesth 2010; 105:26-33. [PMID: 20511333 DOI: 10.1093/bja/aeq126] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Unreliable delivery of best practice care is a major component of medical error. Critically ill patients are particularly susceptible to error and unreliable care. Human factors analysis, widely used in industry, provides insights into how interactions between organizations, tasks, and the individual worker impact on human behaviour and affect systems reliability. We adopt a human factors approach to examine determinants of clinical reliability in the management of critically ill patients. We conducted a narrative review based on a Medline search (1950-March 2010) combining intensive/critical care (units) with medical errors, patient safety, or delivery of healthcare; keyword and Internet search 'human factors' or 'ergonomics'. Critical illness represents a high-risk, complex system spanning speciality and geographical boundaries. Substantial opportunities exist for improving the safety and reliability of care of critically ill patients at the level of the task, the individual healthcare provider, and the organization or system. Task standardization (best practice guidelines) and simplification (bundling or checklists) should be implemented where scientific evidence is strong, or adopted subject to further research ('dynamic standardization'). Technical interventions should be embedded in everyday practice by the adjunctive use of non-technical (behavioural) interventions. These include executive 'adoption' of clinical areas, systematic methods for identifying hazards and reflective learning from error, and a range of techniques for improving teamworking and communication. Human factors analysis provides a useful framework for understanding and rectifying the causes of error and unreliability, particularly in complex systems such as critical care.
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Affiliation(s)
- J F Bion
- University Department of Anaesthesia and ICM, N5, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK.
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Ksouri H, Balanant PY, Tadié JM, Heraud G, Abboud I, Lerolle N, Novara A, Fagon JY, Faisy C. Impact of morbidity and mortality conferences on analysis of mortality and critical events in intensive care practice. Am J Crit Care 2010; 19:135-45; quiz 146. [PMID: 20194610 DOI: 10.4037/ajcc2010590] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Morbidity and mortality conferences are a tool for evaluating care management, but they lack a precise format for practice in intensive care units. OBJECTIVES To evaluate the feasibility and usefulness of regular morbidity and mortality conferences specific to intensive care units for improving quality of care and patient safety. METHODS For 1 year, a prospective study was conducted in an 18-bed intensive care unit. Events analyzed included deaths in the unit and 4 adverse events (unexpected cardiac arrest, unplanned extubation, reintubation within 24-48 hours after planned extubation, and readmission to the unit within 48 hours after discharge) considered potentially preventable in optimal intensive care practice. During conferences, events were collectively analyzed with the help of an external auditor to determine their severity, causality, and preventability. RESULTS During the study period, 260 deaths and 100 adverse events involving 300 patients were analyzed. The adverse events rate was 16.6 per 1000 patient-days. Adverse events occurred more often between noon and 4 pm (P = .001).The conference consensus was that 6.1% of deaths and 36% of adverse events were preventable. Preventable deaths were associated with iatrogenesis (P = .008), human errors (P < .001), and failure of unit management factors or communication (P = .003). Three major recommendations were made concerning standardization of care or prescription and organizational management, and no similar incidents have recurred. CONCLUSION In addition to their educational value, regular morbidity and mortality conferences formatted for intensive care units are useful for assessing quality of care and patient safety.
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Affiliation(s)
- Hatem Ksouri
- All authors are from the Department of Medical Intensive Care, European Hospital Georges Pompidou, Assistance Publique–Hôpitaux de Paris, Université Paris–Descartes, Paris, France
| | - Per-Yann Balanant
- All authors are from the Department of Medical Intensive Care, European Hospital Georges Pompidou, Assistance Publique–Hôpitaux de Paris, Université Paris–Descartes, Paris, France
| | - Jean-Marc Tadié
- All authors are from the Department of Medical Intensive Care, European Hospital Georges Pompidou, Assistance Publique–Hôpitaux de Paris, Université Paris–Descartes, Paris, France
| | - Guillaume Heraud
- All authors are from the Department of Medical Intensive Care, European Hospital Georges Pompidou, Assistance Publique–Hôpitaux de Paris, Université Paris–Descartes, Paris, France
| | - Imad Abboud
- All authors are from the Department of Medical Intensive Care, European Hospital Georges Pompidou, Assistance Publique–Hôpitaux de Paris, Université Paris–Descartes, Paris, France
| | - Nicolas Lerolle
- All authors are from the Department of Medical Intensive Care, European Hospital Georges Pompidou, Assistance Publique–Hôpitaux de Paris, Université Paris–Descartes, Paris, France
| | - Ana Novara
- All authors are from the Department of Medical Intensive Care, European Hospital Georges Pompidou, Assistance Publique–Hôpitaux de Paris, Université Paris–Descartes, Paris, France
| | - Jean-Yves Fagon
- All authors are from the Department of Medical Intensive Care, European Hospital Georges Pompidou, Assistance Publique–Hôpitaux de Paris, Université Paris–Descartes, Paris, France
| | - Christophe Faisy
- All authors are from the Department of Medical Intensive Care, European Hospital Georges Pompidou, Assistance Publique–Hôpitaux de Paris, Université Paris–Descartes, Paris, France
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To report or not to report: A descriptive study exploring ICU nurses’ perceptions of error and error reporting. Intensive Crit Care Nurs 2010; 26:1-9. [DOI: 10.1016/j.iccn.2009.10.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 10/02/2009] [Accepted: 10/21/2009] [Indexed: 11/20/2022]
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Abstract
OBJECTIVE To develop and examine the reliability and validity of a new instrument, the nurse-nurse collaboration (NNC) scale. BACKGROUND Nurse-nurse collaboration (NNC) is recommended to reduce medical errors and improve patient care and nurses' job satisfaction. While instruments are available to measure nurse-physician collaboration, an instrument to measure NNC was not available in the literature. Because collaboration is necessary for optimal patient care, a valid and reliable instrument would make it possible to measure the level of collaboration among nurses. METHODS A comprehensive literature review was conducted to develop a definition and define relevant domains of NNC and identify instruments with acceptable psychometrics that included items measuring NNC. Instrument items to develop the Nurse-Nurse Collaboration Scale (NNC Scale) were adapted from previously published tools or developed based on domains identified in the literature. Five domains were identified: problem solving, communication, coordination, shared process, and professionalism. Psychometric testing of the NNC Scale included pilot testing for content and construct validity and field testing among 76 staff nurses working in 4 ICUs in a large tertiary-care academic medical center in the northeast United States. Psychometric tests assessing reliability and convergent validity correlations were conducted. RESULTS The overall Cronbach alpha for the scale was .89. Convergent validity correlations, however, were low to moderate, indicating minimal shared variance among the subscales. Therefore, the instrument did not measure a global concept but rather 5 separate domains of collaboration. Internal consistency testing of the 5 subscales produced acceptable results ranging from .66 to .91. CONCLUSION The NNC Scale demonstrated acceptable reliability and validity for measuring the level of NNC in intensive care nurses. Further psychometric testing and a factor analysis with a larger-sample, more diverse groups of nurses are necessary to further characterize the generalizability of the NNC Scale.
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