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Tlili MA, Aouicha W, Gambashidze N, Ben Cheikh A, Sahli J, Weigl M, Mtiraoui A, Chelbi S, Said Laatiri H, Mallouli M. A retrospective analysis of adverse events reported by Tunisian intensive care units' professionals. BMC Health Serv Res 2024; 24:77. [PMID: 38229159 DOI: 10.1186/s12913-024-10544-9] [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: 06/10/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024] Open
Abstract
INTRODUCTION Adverse events (AEs) that occur in hospitals remain a challenge worldwide, and especially in intensive care units (ICUs) where they are more likely to occur. Monitoring of AEs can provide insight into the status and advances of patient safety. This study aimed to examine the AEs reported during the 20 months after the implementation of the AE reporting system. METHODS We conducted a retrospective analysis of a voluntary ICU AE reporting system. Incidents were reported by the staff from ten ICUs in the Sahloul University Hospital (Tunisia) between February 2020 and September 2021. RESULTS A total of 265 reports were received, of which 61.9% were deemed preventable. The most frequently reported event was healthcare-associated infection (30.2%, n = 80), followed by pressure ulcers (18.5%, n = 49). At the time of reporting, 25 patients (9.4%) had died as a result of an AE and in 51.3% of cases, the event had resulted in an increased length of stay. Provider-related factors contributed to 64.2% of the events, whilst patient-related factors contributed to 53.6% of the events. As for criticality, 34.3% of the events (n = 91) were unacceptable (c3) and 36.3% of the events (n = 96) were 'acceptable under control' (c2). CONCLUSIONS The reporting system provided rich information on the characteristics of reported AEs that occur in ICUs and their consequences and may be therefore useful for designing effective and evidence-based interventions to reduce the occurrence of AEs.
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Affiliation(s)
- Mohamed Ayoub Tlili
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia.
| | - Wiem Aouicha
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Nikoloz Gambashidze
- Institute for Patient Safety, University Hospital Bonn, Venusberg-Campus-1, 53127, Bonn, Germany
| | - Asma Ben Cheikh
- Department of Prevention and Care Safety, Sahloul University Hospital, 4054, Sousse, Tunisia
| | - Jihene Sahli
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Matthias Weigl
- Institute for Patient Safety, University Hospital Bonn, Venusberg-Campus-1, 53127, Bonn, Germany
| | - Ali Mtiraoui
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Souad Chelbi
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Houyem Said Laatiri
- Department of Prevention and Care Safety, Sahloul University Hospital, 4054, Sousse, Tunisia
| | - Manel Mallouli
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
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Wu N, Zhang Y, Wang S, Zhao Y, Zhong X. Incidence, prevalence and risk factors of delirium in
ICU
patients: A systematic review and meta‐analysis. Nurs Crit Care 2022. [DOI: 10.1111/nicc.12857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nan‐Nan Wu
- The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Ya‐Bin Zhang
- The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Shu‐Yun Wang
- The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Yu‐Hua Zhao
- The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Xue‐Mei Zhong
- Guangdong Women and Children Hospital Guangzhou China
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3
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Análise dos custos de eventos adversos infecciosos em saúde. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao01187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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4
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Silva AMD, Colaço AD, Bertoncello KCG, Silva TGD, Amante LN, Matos FGDOA. Acurácia dos diagnósticos de Enfermagem nos cuidados ao paciente crítico. REME: REVISTA MINEIRA DE ENFERMAGEM 2022. [DOI: 10.35699/2316-9389.2022.38659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objetivo: avaliar a acurácia dos diagnósticos de Enfermagem de pacientes internados em uma Unidade de Terapia Intensiva. Método: pesquisa quantitativa, documental, retrospectiva e transversal. Foram avaliados 122 prontuários de pacientes adultos internados na Unidade de Terapia Intensiva de um hospital público catarinense, no período de 12 meses, que continham o histórico de Enfermagem e os diagnósticos de Enfermagem documentados nas primeiras 24 horas de internação do paciente. A avaliação da acurácia dos diagnósticos de Enfermagem foi realizada por duas avaliadoras utilizando a Escala de Acurácia dos Diagnósticos de Enfermagem - versão 2. Resultados: foram avaliados 809 diagnósticos, contidos em 122 prontuários, documentados por nove enfermeiros. Houve predominância de diagnósticos de Enfermagem com alta acurácia (n=665; 82,2%). Diagnósticos com acurácia moderada (n=64; 7,9%), acurácia baixa (n=54; 6,6%) e acurácia nula (n=26; 3,2%) foram pouco frequentes. Conclusão: o alto grau de acurácia da maioria significativa dos diagnósticos de Enfermagem avaliados indica o nível de refinamento do raciocínio clínico diagnóstico dos enfermeiros.
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Tlili MA, Aouicha W, Sahli J, Ben Cheikh A, Mtiraoui A, Ajmi T, Zedini C, Chelbi S, Ben Rejeb M, Mallouli M. Assessing patient safety culture in 15 intensive care units: a mixed-methods study. BMC Health Serv Res 2022; 22:274. [PMID: 35232452 PMCID: PMC8887118 DOI: 10.1186/s12913-022-07665-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Within hospitals, intensive care units (ICUs) are particularly high-risk areas for medical errors and adverse events that could occur due to the complexity of care and the patients' fragile medical conditions. Assessing patient safety culture (PSC) is essential to have a broad view on patient safety issues, to orientate future improvement actions and optimize quality of care and patient safety outcomes. This study aimed at assessing PSC in 15 Tunisian ICUs using mixed methods approach. METHODS A cross-sectional mixed methods approach using a sequential explanatory design was conducted from December 2019 to January 2020. The first quantitative stage was conducted in 15 ICUs belonging to the two university hospitals in the region of Sousse (Tunisia). All the 344 healthcare professionals (clinical staff) working for more than 1 month in these ICUs were contacted in order to take part in the study. In the second qualitative stage 12 participants were interviewed based on purposive sampling. RESULTS All of the PSC dimensions had a score of less than 50%. The developed dimension was 'teamwork within units' (48.8%). The less developed dimensions were 'frequency of event reporting' (20.8%), 'communication openness' (22.2%) and 'non-punitive response to error' (19.7%). Interviews' thematic analysis revealed four main themes including "Hospital management/system failure", "Teamwork and communication", "Error management" and "Working conditions". CONCLUSION This research revealed that PSC is still in need of improvement and provided a clearer picture of the patient safety issues that require specific attention. Improving PSC through the use of quality management and error reporting systems may help to improve patient safety outcomes.
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Affiliation(s)
- Mohamed Ayoub Tlili
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia. .,Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia. .,Higher School of Health Sciences and Techniques of Sousse, University of Sousse, 4054, Sousse, Tunisia.
| | - Wiem Aouicha
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia.,Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia.,Higher School of Health Sciences and Techniques of Sousse, University of Sousse, 4054, Sousse, Tunisia
| | - Jihene Sahli
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia.,Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Asma Ben Cheikh
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia.,Department of Prevention and Care Safety, Sahloul University Hospital, 4054, Sousse, Tunisia
| | - Ali Mtiraoui
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia.,Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Thouraya Ajmi
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia.,Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Chekib Zedini
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia.,Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Souad Chelbi
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia.,Higher School of Health Sciences and Techniques of Sousse, University of Sousse, 4054, Sousse, Tunisia
| | - Mohamed Ben Rejeb
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia.,Department of Prevention and Care Safety, Sahloul University Hospital, 4054, Sousse, Tunisia
| | - Manel Mallouli
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia.,Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
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Assis SFD, Vieira DFVB, Sousa FREGD, Pinheiro CEDO, Prado PRD. Eventos adversos em pacientes de terapia intensiva: estudo transversal. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2021-0481pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: identificar a prevalência de eventos adversos e a necessidade de cuidado do paciente crítico em uma unidade de terapia intensiva. Método: estudo transversal, realizado de janeiro a março de 2020. Os eventos adversos investigados foram: lesão por pressão, extubação orotraqueal acidental, queda, perda de acesso venoso central e infecção relacionada à assistência à saúde. O número de horas necessárias para o cuidado do paciente foi mensurado pela Nursing Activities Score. As variáveis independentes categóricas foram descritas por frequências absoluta e relativa, e as contínuas, por tendência central. A medida de magnitude foi a razão de chance e considerou-se intervalo de confiança de 95%. Resultados: dos 88 pacientes avaliados, 52,3% apresentaram eventos adversos, os quais foram associados à maior necessidade de cuidados, gravidade e ao maior tempo de internação. O Nursing Activities Score médio foi 51,01% (12 h 24 min), sendo identificado um déficit de 20% a 30% de pessoal de enfermagem na unidade. Conclusão: a prevalência dos eventos adversos na unidade é alta e o déficit de pessoal de enfermagem na unidade revelou a necessidade de dimensionamento adequado de pessoal para reduzir os danos ocasionados pelos cuidados prestados aos pacientes críticos.
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Luiz RB, Estevam LO, Raponi MBG, Felix MMDS, Barbosa MH. Efficacy of educational strategies in patient involvement for safety in care: a systematic review. Rev Gaucha Enferm 2022; 43:e20210198. [DOI: 10.1590/1983-1447.2022.20210198.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 05/02/2022] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT Objective To evaluate the effectiveness of educational strategies in the involvement of hospitalized adult patient for safety in care. Method Systematic review carried out by searching for experimental and quasi-experimental studies, published from January/2010 to December/2021, in PubMed®, Cochrane Library CENTRAL, Scopus, Web of Science, LILACS, CINAHL and EMBASE. Results Twelve studies were included to involve the patient in safe care practices, five (41.7%) experimental and seven (58.3%) quasi-experimental. Different educational strategies were adopted in the articles included: verbal guidance, books, leaflets and folders (n=4; 33.3%); videos, e-books and electronic applications (n=5; 41.7%); poster, leaflets and video (n=3; 25%). Four experimental studies had a high risk of bias (80%) and all quasi-experimental studies had a low risk of bias (100%). Conclusion The use of educational strategies proved to be effective in involving the patient in safe care practices. Considering the heterogeneity between studies, it is recommended carrying out future research.
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8
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Assis SFD, Vieira DFVB, Sousa FREGD, Pinheiro CEDO, Prado PRD. Adverse events in critically ill patients: a cross-sectional study. Rev Esc Enferm USP 2022; 56:e20210481. [PMID: 35551577 PMCID: PMC10111387 DOI: 10.1590/1980-220x-reeusp-2021-0481en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/20/2022] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To identify the prevalence of adverse events and the critically ill patient’s need for care in an intensive care unit. Method: This is a cross-sectional study, carried out from January to March 2020. The adverse events investigated were pressure injury, accidental orotracheal extubation, fall, loss of central venous access, and healthcare-associated infection. The number of hours required for patient care was measured by the Nursing Activities Score. The categorical independent variables were described by absolute and relative frequencies, and the continuous ones, by central tendency. The magnitude measure was the odds ratio and a confidence interval of 95% was considered. Results: of the 88 patients evaluated, 52.3% had adverse events, which were associated with a greater need for care, severity, and longer hospital stay. The mean Nursing Activities Score was 51.01% (12 h 24 min), with a deficit of 20% to 30% of nursing staff in the unit being identified. Conclusion: The prevalence of adverse events in the unit is high and the shortage of nursing staff in the unit revealed the need for adequate staffing to reduce the damage caused by the care provided to critically ill patients.
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Luiz RB, Estevam LO, Raponi MBG, Felix MMDS, Barbosa MH. Eficácia de estratégias educativas no envolvimento do paciente para a segurança no cuidado: revisão sistemática. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20210198.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
RESUMO Objetivo Avaliar a eficácia de estratégias educativas no envolvimento do paciente adulto hospitalizado para a segurança no cuidado. Método Revisão sistemática realizada por meio da busca de estudos experimentais e quase-experimentais, publicados de janeiro/2010 a dezembro/2021, no PubMed®, Cochrane Library CENTRAL, Scopus, Web of Science, LILACS, CINAHL e EMBASE. Resultados Foram incluídos doze estudos para envolver o paciente nas práticas seguras do cuidado, cinco (41,7%) experimentais e sete (58,3%) quase experimentais. Diferentes estratégias educativas foram adotadas nos artigos incluídos: orientações verbais, livretos, folhetos e folders (n=4; 33,3%); vídeos, e-book e aplicativos eletrônicos (n=5; 41,7%); pôster, folhetos e vídeo (n=3; 25%). Quatro estudos experimentais apresentaram alto risco de viés (80%) e todos quase-experimentais baixo risco de viés (100%). Conclusão O uso de estratégias educativas se demonstrou eficaz no envolvimento do paciente em práticas seguras do cuidado. Recomenda-se a condução de futuras pesquisas ao se considerar a heterogeneidade entre os estudos.
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Raut A, Krishna K, Adake U, Sharma AA, Thomas A, Shah J. Off-label Drug Prescription Pattern and Related Adverse Drug Reactions in the Medical Intensive Care Unit. Indian J Crit Care Med 2021; 25:872-877. [PMID: 34733026 PMCID: PMC8559754 DOI: 10.5005/jp-journals-10071-23909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: The utilization of prescription drugs as off-label is common. While this practice can be beneficial to some patients, it can raise a safety concern when scientific evidence is lacking; hence, this study was conducted to evaluate the off-label drug consumption and its adverse drug reactions (ADRs) in the medical intensive care unit (ICU). Materials and methods: In the prospective cohort study conducted for a duration of 6 months, data pertaining to ICU patients' (age ≥18 years) demography, diagnosis, treatment, and laboratory investigation were collected to assess for off-label use as well as the strength of evidence and the occurrence of ADRs by using MICROMEDEX 2017 version (Healthcare Series Thomson Reuter, Greenwood, CO). Results: Of total 3574 drugs prescribed, 1453 (41%) were off-label indications and 65 (1.81%) were off-label dose. On the evaluation of off-label indication use, 1279 (88%) were evidence-based and 174 (12%) were low/no evidence-based medications (EBMs); 59 (91%) were evidence-based and 6 (9%) were low/no EBMs for off-label dose. Most commonly prescribed evidence-based off-label drug belonged to the gastrointestinal class while low/no evidence drugs were mostly of anti-infective class. A total of 383 ADRs were identified and 139 (36.2%) were implicated due to off-label medications, of which ADRs with evidence off-label medications (87.8%) were higher than low/no evidence off-label medication (12.2%) (P < 0.001). Conclusion: Widespread presence of off-label use was observed in medical ICU. Although incidence of ADRs was similar to the FDA-approved use, ongoing monitoring of such practice is needed. How to cite this article: Raut A, Krishna K, Adake U, Sharma AA, Thomas A, Shah J. Off-label Drug Prescription Pattern and Related Adverse Drug Reactions in the Medical Intensive Care Unit. Indian J Crit Care Med 2021;25(8):872-877.
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Affiliation(s)
- Asawari Raut
- Department of Clinical Pharmacy, BVDU Poona College of Pharmacy, Pune, Maharashtra, India
| | - Kavita Krishna
- Department of Internal Medicine, Bharati Hospital, Pune, Maharashtra, India
| | - Utkarsha Adake
- Department of Clinical Pharmacy, BVDU Poona College of Pharmacy, Pune, Maharashtra, India
| | - Apurva A Sharma
- Department of Clinical Pharmacy, BVDU Poona College of Pharmacy, Pune, Maharashtra, India
| | - Anitta Thomas
- Department of Clinical Pharmacy, BVDU Poona College of Pharmacy, Pune, Maharashtra, India
| | - Jignesh Shah
- Department of Critical Care Medicine, Bharati Vidyapeeth [Deemed to be University] Medical College, Pune, Maharashtra, India
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Aikawa G, Ouchi A, Sakuramoto H, Ono C, Hatozaki C, Okamoto M, Hoshino T, Shimojo N, Inoue Y. Impact of adverse events on patient outcomes in a Japanese intensive care unit: a retrospective observational study. Nurs Open 2021; 8:3271-3280. [PMID: 34405588 PMCID: PMC8510737 DOI: 10.1002/nop2.1040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/10/2021] [Accepted: 08/04/2021] [Indexed: 01/20/2023] Open
Abstract
Aim We investigated adverse events (AEs) in a Japanese intensive care unit (ICU) and evaluated the impact of cause‐specific AEs on mortality and length of stay. Design A retrospective observational study in the ICU of an academic hospital. Methods We reviewed medical records with the Global Trigger Tool. Results Of the 246 patients, 126 (51%) experienced one or more AEs with an incidence of 201 per 1000 patient‐days and 115 per 100 admissions. A total of 294 AEs were detected with 119 (42%) adverse drug events, 67 (24%) procedural complications, 63 (22%) surgical complications, 26 (9%) nosocomial infections, 5 (2%) therapeutic errors and 4 (1%) diagnostic errors. Adverse event (AE) presence was associated with length of ICU stay (β = 2.85, 95% confidence interval [CI]: 1.09–4.61). Adverse drug events, procedural complications and nosocomial infections were strongly associated with length of ICU stay (β = 2.38, 95% CI: 0.77–3.98; β = 3.75, 95% CI: 2.03–5.48; β = 6.52, 95% CI: 4.07–8.97 respectively).
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Affiliation(s)
- Gen Aikawa
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Intensive Care Unit, University of Tsukuba Hospital, Tsukuba, Japan
| | - Akira Ouchi
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Japan
| | - Hideaki Sakuramoto
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Japan
| | - Chiemi Ono
- Intensive Care Unit, University of Tsukuba Hospital, Tsukuba, Japan
| | - Chie Hatozaki
- Intensive Care Unit, University of Tsukuba Hospital, Tsukuba, Japan
| | - Mayu Okamoto
- Intensive Care Unit, University of Tsukuba Hospital, Tsukuba, Japan
| | - Tetsuya Hoshino
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Nobutake Shimojo
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Oliveira ECDS, Silva RCLD, Arruda GAD, Oliveira RCD. Usability of volumetric infusion pumps in pediatric intensive care. Rev Esc Enferm USP 2021; 55:e03712. [PMID: 33978144 DOI: 10.1590/s1980-220x2020001103712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/23/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the usability of two infusion pump models in a Pediatric Intensive Care Unit. METHOD This is a cross-sectional study of exploratory descriptive quantitative approach. A task was carried out in a controlled environment using infusion pump with 72 nursing staff members from August to September 2018. The Methodological Guideline for Medical Care Equipment Assessment Studies and the quality model proposed by NBR ISO/IEC 9126-1 were followed. Descriptive statistical analysis was used applying Fisher's exact test, binomial test and Mann-Whitney test. RESULTS 91.7% of tasks were completed. The infusion pump-2 model was associated (p < 0.001) with operationalization, tasks accomplished with non-conformities, use of a manual calculator (measure effectiveness) and task accomplishment time (measure efficiency). CONCLUSION Efficacy and efficiency measures can evidence a better context of usability of IPs and identify interaction failures with the nursing staff to be improved in care practice.
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Affiliation(s)
| | - Roberto Carlos Lyra da Silva
- Universidade Federal do Estado do Rio de Janeiro, Escola de Enfermagem Alfredo Pinto, Programa de Pós-Graduação em Enfermagem, Rio de Janeiro, RJ, Brazil
| | - Gustavo Aires de Arruda
- Universidade Estadual de Londrina, Centro de Educação Física e Esporte, Londrina, PR, Brazil
| | - Regina Célia de Oliveira
- Universidade de Pernambuco, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, Recife, PE, Brazil
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Freitas LA, Fagundes AL, do Prado PR, Pereira MCA, de Medeiros AP, de Freitas LM, Teixeira TCA, Koepp J, de Carvalho REFL, Gimenes FRE. Factors associated with length of stay and death in tube-fed patients: A cross-sectional multicentre study. Nurs Open 2021; 8:2509-2519. [PMID: 33503335 PMCID: PMC8363365 DOI: 10.1002/nop2.774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/10/2020] [Accepted: 12/03/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To analyse the factors associated with length of stay (LOS) and death in nasogastric/nasoenteric tube (NG/NET)-fed patients. DESIGN A cross-sectional multicentre study. METHOD Data collection took place from October 2017-April 2019, and the sample consisted of 365 participants from seven Brazilian hospitals. Demographic, clinical and therapeutic data were collected from the patients' medical records. Data analysis was performed using bivariate and multivariate tests, considering a significance level of p<.05. RESULTS Most patients were male, older adults, with high risk of death and highly dependent on nursing care. The LOS was associated with age, patient care complexity and length of NG/NET use. Death was associated with patient age. In the multivariate analysis, patients highly dependent on nursing care, and intensive and semi-intensive care had a greater chance of dying when compared with patients receiving minimal care. Screening for factors affecting LOS and death is important to plan effective nursing care.
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Affiliation(s)
| | - Alex Luís Fagundes
- University of São Paulo at Ribeirão Preto College of Nursing, São Paulo, Brazil
| | | | | | | | | | | | - Janine Koepp
- University of Santa Cruz do Sul, Rio Grande do Sul, Brazil
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Forte ECN, Pires DEPD, Schneider DG, Padilha MICDS, Ribeiro OMPL, Martins MMFPDS. THE OUTCOME OF NURSING ERROR AS ATTRACTIVE TO THE MEDIA. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2019-0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to interpret, from the perspective of the Theory of Communicative Action, how the outcome of nursing errors can become attractive to the media, highlighting the main implications for the image of the profession and the imaginary of society. Method: qualitative research, carried out in documentary sources using news published in the major newspapers available online in two countries, Brazil and Portugal, from 2012 to 2016. The analysis of the findings was carried out following the steps of hermeneutics, based on the Theory of Communicative Action. The data were organized and coded in the ATLAS.ti software. Results: the research included 112 published news. Four categories emerged from the analysis: The highlights in the headlines - The beginning of persuasion; Combining image and initial text - An explosive mix; The error that is not an error - The error that is a crime; and Applying the validity claims in the discourses. Conclusion: the media are continuous producers of ideologies and, therefore, possess social responsibility by inducing misinterpretations that can negatively interfere in the nurse-patient interaction. Giving greater emphasis to the outcome of the error, the media influences negatively the people perception of nursing labour which has a unique social importance.
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Lima EDC, Camarinha BD, Ferreira Bezerra NC, Panisset AG, Belmino de Souza R, Silva MT, Lopes LC. Severe Potential Drug-Drug Interactions and the Increased Length of Stay of Children in Intensive Care Unit. Front Pharmacol 2020; 11:555407. [PMID: 33343344 PMCID: PMC7744879 DOI: 10.3389/fphar.2020.555407] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
Children are exposed to drug-drug interactions (DDI) risks due to their organism’s complexity and the need for several medicines prescriptions in pediatric intensive care units (PICU). This study aimed to assess the prevalence of potential DDIs in a Brazilian PICU. We carried out a cross-sectional study at a pediatric teaching hospital from Rio de Janeiro (Brazil) over one year. Potential DDIs (pDDIs) between prescribed medicines for hospitalized children in PICU (n = 143) were analyzed according to severity using Micromedex®. Sex, age group, number of drugs prescribed, vasoactive amines use (a proxy of clinical complexity), and the PICU length of stay were summarized using descriptive statistics. Association between the PICU length stay, and variables sex, age, clinical condition complexity, number of drugs prescribed, and severity of pDDI were examined by univariate and multiple linear regression. Seventy percent of patients aged three days to 14 years old were exposed at least one potential DDIs during PICU stay. Two hundred eighty-four different types of pDDIs were identified, occurring 1,123 times. Nervous system drugs were implicated in 55% of the interactions, and fentanyl (10%) was most involving in pDDIs. Most pDDIs were classified as higher severity (56.2%), with reasonable documentation (64.6%) and unspecified onset time (63.8%). Worse clinical condition, ten or more drugs prescribed, and most severe pDDIs were associated with a longer PICU length of stay. Multiple linear regression analysis showed an increase of 9.83 days (95% confidence interval: 3.61–16.05; p = 0.002) in the PICU length of stay in children with major or contraindicated pDDIs. The results of this research may support the monitoring and prevention of pDDIs related to adverse events in children in intensive care and the design and conduction of new studies.
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Affiliation(s)
| | - Barbara Dias Camarinha
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | | | - Anderson Gonçalves Panisset
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Raquel Belmino de Souza
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | | | - Luciane Cruz Lopes
- Graduate Course of Pharmaceutical Science, Universidade de Sorocaba, Sorocaba, Brazil
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Gimenes FRE, Baracioli FFLR, de Medeiros AP, do Prado PR, Koepp J, Pereira MCA, Travisani CB, Rabeh SAN, de Souza FB, Miasso AI. Factors associated with mechanical device-related complications in tube fed patients: A multicenter prospective cohort study. PLoS One 2020; 15:e0241849. [PMID: 33211726 PMCID: PMC7676660 DOI: 10.1371/journal.pone.0241849] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/21/2020] [Indexed: 01/03/2023] Open
Abstract
AIMS To identify the types of nasogastric/nasoenteric tube (NGT/NET)-related adverse events and to analyze the degree of harm and the factors associated with mechanical device-related complications. MATERIALS AND METHODS A prospective cohort study was conducted from October 2017 to April 2019 in seven Brazilian hospitals. Data from 447 adult patients with NGT/NET were collected through electronic forms. Three methods were used to assess the NGT/NET-related adverse events: (1) encouraging spontaneous reports; (2) regular visits to the wards; and (3) review of medical records. The events were classified as mechanical device-related complications and other events. The degree of harm was classified according to the World Health Organization's International Classification for Patient Safety. Data were analyzed using the R program, version 3.5.3. The following tests were applied to identify associations between the explanatory and response variables: Cochran-Armitage Chi-Square test, Fisher's exact test, and Linear-by-linear Chi-Square test. Logistic regression analysis was performed to verify the predictors of mechanical device-related complications. All analyses were performed considering a 5% significance level. RESULTS 191 NGT/NET-related adverse events were identified in 116 patients; the majority were mechanical device-related complications and resulted in mild harm to the patient. At the moment of the event, patients had a mean of 3.27 comorbidities, were highly dependent on nursing care, with high risk of death and altered level of consciousness. There was no association between the degree of harm and the care complexity, disease severity or level of consciousness. Intensive care was the strongest predictor for mechanical device-related complications and critical patients had a four times greater likelihood of presenting this type of event when compared to patients receiving minimal care. CONCLUSION Intensive care patients should receive special attention as the complexity of care is an important predictor for mechanical device-related complications in tube fed patients.
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Affiliation(s)
| | | | | | | | - Janine Koepp
- University of Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | | | | | | | - Fabiana Bolela de Souza
- University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Adriana Inocenti Miasso
- University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
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de Macêdo Filho LJM, Aragão ACA, Moura IA, Olivier LB, Albuquerque LAF. Malpractice and socioeconomic aspects in neurosurgery: a developing-country reality. Neurosurg Focus 2020; 49:E13. [DOI: 10.3171/2020.8.focus20571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVENeurosurgery occupies a prominent place in medical malpractice, but cases are still underreported in Brazil. This study describes the socioeconomic issues of medical malpractice in neurosurgery procedures and how they culminate in unfavorable outcomes in a developing country.METHODSThe authors analyzed 112 neurosurgical procedures listed in the Brazilian Hospital Information System (Sistema de Informações Hospitalares do Sistema Único de Saúde [SIHSUS]) records in the DATASUS (Departamento de Informática do SUS) database between January 2008 and February 2020. Malpractice data were collected using the JusBrasil platform, with the authors searching the name of each of the 112 neurosurgical procedures plus “medical malpractice” among the jurisprudence records for January 2008 to February 2020. A simple linear regression analysis was performed using appropriate software. Analyses were considered statistically significant at p < 0.05.RESULTSAccording to DATASUS, 842,041 neurosurgical procedures were performed by the Brazilian Unified Health System between January 2008 and February 2020. The mean hospitalization cost for neurosurgical procedures was $714.06, and the average amount paid to professionals per procedure was $145.28 with variations according to the type of practice (public or private) in which they were performed, the complexity of the procedure, and the Brazilian region. The mortality rate and mean length of stay for neurosurgical procedures were 11.37% and 10.15 days, respectively. There were 79 medical malpractice lawsuits in the studied period. In these lawsuits, 26.58% of the court decisions were unfavorable to the neurosurgeons, with a mean compensation per procedure 15 times higher than the median value paid for all professionals in a neurosurgical procedure. The spine subspecialty had more lawsuits, and the brain tumor subspecialty had the most expensive compensation.A lack of resources in public healthcare negatively impacts inpatient care. The mortality rate was 1.5 times higher in public practice than in private practice and was inversely proportional to the MTCs paid for the neurosurgical procedure. Patients with the lower educational levels associated with limited access to good medical care could reflect the lower plaintiff motivation in regions with a low gross domestic product and Human Development Index. In most cases, there is no understanding from either the patient or his family about the health-disease process, nor that there was medical malpractice committed by the physician to be sued.CONCLUSIONSThe socioeconomic inequalities and the population’s low awareness of their rights could explain the few malpractice cases reported in Brazil. The authors recommend better decisions regarding the investments to be made in neurosurgical procedures to reduce malpractice lawsuits.
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Affiliation(s)
| | | | - Ian A. Moura
- 1University of Fortaleza, Health Science Center, Fortaleza
| | - Lucas B. Olivier
- 2Federal University of Ceará, Department of Mathematics, Fortaleza; and
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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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Maziero ECS, Cruz EDDA, Alpendre FT, Brandão MB, Teixeira FFR, Krainski ET. Association between nursing work conditions and adverse events in neonatal and pediatric Intensive Care Units. Rev Esc Enferm USP 2020; 54:e03623. [PMID: 33084797 DOI: 10.1590/s1980-220x2019017203623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 10/11/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate the association between intensive nursing staff's work conditions and the occurrence of adverse events in patients. METHOD Evaluative documentary study conducted in six public neonatal and pediatric Intensive Care Units from hospitals in Paraná state, from April 2017 to January 2018. The predictive variables concerning staff sizing and work environment were measured through the instruments Nursing Activities Score and Brazilian Nursing Work Index-Revised. The thirty adverse events corresponded to the outcome variable and were detected using the instruments Pediatric and Neonatal Trigger Tool. RESULTS Two-hundred and three professionals participated in this research. The nursing staff sizing was verified to be appropriate. Work conditions were favorable and Cronbach's Alpha was 0.90 (IC= 0.87 - 0.92). The most frequently detected events in patients were infection and skin lesion. The statistical analysis of correlation and adverse event occurrence was not significant. CONCLUSION Despite the lack of evidence on statistical significance between the variables, the results reveal commitment by the public sector and professionals with patient safety and assistance quality.
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Affiliation(s)
| | | | | | - Marilise Borges Brandão
- Universidade Federal do Paraná, Hospital de Clínicas, Setor de Vigilância em Saúde e Segurança do Paciente/ e Gestão da Qualidade, Curitiba, PR, Brasil
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Sundberg F, Fridh I, Lindahl B, Kåreholt I. Associations between healthcare environment design and adverse events in intensive care unit. Nurs Crit Care 2020; 26:86-93. [DOI: 10.1111/nicc.12513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Fredrika Sundberg
- Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
| | - Isabell Fridh
- Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
- Department of Anaesthesiology and Intensive Care Sahlgrenska University Hospital Gothenburg Sweden
| | - Berit Lindahl
- Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
| | - Ingemar Kåreholt
- School of Health and Welfare, Institute of Gerontology Jönköping University Jönköping Sweden
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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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Gqaleni TM, Bhengu BR. Analysis of Patient Safety Incident reporting system as an indicator of quality nursing in critical care units in KwaZulu-Natal, South Africa. Health SA 2020; 25:1263. [PMID: 32284886 PMCID: PMC7136690 DOI: 10.4102/hsag.v25i0.1263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 12/16/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patient Safety Incidents occur frequently in critical care units, contribute to patient harm, compromise quality of patient care and increase healthcare costs. It is essential that Patient Safety Incidents in critical care units are continually measured to plan for quality improvement interventions. AIM To analyse Patient Safety Incident reporting system, including the evidence of types, frequencies, and patient outcomes of reported incidents in critical care units. SETTING The study was conducted in the critical care units of ten hospitals of eThekwini district, in KwaZulu-Natal, South Africa. METHODS A quantitative approach using a descriptive cross sectional survey was adopted to collect data from the registered nurses working in critical care units of randomly selected hospitals. Self-administered questionnaires were distributed to 270 registered nurses of which 224 (83%) returned completed questionnaires. A descriptive statistical analysis was initially conducted, then the Pearson Chi-square test was performed between the participating hospitals. FINDINGS One thousand and seventeen (n = 1017) incidents in ten hospitals were self-reported. Of these incidents, 18% (n = 70) were insignificant, 35% (n = 90) minor, 25% (n = 75) moderate, 12% (n = 32) major and 10% (n = 26) catastrophic. Patient Safety Incidents were classified into six categories: (a) Hospital-related incidents (42% [n = 416]); (b) Patient care-related incidents (30% [n = 310]); (c) (Death 12% [n = 124]); (d) Medication-related incidents, (7% [n = 75]); (e) Blood product-related incidents (5% [n = 51]) and (f) Procedure-related incidents (4% [n = 41]). CONCLUSION This study's findings indicating 1017 Patient Safety Incidents of predominantly serious nature, (47% considering moderate, major and catastrophic) are a cause for concern.
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Affiliation(s)
- Thusile M Gqaleni
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Busisiwe R Bhengu
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Iwata E, Kondo T, Kato T, Okumura T, Nishiyama I, Kazama S, Ishihara T, Kondo S, Hiraiwa H, Tsuda T, Ito M, Aoyama M, Tanimura D, Awaji Y, Unno K, Murohara T. Prognostic Value of Delirium in Patients With Acute Heart Failure in the Intensive Care Unit. Can J Cardiol 2020; 36:1649-1657. [PMID: 32615071 DOI: 10.1016/j.cjca.2020.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Delirium is a common adverse event observed in patients admitted to the intensive care unit (ICU). However, the prognostic value of delirium and its determinants have not been thoroughly investigated in patients with acute heart failure (AHF). METHODS We investigated 408 consecutive patients with AHF admitted to the ICU. Delirium was diagnosed by means of the Confusion Assessment Method for ICU tool and evaluated every 8 hours during the patients' ICU stays. RESULTS Delirium occurred in 109 patients (26.7%), and the in-hospital mortality rate was significantly higher in patients with delirium (13.8% vs 2.3%; P < 0.001). Multivariate logistic regression analysis showed that delirium independently predicted in-hospital mortality (odds ratio [OR] 4.33, confidence interval [CI] 1.62-11.52; P = 0.003). Kaplan-Meier analysis showed that the 12-month mortality rate was significantly higher in patients with delirium compared with those without (log-rank test: P < 0.001), and Cox proportional hazards analysis showed that delirium remained an independent predictor of 12-month mortality (hazard ratio 2.19, 95% CI 1.49-3.25; P < 0.001). The incidence of delirium correlated with severity of heart failure as assessed by means of the Get With The Guidelines-Heart Failure risk score (chi-square test: P = 0.003). Age (OR 1.05, 95% CI 1.02-1.09; P = 0.003), nursing home residential status (OR 3.32, 95% CI 1.59-6.94; P = 0.001), and dementia (OR 5.32, 95% CI 2.83-10.00; P < 0.001) were independently associated with the development of delirium. CONCLUSIONS Development of delirium during ICU stay is associated with short- and long-term mortality and is predicted by the severity of heart failure, nursing home residential, and dementia status.
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Affiliation(s)
- Etsuo Iwata
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
| | - Toshiaki Kato
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Itsumure Nishiyama
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Shingo Kazama
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Toshikazu Ishihara
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Sayano Kondo
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takuma Tsuda
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Masanori Ito
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Morihiko Aoyama
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Daisuke Tanimura
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Yoshifumi Awaji
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Kazumasa Unno
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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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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Nihayati HE, Gunawan G, Wahyuni EDD, Purwanza SW, Arifin H. Attitude of Nurses Related to The Implementation of Patient Safety in The Intensive Care Unit. JURNAL NERS 2020. [DOI: 10.20473/jn.v14i3.17313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: The error events in the Intensive Care Unit (ICU) were caused by nurses focusing more towards collaborative intervention with other medical staff and workload documentation which was not optimal. The purpose of this study was to determine the predisposing factors related to the implementation of patient safety in the ICU.Methods: This study was a descriptive analytic correlational study. Sample size was determined by purposive sampling and obtained 26 nurses. The independent variables were the predisposing factors and the dependent variable was the implementation of patient safety. Instruments used were a questionnaire and observation sheet. Analysis was performed using Spearman's Rho and Logistic Regression.Results: Spearman’s Rho showed there was a significant correlation between knowledge (p=0.019) and attitude (p=0.040) towards implementation of patient safety. There was no significant of motivation (p=0.073) towards the implementation of patient safety. Logistic Regression showed the dominant factor in implementation of patient safety was attitude.Conclusion: Predisposing factors, that include knowledge and attitude, had a significant effect on the implementation of patient safety, but still required high motivation in the implementation of patient safety. In addition to knowledge and good attitude, nurses are expected to improve motivation in the implementation of patient safety.
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Gulin FS, Menegueti MG, Auxiliadora-Martins M, de Araujo TR, Bellissimo-Rodrigues F, Nassiff A, Basile-Filho A, Laus AM. APACHE II Death Risk and Length of Stay in the ICU Are Associated With Pressure Injury in Critically Ill Patients. J Clin Med Res 2018; 10:898-903. [PMID: 30425762 PMCID: PMC6225865 DOI: 10.14740/jocmr3636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 10/16/2018] [Indexed: 11/11/2022] Open
Abstract
Background The aim of this study was to identify factors associated with pressure injury (PI) occurrence in critically ill patients. This was a retrospective cohort study conducted at a mixed intensive care unit (ICU). Methods Univariate analysis and logistic regression were used to identify which variables are associated with PI. Results Twenty-one (15%) of 142 patients developed PI. The median and the range of the variables in the groups without and with PI were as follows: Braden scale risk score, 13 (8 - 20) and 10 (8 - 14) points, respectively; Acute Physiology and Chronic Health Evaluation II (APACHE II) death risk, 39% (2 - 97%) and 75% (26 - 96%), respectively; and length of stay in the ICU, 4 (2 - 36) and 16 (5 - 29) days, respectively. The socio-demographic variables included in the logistic regression were age (P = 0.09), Braden scale risk score (P = 0.0003), APACHE II death risk (P < 0.0001), length of stay in the ICU (P < 0.0001) and reason for ICU admission (P = 0.09). Only APACHE II death risk and length of stay in the ICU presented significant differences; the odds ratios were 1.05 and 1.25, respectively, and the 95% confidence intervals were 1.01 - 1.09 and 1.12 - 1.39, respectively. Conclusion APACHE II death risk and length of stay in the ICU are probably associated with PI occurrence in the study population.
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Affiliation(s)
- Francine Sanchez Gulin
- Department of Fundamental Nursing, University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil.,Department of Surgery and Anatomy, Division of Intensive Care University of Sao Paulo at Ribeirao Preto Medical School, Ribeirao Preto, Sao Paulo, Brazil
| | - Mayra Goncalves Menegueti
- Department of Fundamental Nursing, University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil.,Department of Surgery and Anatomy, Division of Intensive Care University of Sao Paulo at Ribeirao Preto Medical School, Ribeirao Preto, Sao Paulo, Brazil
| | - Maria Auxiliadora-Martins
- Department of Surgery and Anatomy, Division of Intensive Care University of Sao Paulo at Ribeirao Preto Medical School, Ribeirao Preto, Sao Paulo, Brazil
| | - Thamiris Ricci de Araujo
- Department of Fundamental Nursing, University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| | - Fernando Bellissimo-Rodrigues
- Department of Social Medicine, University of Sao Paulo at Ribeirao Preto Medical School, Ribeirao Preto, Sao Paulo, Brazil
| | - Aline Nassiff
- Department of Fundamental Nursing, University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| | - Anibal Basile-Filho
- Department of Surgery and Anatomy, Division of Intensive Care University of Sao Paulo at Ribeirao Preto Medical School, Ribeirao Preto, Sao Paulo, Brazil
| | - Ana Maria Laus
- Department of Fundamental Nursing, University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
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Strazzieri-Pulido KC, S. González CV, Nogueira PC, Padilha KG, G. Santos VLC. Pressure injuries in critical patients: Incidence, patient-associated factors, and nursing workload. J Nurs Manag 2018; 27:301-310. [DOI: 10.1111/jonm.12671] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/12/2018] [Accepted: 05/17/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Kelly C. Strazzieri-Pulido
- Independent Practitioner Enterostomal Therapy Nurse; School of Nursing (EEUSP) University of São Paulo; São Paulo Brazil
| | - Carol Viviana S. González
- Adult Health Nursing Graduate Program - PROESA; School of Nursing (EEUSP) University of São Paulo; São Paulo Brazil
| | - Paula C. Nogueira
- Medical-Surgical Department, School of Nursing; University of Sao Paulo; São Paulo Brazil
- Menzies Health Institute Queensland - Griffith University, Gold Coast campus; Australia
| | - Kátia G. Padilha
- Medical-Surgical Department, School of Nursing; University of Sao Paulo; São Paulo Brazil
| | - Vera L. C. G. Santos
- Medical-Surgical Department, School of Nursing; University of Sao Paulo; São Paulo Brazil
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Gadelha GO, Paixão HCDS, Prado PRD, Viana RAPP, Amaral TLM. Risk factors for death in patients with non-infectious adverse events. Rev Lat Am Enfermagem 2018; 26:e3001. [PMID: 30020335 PMCID: PMC6053290 DOI: 10.1590/1518-8345.2069.3001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 01/12/2018] [Indexed: 11/27/2022] Open
Abstract
Objetive: to identify risk factors for death in patients who have suffered
non-infectious adverse events. Method: a retrospective cohort study with patients who had non-infectious Adverse
Events (AE) in an Intensive Care Unit. The Kaplan Meier method was used to
estimate the conditional probability of death (log-rank test 95%) and the
risk factors associated with death through the Cox regression. Results: patients over 50 years old presented a risk 1.57 times higher for death;
individuals affected by infection/sepsis presented almost 3 times the risk.
Patients with a Simplified Acute Physiology Score III (SAPS3) greater than
60 points had four times higher risk for death, while those with a Charlson
scale greater than 1 point had approximately two times higher risk. The
variable number of adverse events was shown as a protection factor reducing
the risk of death by up to 78%. Conclusion: patients who had suffered an adverse event and who were more than 50 years of
age, with infection/sepsis, greater severity, i.e., SAPS 3>30 and
Charlson>1, presented higher risk of death. However, the greater number
of AEs did not contributed to the increased risk of death.
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Affiliation(s)
- Gilcilene Oliveira Gadelha
- RN, Unidade Básica de Saúde Francisco Taveira, Secretaria Municipal de Saúde, Senador Guiomard, AC, Brazil
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Toffoletto MC, Oliveira EMD, Andolhe R, Barbosa RL, Padilha KG. COMPARAÇÃO ENTRE GRAVIDADE DO PACIENTE E CARGA DE TRABALHO DE ENFERMAGEM ANTES E APÓS A OCORRÊNCIA DE EVENTOS ADVERSOS EM IDOSOS EM CUIDADOS CRÍTICOS. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-070720180003780016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: comparar a gravidade do paciente e a carga de trabalho de enfermagem antes e após a ocorrência de evento adverso moderado e grave em idosos internados em unidades de terapia intensiva. Método: estudo comparativo, realizado em nove unidades de terapia intensiva de um Hospital Universitário de São Paulo. Os eventos foram coletados dos prontuários dos pacientes e classificados em moderados e graves segundo a Organização Mundial de Saúde. A análise da gravidade foi realizada segundo o Symplified Acute Phsiologic Score II e a carga de trabalho segundo o Nursing Activities Score, 24 horas antes e depois do evento moderado e grave. O teste t, com significância de 5%, foi utilizado para a comparação das médias da gravidade clínica e da carga de trabalho, antes e após o evento. Resultados: a amostra foi composta por 315 idosos, sendo que 94 (29,8%) sofreram eventos moderados e graves nas unidades. Dos 94 eventos, predominou o tipo processo clínico e procedimento (40,0%). A instalação e manutenção de artefatos terapêuticos e cateteres foram as intervenções prevalentes que resultaram em danos fisiopatológicos (66,0%), de grau moderado (76,5%). A média de pontuação da carga de trabalho (75,19%) diminuiu 24 horas após a ocorrência do evento (71,97%, p=0,008) e, a gravidade, representada pela probabilidade de morte, aumentou de 22,0% para 29,0% depois do evento (p=0,045). Conclusão: no contexto da segurança do paciente, a identificação das alterações nas condições clínicas e na carga de trabalho de enfermagem em idosos que sofrem eventos subsidiam a prevenção dessas ocorrências.
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DAMASCENA LCL, RODRIGUES LV, COSTA RC, DA NÓBREGA JBM, DANTAS ELDA, VALENÇA AMG. Factors associated with oral biofilm in ICU patients with infectious diseases. REVISTA DE ODONTOLOGIA DA UNESP 2017. [DOI: 10.1590/1807-2577.05117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction Hospitalization may cause a decline in oral health and affect the entire body. The intensive care unit (ICU) may be a favorable environment for oral biofilm to accumulate in critically ill patients. Objective To identify factors associated with oral biofilm in ICU patients in a hospital for infectious diseases. Method This was a retrospective, descriptive and inferential study with a quantitative approach. Data were collected from 178 medical records of patients from January 2012 to July 2015. Biofilm presence was assessed according to the Greene and Vermillion index. Potential influential factors were analyzed by logistic regression. Result Among ICU patients, 69.1% were men, 60.7% had acquired immune deficiency (AIDS), 66.3% were ward patients, 50.6% were intubated, and 50.0% were sedated. The oral elements of the patients were mostly normal. The following characteristics were significantly associated with oral biofilm: changes in the lips, gums, cheeks, and palates and bleeding. Patients from the ward had a lower risk of biofilm. Conclusion Increased oral biofilm accumulation was observed in patients with oral changes, and patient origin was associated with the presence of biofilm.
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Ortega DB, D’Innocenzo M, Silva LMGD, Bohomol E. Análise de eventos adversos em pacientes internados em unidade de terapia intensiva. ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Avaliar a incidência de eventos adversos e associá-los com a carga de trabalho de enfermagem, o dimensionamento da equipe de enfermagem e o perfil de gravidade do paciente. Métodos Foi realizado um estudo transversal, prospectivo, com abordagem quantitativa, em 304 pacientes consecutivos internados em Unidade de Terapia Intensiva geral de um hospital privado, admitidos entre setembro e dezembro de 2013 (quatro meses). Resultados Ocorreram 39 eventos adversos sendo a lesão por pressão a mais prevalente. Os pacientes que apresentaram algum evento tiveram maior média de idade, maior prevalência de internações clínicas, internações mais prolongadas, maior escala Acute Physiology and Chronic Health Evaluation (APACHE) II, maior pontuação do Nursing Activities Score (NAS), menor escore na escala de Braden e menor escala de Glasgow e não tiveram diferenças significantes em relação ao dimensionamento da equipe de enfermagem. Conclusão Houve maior incidência de eventos adversos em pacientes que exibiram um perfil de maior risco e gravidade identificados por meio de escalas preditoras.
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