Adverse event reporting in adult intensive care units and the impact of a multifaceted intervention on drug-related adverse events

Abstract

BackgroundAdverse events (AEs) frequently occur in intensive care units (ICUs) and affect negatively patient outcomes. Targeted improvement strategies for patient safety are difficult to evaluate because of the intrinsic limitations of reporting crude AE rates. Single interventions influence positively the quality of care, but a multifaceted approach has been tested only in selected cases. The present study was designed to evaluate the rate, types, and contributing factors of emerging AEs and test the hypothesis that a multifaceted intervention on medication might reduce drug-related AEs.MethodsThis is a prospective, multicenter, before-and-after study of adult patients admitted to four ICUs during a 24-month period. Voluntary, anonymous, self-reporting of AEs was performed using a detailed, locally designed questionnaire. The temporal impact of a multifaceted implementation strategy to reduce drug-related AEs was evaluated using the risk-index scores methodology.ResultsA total of 2,047 AEs were reported (32 events per 100 ICU patient admissions and 117.4 events per 1,000 ICU patient days) from 6,404 patients, totaling 17,434 patient days. Nurses submitted the majority of questionnaires (n = 1,781, 87%). AEs were eye-witnessed in 49% (n = 1,003) of cases and occurred preferentially during an elective procedure (n = 1,597, 78%) and on morning shifts (n = 1,003, 49%), with a peak rate occurring around 10 a.m. Drug-related AEs were the most prevalent (n = 984, 48%), mainly as a consequence of incorrect prescriptions. Poor communication among caregivers (n = 776) and noncompliance with internal guidelines (n = 525) were the most prevalent contributing factors for AE occurrence. The majority of AEs (n = 1155, 56.4%) was associated with minimal, temporary harm. Risk-index scores for drug-related AEs decreased from 10.01 ± 2.7 to 8.72 ± 3.52 (absolute risk difference 1.29; 95% confidence interval, 0.88-1.7; p < 0.01) following the introduction of the intervention.ConclusionsAEs occurred in the ICU with a typical diurnal frequency distribution. Medication-related AEs were the most prevalent. By applying the risk-index scores methodology, we were able to demonstrate that our multifaceted implementation strategy focused on medication-related adverse events allowed to decrease drug related incidents.

Análise de eventos adversos em pacientes internados em unidade de terapia intensiva

“…(7,10) In this study, the profile of the patients was characterized by a more advanced age, despite the great variation. A study assessing AE in an ICU also showed a predominance of older patients, (10) although other studies showed different results with a median age under 65 years. (3,7) Other studies found higher age mean and longer hospital stays for the patients who had an AE, compared to those who did not.…”

“…(10) This study focused on the analysis of six specific AE, which certainly underestimated the rate of events as a whole, especially those related to drugs that were not the subject of the research. However, it is necessary to consider that the institution is accredited with managing work processes and monitoring AE.…”

Adverse events in the intensive care unit: impact on mortality and length of stay in a prospective study

“…Adverse events incidence varies between 0.87 to 34.7 per 100 patients admitted to ICUs 1,2,4,12,13,14,15,16,17,18,19,20 . The high variability observed in estimates can be partly explained by notification and information obtainment mechanisms, and processes for classifying the event and possible damage (who determines the classification and how).…”

“…The complexity of care for critical patients requires advanced technology and specialized professionals able to immediately intervene in any change in their clinical condition 1,2,3,4 . Intensive care units (ICU) concentrate patients with this profile, however, there is a high frequency of adverse events in hospital wards 5,6 .…”

Segurança do paciente em unidades de terapia intensiva: ambiente das práticas profissionais de enfermagem e satisfação profissional na ocorrência de eventos adversos

“…Além disso, os pacientes da UTI, principalmente quando submetidos a procedimentos cirúrgicos, apresentam maior número de dispositivos necessários a assistência e itens na prescrição medicamentosa, o que aumentam as chances de ocorrência de EA, como a infecção associada a assistência causada pela quebra de protocolos assistenciais ou mesmo a retirada não programada dos dispositivos 4,16 . A literatura mostra que o paciente internado na UTI apresenta maior chance de sofrer EA 54,61,67 .…”