French national survey of inpatient adverse events prospectively assessed with ward staff

Abstract

Objectives: To estimate the incidence of adverse events in medical and surgical activity in public and private hospitals, and to assess the clinical situation of patients and the active errors. Design: Prospective assessment of adverse events by external senior nursing and doctor investigators with ward staff. Setting: Random three-stage stratified cluster sampling of stays or fractions of stay in a 7-day observation period for each ward. Participants: 8754 patients observed in 292 wards in 71 hospitals, over 35 234 hospitalisation days. Main outcome measures: Number of adverse events in relation to number of days of hospitalisation. Results: The incidence density of adverse events was 6.6 per 1000 days of hospitalisation (95% CI 5.7 to 7.5), of which 35% were preventable. Invasive procedures were the source of half the adverse events, of which 20% were preventable. Adverse events related to the psychological sphere and pain were mostly considered as preventable. Ward staff found it difficult to assess the role of care management in the occurrence of adverse events: 41% of adverse events were expected because of the disease itself, and could have occurred in the absence of the related medical management. Conclusion: At the national level in France, every year 120 000-190 000 adverse events during hospitalisation can be considered as preventable. Areas such as perioperative period and geriatric units should receive closer attention. As adverse events occurred more commonly in vulnerable patients, who are not specifically targeted by clinical guidance, practising evidence-based medicine is not likely to prevent all cases. Therefore clinical risk management should prioritise empowerment of local staff, provision of favourable conditions within the organisation, and staff training based on simple tools appropriate for wardlevel identification and analysis of adverse events.

Déclaration informatisée des évènements indésirables : un outil pour les comités de retour d’expérience en anesthésie

“…Cependant, la définition des EIG utilisés dans l'enquête nationale de 2004 est un peu différente puisqu'un EIG y est considéré comme grave s'il est susceptible d'entraîner une hospitalisation, une prolongation d'hospitalisation d'au moins un jour, un handicap ou une incapacité à la fin de l'hospitalisation, ou encore s'il est associé à une menace vitale ou à un décès, sans qu'il en ait été nécessaire-ment la cause directe. Avec cette définition, la densité d'EIG exprimée pour 1000 journées d'hospitalisation est de 6,6 [3,11]. Ces différences font apparaître la nécessité d'homogénéiser les définitions pour les prochaines études, et aussi de choisir des EI marqueurs permettant de s'affranchir de l'aléa de la définition d'un EI.…”

Patient Safety Culture in a Tunisian Teaching Tertiary Care Hospital

“…They are defi ned as unintended injuries or complications caused by health care management, rather than by the patient's underlying disease and that lead to death, disability at the time of discharge or prolonged hospital stay [2]. While, 35 to 70% of AEs have been judged to be preventable [3][4][5], they appear to be responsible for 44,000 to 98,000 accidental deaths and over one million excess injuries each year [6,7]. The situation is thought to be more challenging in developing countries with higher risk of patient harm due to the limitation of resources and lack of adequate infrastructures [8].…”

Nécrolyse épidermique toxique à la lamotrigine par erreur de délivrance

“…Selon les études, la part d'erreurs dans la survenue des EI varie de 27 à 58 % [12][13][14][15][16]. Dans ce contexte, toute erreur médica-menteuse est une erreur de trop.…”