Severity and workload related to adverse events in the ICU

Abstract

Objective: To analyze whether an increase in patient severity and nursing workload are correlated to a greater incidence of adverse events (AEs) in critical patients. Method: A prospective single cohort study was performed on a sample of 138 patients hospitalized in an intensive care unit (ICU). Results: A total of 166 AEs, occurred, affecting 50.7% of the patients. Increased patient severity presented a direct relationship to the probability of AEs occurring. However, nursing workload did not present a statistically signifi cant relationship with the occurrence of AEs. Conclusion: The results cast light on the importance of using evaluation tools by the nursing personnel in order to optimize their daily activities and focus on patient safety. Descriptors: Nursing Care; Patient Severity; Workload; Safety Management; Patient Safety. RESUMO Objetivo: Analisar se o aumento da gravidade do paciente e a carga de trabalho de enfermagem está relacionado à maior incidência de Eventos Adversos (EAs) em pacientes críticos. Método: Estudo de coorte única, prospectivo, com amostra de 138 pacientes internados em uma Unidade de Terapia Intensiva (UTI). Resultados: Ao todo, foram evidenciados 166 EAs, que acometeram 50,7% dos pacientes. O aumento da gravidade do paciente apresentou relação direta com a chance de ocorrência de EAs. Entretanto, a carga de trabalho de enfermagem não apresentou relação estatisticamente signifi cativa, na ocorrência de EAs. Conclusão: Os resultados permitem refl etir acerca da importância da equipe de enfermagem, em utilizar instrumentos de avaliação, com o objetivo de melhorar e planejar suas ações diárias, com foco na segurança do paciente. Descritores: Cuidados de Enfermagem; Gravidade do Paciente; Carga de Trabalho; Gestão da Segurança; Segurança do Paciente. RESUMENObjetivo: Analizar si el aumento de la gravedad del paciente y la carga de trabajo de enfermería está relacionada con mayor incidencia de Eventos Adversos (EAs) en pacientes críticos. Método: Estudio de cohorte única, prospectivo, con muestra de 138 pacientes internados en una Unidad de Terapia Intensiva (UTI). Resultados: En total, fueron evidenciados 166 EAs, incidiendo sobre 50,7% de los pacientes. El aumento de la gravedad del paciente mostró relación directa con la posibilidad de ocurrencia de EAs. Sin embargo, la carga de trabajo de enfermería no demostró relación estadísticamente signifi cativa en la ocurrencia de EAs. Conclusión: Los resultados permiten refl exionar sobre la importancia del equipo de enfermería, en utilizar instrumentos de evaluación, con el objeto de mejorar y planifi car sus acciones diarias, enfocándose en la seguridad del paciente. Descriptores: Atención de Enfermería; Gravedad del Paciente; Carga de Trabajo; Gestión de la Seguridad; Seguridad del Paciente. Severity and workload related to adverse events in the ICU Serafim CTR, et al. Severity and workload related to adverse events in the ICU

A multicenter observational study investigating care errors, staffing levels, and workload in small animal intensive care units

“…This was done using 2 previously validated illness severity scores, 15,16 and was possible because the exotics caseload of the units (for which no score was available) was negligible at 0.6%. Associations between patient illness severity and adverse care events have been previously identified in human healthcare populations, 21 presumably mediated through the increased need of severely ill patients for high‐level, often technically demanding, care. Two parameters, patient‐to‐technician ratio and APPLE fast ‐to‐technician ratio, were assessed as potential management tools that could be continuously monitored and used to act as triggers that might indicate an increased error risk.…”

Cross mapping between clinical indicators for assistance in intensive care and nursing interventions

“…Change in level of consciousness (2,16,38,40,42) , care with central venous catheter (24,26,(43)(44)(45) . 5…”

“…Endotracheal suction (24,28,32) , mental confusion (29,36,38) , incontinence dermatitis (25,37,41) , dyspnoea (4,18,30) , hypertension (4,31,39) , hyperthermia (17,25,38) , hypotension (2,31,39) , hypothermia (17,25,38) , hemodynamic instability (4,26,43) , skin injury (4,41,44) , obesity (38,41,46) , nasal probe / oroenteral (24,26,44) , bladder catheter (24,26,41) , vomiting (27,35,38) .…”

“…Respiratory acidosis (21) , administration of laxative drugs (37) , administration of insulin (27) , distress (30) , alertness (29) , altered breathing pattern (38) , hallucinations (36) , antibiotic therapy (26) , anuria (2) , apathy (30) , apnea (39) , apprehension (19) , asynchrony with ventilator (33) , aid in feeding (30) , aid in walking (30) , underweight (46) , tiredness (33) , coma (38) , mechanical restraint (26) , compressive dressing in arterial puncture (4) , depression (4) , discomfort (30) , disorientation (14) , communication difficulties (41) , dysphonia (28) , dysrhythmia (18) , abdominal distension (35) , abdominal pain (35) , health education (45) , spirituality (45) , erythema (41) , exhaustion (14) , extubation (44) , fatigue (33) , liquid stools (37) , hemodialysis (27) , oral hygiene (32) , hyperalbuminemia (25) , hypercapnia (21) , hypercreatinemia (38) , hypernatremia (17) , hyperuremia (38) , hypocapnia (38) , hyponatremia (17) , hypoperfusion…”

“…Change in sleep pattern (14,30) , analgesia (18,24) , arrhythmia (26,39) , bed bath (25,32) , calm (30,33) , constipation (20,35) , convulsion (16,38) , malnutrition (37)(38) , desaturation (38)(39) , dysphagia (28,40) , edema (4,35) , altered respiratory rate (2,38) , body hygiene (30,32) , hyperglycemia (38,47) , hypoalbuminemia (25)(26) , hypoglycemia (27,47) , hypoxia (2,26) , insomnia (4,33) , respiratory failure (16)(17) , pressure injury (44,46) , fear (30,33) , restricted mobilization (17,26) , change of position (2,32) , nausea (4,38) , parenteral nutrition (26)(27)…”