viernes, 23 de mayo de 2014

Errores y riesgos en UCI/ICU risk and errors

Caracterización de la complejidad de la seguridad de los medicamentos utilizando un enfoque de factores humanos: un estudio observacional en dos unidades de cuidados intensivos.

Characterising the complexity of medication safety using a human factors approach: an observational study in two intensive care units.
Carayon P, Wetterneck TB, Cartmill R, Blosky MA, Brown R, Kim R, Kukreja S, Johnson M, Paris B, Wood KE, Walker J.
BMJ Qual Saf. 2014 Jan;23(1):56-65. doi: 10.1136/bmjqs-2013-001828. Epub 2013 Sep 19.
OBJECTIVE: To examine medication safety in two intensive care units (ICU), and to assess the complexity of medication errors and adverse drug events (ADE) in ICUs across the stages of the medication-management process. METHODS: Four trained nurse data collectors gathered data on medication errors and ADEs between October 2006 and March 2007. Patient caredocuments (eg, medication order sheets, notes) and incident reports were used to identify medication errors and ADEs in a 24-bed adultmedical/surgical ICU and an 18-bed cardiac ICU in a tertiary care, community teaching hospital. In this cross-sectional study, a total of 630 consecutive ICU patient admissions were assessed to produce data on the number, rates and types of potential and preventable ADEs across stages of the medication-management process. RESULTS: An average of 2.9 preventable or potential ADEs occurred in each admission, that is, 0.4 events per patient-day. Preventable or potential ADEs occurred in 2.6% of the medication orders. The rate of potential ADEs per 1000 patient-days was 276, whereas the rate of preventable ADEs per 1000 patient-days was 9.2. Most medication errors occur at the ordering (32%) and administration stages (39%). In 16-24% of potential and preventable ADEs, clusters of errors occurred either as a sequence of errors (eg, delay in medication dispensing leading to delay in medication administration) or grouped errors (eg, route and frequency errors in the order for a medication). Many of the sequences led to administration errorsthat were caused by errors earlier in the medication-management process. CONCLUSIONS: Understanding the complexity of the vulnerabilities of the medication-management process is important to devise solutions to improve patient safety. Electronic health record technology with computerised physician order entry may be one step necessary to improve medication safety in ICUs. Solutions that target multiple stages of the medication-management process are necessary to address sequential errors.
KEYWORDS: Critical Care, Human Factors, Medication Safety

Evaluación clínica del riesgo en la UCI

Clinical risk assessment in intensive care unit.

Asefzadeh S, Yarmohammadian MH, Nikpey A, Atighechian G.

Int J Prev Med. 2013 May;4(5):592-8.


BACKGROUND: Clinical risk management focuses on improving the quality and safety of health care services by identifying the circumstances and opportunities that put patients at risk of harm and acting to prevent or control those risks. The goal of this study is to identify and assess the failure modes in the ICU of Qazvin's Social Security Hospital (Razi Hospital) through Failure Mode and Effect Analysis (FMEA). METHODS: This was a qualitative-quantitative research by Focus Discussion Group (FDG) performed in Qazvin Province, Iran during 2011. The study population included all individuals and owners who are familiar with the process in ICU. Sampling method was purposeful and the FDG group members were selected by the researcher. The research instrument was standard worksheet that has been used by several researchers. Data was analyzed by FMEA technique. RESULTS: Forty eight clinical errors and failure modes identified, results showed that the highest risk probability number (RPN) was in respiratorycare "Ventilator's alarm malfunction (no alarm)" with the score 288, and the lowest was in gastrointestinal "not washing the NG-Tube" with the score 8. CONCLUSIONS: Many of the identified errors can be prevented by group members. Clinical risk assessment and management is the key to delivery of effective health care.

KEYWORDS: Intensive care unit, Risk assessment, failure mode and effect analysis

Impacto de los límites de horas de servicio de los residentes en materia de seguridad en la unidad de cuidados intensivos: una encuesta nacional de intensivistas pediátricos y neonatales.
Impact of resident duty hour limits on safety in the intensive care unit: a national survey of pediatric and neonatal intensivists.
Typpo KV, Tcharmtchi MH, Thomas EJ, Kelly PA, Castillo LD, Singh H.
Pediatr Crit Care Med. 2012 Sep;13(5):578-82.
OBJECTIVE: Resident duty-hour regulations potentially shift the workload from resident to attending physicians. We sought to understand how current or future regulatory changes might impact safety in academic pediatric and neonatal intensive care units. DESIGN: Web-based survey. SETTING: U.S. academic pediatric and neonatal intensive care units. SUBJECTS:
Attending pediatric and neonatal intensivists. INTERVENTIONS: We evaluated perceptions on four intensive care unit safety-related risk measures potentially affected by current duty-hour regulations: 1) attending physician and resident fatigue; 2) attending physician workload; 3) errors (self-reported rates by attending physicians or perceived resident error rates); and 4) safety culture. We also evaluated perceptions of how these risks would change with further duty-hour restrictions. MEASUREMENTS AND MAIN RESULTS: We administered our survey between February and April 2010 to 688 eligible physicians, of whom 360 (52.3%) responded. Most believed that resident error rates were unchanged or worse (91.9%) and safety culture was unchanged or worse (84.4%) with current duty-hour regulations. Of respondents, 61.9% believed their own work-hours providing direct patient care increased and 55.8% believed they were more fatigued while providing direct patient care. Most (85.3%) perceived no increase in their own error rates currently, but in the scenario of further reduction in resident duty-hours, over half (53.3%) believed that safety culture would worsen and a significant proportion (40.3%) believed that their own error rates would increase. CONCLUSIONS: Pediatric intensivists do not perceive improved patient safety from current resident duty-hour restrictions. Policies to further restrict resident duty-hours should consider unintended consequences of worsening certain aspects of intensive care unit safety.

Anestesiología y Medicina del Dolor
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