[Prospective, multi-center investigation on safety of critical patients in intensive care units]

To perform a prospective, multi-center investigation of the incidence and causes of medical errors happened in intensive care unit (ICU).

This investigation was performed in eight ICUs in level A, grade 3 teaching hospitals from October 23 to December 23, 2006. One attending physician and the head nurse in each center were entrusted with the responsibility for this project. Medical errors were identified as (1) type of errors (happened in diagnosis, medication, caring procedures or monitoring etc.); (2)characteristics of errors (related to complications, emergency intervention, low ability or carelessness of care givers and others); (3) consequence of errors (resulted in non-serious influence, vital signs fluctuation, alternation of respiratory or circulatory function, organ injury or death). Besides the medical errors, data included ICU beds, numbers of doctors or nurses, numbers of critical patients receiving intensive care during the investigation period and their acute physiology and chronic health evaluation II (APACHE II) scores, the academic degree and title and years of ICU working experience of doctors or nurses who made medical errors.

Data from three of eight centers were excluded due to lack of objectivity. A total number of 232 critical patients were surveyed in 1 319 ICU patient x days. Two hundred and ninety-six ICU errors were found. One error occurred in average of 4.46 patient x days. Medical errors happened in 157 patients (67.6%). The percentage of error related to nursing (74.3%) was significantly higher than that made by doctor's caring (25.7%). Two hundred and twelve errors (71.6%) were devoid of serious effects to patients. However, Eighty-two errors were followed by vital signs instability. Medical errors occurred more frequently in patients with the higher (greater than 20) than the lower (less than 20) APACHE II score. The frequency of nursing oriented errors was closely positively correlated with the rates of shortage of working force, low educational level and working years less than 3 years respectively.

Our survey indicates that critical patients are facing high medical error risk in the higher level Chinese teaching hospitals. There is a close relationship between ICU errors and severity of patient's disease, inadequate training and less working experience.