Identifying neonatal adverse events in preterm and term infants using a paediatric trigger tool

Area of Science:

• Neonatal care
• Patient safety
• Healthcare quality

Background:

• Neonatal adverse events (NAEs) pose a significant risk to vulnerable infants.
• Understanding the incidence and characteristics of NAEs is crucial for improving care.
• Previous research has not fully elucidated NAEs in a Swedish neonatal intensive care unit (NICU) setting.

Purpose of the Study:

• To determine the incidence and characteristics of inpatient neonatal adverse events.
• To identify common types and causes of NAEs in a Swedish hospital.
• To provide data for enhancing patient safety protocols in neonatal care.

Main Methods:

• Retrospective record review of 150 neonatal admissions.
• Utilized a trigger tool for adverse event identification.
• Adverse events were categorized by preventability, severity, and timing.

Main Results:

• 360 adverse events were identified in 78 (52.0%) infants.
• The overall NAE rate was 240 per 100 admissions (102.0 per 1000 patient days).
• Preterm infants had significantly higher NAE rates (353 vs. 79 per 100 admissions).
• Most events (93.9%) were temporary and less severe, commonly affecting skin, tissue, or blood vessels (45.3%).
• 40% of NAEs occurred within the first week of admission.

Conclusions:

• Adverse events are common in neonatal care, with a high proportion being preventable.
• Early occurrence of NAEs emphasizes the need for vigilant monitoring during initial treatment phases.
• Characterizing NAEs provides critical insights for targeted interventions to improve neonatal patient safety.