导致非计划性重症监护入院的不良事件的表征
Abid Omar1, Julien Carlier1, Nordin Zaidi2
1Intensive Care Unit, EpiCURA Hospital Group, Ath, Belgium.
概括
与护理相关的不良事件 (AEACs) 显著推动非计划的重症监护室 (ICU) 住院,其中大多数是可以预防的. 改善早期检测和实施有针对性的策略,特别是在低监督时期,可以提高患者的安全性和降低成本.
科学领域:
- 患者安全 患者安全
- 改善医疗保健质量 改善医疗保健质量
- 关键护理医学 关键护理医学
背景情况:
- 不定期的重症监护室 (ICU) 住院对患者安全,医院运作和医疗保健支出构成重大挑战.
- 相当数量的这些入院病例与来自ICU以外的与护理相关的不良事件 (AEAC) 有关,将其标记为质量提升的关键目标.
研究的目的:
- 调查AEACs的发病率和特征,这些AEACs有助于非计划的ICU入院.
- 确定AEAC导致ICU转移的常见原因和促成因素.
- 分析AEACs因果关系,严重程度和可避免性之间的关系.
主要方法:
- 在12个月的时间里,对区域医院的非计划性ICU入院的回顾性分析.
- 多学科专家小组对患者病历进行审查,以根据既定标准识别和评估AEAC.
- 使用石川图和统计分析 (斯皮尔曼相关性,线性回归) 来检查事件特征的根本原因分析.
主要成果:
- 在122个非计划的ICU入院中,89个 (73%) 与AEAC有关,约占所有ICU入院的10%.
- 组织失败 (36%),治疗错误 (25%),诊断错误 (19%) 和药物错误 (12%) 是AEAC的主要类别.
- 在AEAC因果关系和严重程度 (r=0.78) 和因果关系和可避免性 (r=0.72) 之间发现了强烈的正相关性,大多数事件都是严重的和可预防的,特别是在晚上/夜班期间.
结论:
- AEACs是非计划性ICU入院的重要原因之一,并且往往是可以预防的.
- 针对性的干预措施,重点是早期检测,加强监测,结构化工作流程和解决组织因素至关重要,特别是在减少监督的时期.
- 需要进一步的多中心研究来验证研究结果,并评估干预措施的成本效益,以减少可预防的ICU转移.
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