Indicators of healthcare results:: Analysis of adverse events during hospital stays

被引:36
|
作者
Pires Nascimento, Camila Cristina [1 ]
Toffoletto, Maria Cecilia [2 ]
Goncalves, Leilane Andrade [2 ]
Freitas, Walkiria das Gracas [3 ]
Padilha, Katia Grillo [2 ]
机构
[1] Hosp Alemao Oswaldo Cruz, Sao Paulo, Brazil
[2] Univ Sao Paulo, Sch Nursing, BR-05508 Sao Paulo, Brazil
[3] Hosp 9 Julho, Sao Paulo, Brazil
来源
关键词
sentinel surveillance; nursing; indicators;
D O I
10.1590/S0104-11692008000400015
中图分类号
R47 [护理学];
学科分类号
1011 ;
摘要
This quantitative, retrospective study aimed to characterize adverse events (AE) in Intensive Care Units (ICU), Semi-Intensive Care Units (SCU) and Inpatient Units (IU), regarding nature, type, day of the week and nursing professionals / patient ratio at the moment of occurrence; as well as to identify nursing interventions after the event and AE rates. The study was performed at a private hospital in the city of Sao Paulo, Brazil. Two hundred twenty-nine AE were notified. The predominant events were related to nasogastric tubes (NGT) (57.6%), followed by patient fall (16.6%) and medication errors (14.8%). The nursing professionals/patient ratio at the moment of the event was 1:2 for the ICU, 1:3 for the SCU and 1:4 for the IU, A similar distribution was observed for the other days of the week. The nursing interventions were: repositioning the NGT (83.2%) and communication of the occurrence to the physician in case of medication errors (47.6%) and falls (55.2%). The highest AE rate was related to NGT.
引用
收藏
页码:746 / 751
页数:6
相关论文
共 50 条
  • [41] Adverse events in healthcare: learning from mistakes
    Rafter, N.
    Hickey, A.
    Condell, S.
    Conroy, R.
    O'Connor, P.
    Vaughan, D.
    Williams, D.
    QJM-AN INTERNATIONAL JOURNAL OF MEDICINE, 2015, 108 (04) : 273 - 277
  • [42] Analysis of Surgical Adverse Events at a Major University Hospital in South Africa
    Howard Wain
    Victor Kong
    John Bruce
    Grant Laing
    Damian Clarke
    World Journal of Surgery, 2019, 43 : 2117 - 2122
  • [43] An analysis of anticoagulant adverse drug events in a large community teaching hospital
    Khudeira, Z.
    Jain, Satish
    JOURNAL OF THROMBOSIS AND THROMBOLYSIS, 2008, 25 (01) : 121 - 121
  • [44] An analysis of anticoagulant adverse drug events in a large community teaching hospital
    Z. Khudeira
    Satish Jain
    Journal of Thrombosis and Thrombolysis, 2008, 25 : 121 - 121
  • [45] Analysis of Surgical Adverse Events at a Major University Hospital in South Africa
    Wain, Howard
    Kong, Victor
    Bruce, John
    Laing, Grant
    Clarke, Damian
    WORLD JOURNAL OF SURGERY, 2019, 43 (09) : 2117 - 2122
  • [46] Adverse Events and Adverse Drug Reactions in Hospital Observed by Nurses: Prospective Analysis of 4608 Patients
    Opri, S.
    Leone, R.
    Moretti, U.
    Conforti, A.
    D'Incau, P.
    Magro, L.
    Smerghetto, M.
    Velo, G. P.
    DRUG SAFETY, 2010, 33 (10) : 922 - 923
  • [47] Adverse events during anaesthesia at an Ethiopian referral hospital: a prospective observational study
    Burgess, Joe
    Asfaw, Gebrehiwot
    Moore, Jolene
    PAN AFRICAN MEDICAL JOURNAL, 2021, 38
  • [48] Adverse Events Encountered During the Intra-hospital Transport of ICU Patients
    Taggu, Alai
    Thomas, Jerry
    Patil, Shashidhar
    Arun, Mv Pradeep
    CHEST, 2016, 149 (04) : 241A - 241A
  • [49] Adverse Events during Inter-Hospital Transports on Extracorporeal Membrane Oxygenation
    Ericsson, Anders
    Frenckner, Bjoern
    Broman, L. Mikael
    PREHOSPITAL EMERGENCY CARE, 2017, 21 (04) : 448 - 455
  • [50] Status of Reporting of Adverse Events Occurring in a Tertiary Cardiopulmonary and Metabolic Healthcare Center: Preliminary Results
    Lavallee, M.
    Corbin, S.
    Pradhan, P.
    Blonde, Guefack L.
    Thibault, M.
    Methot, J.
    Berard, A.
    Piche, M. E.
    Escobar Gimenes, F. R.
    Leclerc, J.
    CANADIAN JOURNAL OF HOSPITAL PHARMACY, 2023, 76 (02): : 157 - 157