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Merino P. Epidemiology of adverse events in Intensive Medicine units. Med Intensiva 2024:S2173-5727(24)00123-1. [PMID: 38763831 DOI: 10.1016/j.medine.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/23/2024] [Indexed: 05/21/2024]
Abstract
The severity of the critically ill patient, the practice of diagnostic procedures and invasive treatments, the high number of drugs administered, a high volume of data generated during the care of the critically ill patient along with a technical work environment, the stress and workload of work of professionals, are circumstances that favor the appearance of errors, turning Intensive Medicine Services into risk areas for adverse events to occur. Knowing their epidemiology is the first step to improve the safety of the care we provide to our patients, because it allows us to identify risk areas, analyze them and develop strategies to prevent the adverse events, or if this is not possible, be able to manage them. This article analyzes the main studies published to date on incidents related to safety in the field of critically ill patients.
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Affiliation(s)
- Paz Merino
- Grupo de Trabajo Planificación, Organización y Gestión, Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC), Madrid, Spain.
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Pintado Delgado MC, Sánchez Navarro IM, Baldominos Utrilla G. Medication errors reported in an adult Intensive Care Unit in a level 2 hospital in Spain. Med Intensiva 2023; 47:736-738. [PMID: 37867117 DOI: 10.1016/j.medine.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/31/2023] [Accepted: 08/20/2023] [Indexed: 10/24/2023]
Affiliation(s)
| | | | - Gemma Baldominos Utrilla
- Hospital Pharmacy Service, Príncipe de Asturias Universitary Hospital, Alcalá de Henares, Madrid, Spain
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3
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Otero MJ, Merino de Cos P, Aquerreta Gónzalez I, Bodí M, Domingo Chiva E, Marrero Penichet SM, Martín Muñoz R, Martín Delgado MC. Assessment of the implementation of safe medication practices in Intensive Medicine Units. Med Intensiva 2022; 46:680-689. [PMID: 35660285 DOI: 10.1016/j.medine.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess the level of implementation of medication safety practices in Intensive Care Units (ICUs) and to identify opportunities for improvement. DESIGN A descriptive multicenter study was carried out. SETTING Intensive Care Units. PARTICIPANTS/PROCEDURE A total of 40 ICUs voluntarily completed the "Medication use-system safety self-assessment for Intensive Care Units" between March and September 2020. The survey comprised 147 items for evaluation grouped into 10 key elements. MAIN VARIABLES Calculation was made of the mean scores and mean percentages based on the maximum possible values for the overall survey, referred to the key elements and to each individual item for evaluation. RESULTS The mean score of the overall questionnaire among the participating ICUs was 436.8 (49.2% of the maximum possible score). No differences were found according to functional dependence, size of the hospital or type of ICU. The key elements referred to the incorporation of clinical pharmacists in these Units, as well as the competence and training of the professionals in safety practices yielded the lowest values (31.2% and 33.2%, respectively). Three other key elements related to accessibility to information about patients and medicines; to the standardization, storage and distribution of medicines; and to the quality and risk management programs, yielded percentages <50%. CONCLUSIONS Numerous effective safety medication practices have been identified with a low level of implementation in ICUs. This situation must be addressed in order to reduce medication errors in critically ill patients.
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Affiliation(s)
- M J Otero
- Instituto para el Uso Seguro de los Medicamentos (ISMP-España), IBSAL-Hospital Universitario de Salamanca, Salamanca, Spain.
| | - P Merino de Cos
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, Balearic Islands, Spain
| | | | - M Bodí
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Tarragona, Spain
| | - E Domingo Chiva
- Servicio de Farmacia, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - S M Marrero Penichet
- Servicio de Farmacia, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - R Martín Muñoz
- Instituto para el Uso Seguro de los Medicamentos (ISMP-España), IBSAL-Hospital Universitario de Salamanca, Salamanca, Spain
| | - M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital de Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
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Otero MJ, Merino de Cos P, Aquerreta González I, Bodí M, Domingo Chiva E, Marrero Penichet SM, Martín Muñoz R, Martín Delgado MC. Assessment of the implementation of safe medication practices in Intensive Medicine Units. Med Intensiva 2021; 46:S0210-5691(21)00176-5. [PMID: 34452772 DOI: 10.1016/j.medin.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the level of implementation of medication safety practices in Intensive Care Units (ICUs) and to identify opportunities for improvement. DESIGN A descriptive multicenter study was carried out. SETTING Intensive Care Units. PARTICIPANTS/PROCEDURE A total of 40 ICUs voluntarily completed the "Medication use-system safety self-assessment for Intensive Care Units" between March and September 2020. The survey comprised 147 items for evaluation grouped into 10 key elements. MAIN VARIABLES Calculation was made of the mean scores and mean percentages based on the maximum possible values for the overall survey, for the key elements and for each individual item for evaluation. RESULTS The mean score of the overall questionnaire among the participating ICUs was 436.8 (49.2% of the maximum possible score). No differences were found according to functional dependence, size of the hospital or type of ICU. The key elements referred to the incorporation of clinical pharmacists in these units, as well as the competence and training of the professionals in safety practices yielded the lowest values (31.2% and 33.2%, respectively). Three other key elements related to accessibility to information about patients and medicines; to the standardization, storage and distribution of medicines; and to the quality and risk management programs, yielded percentages below 50%. CONCLUSIONS Numerous effective safety medication practices have been identified with a low level of implementation in ICUs. This situation must be addressed in order to reduce medication errors in critically ill patients.
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Affiliation(s)
- M J Otero
- Instituto para el Uso Seguro de los Medicamentos (ISMP-España), IBSAL-Hospital Universitario de Salamanca, Salamanca, España.
| | - P Merino de Cos
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, Islas Baleares, España
| | | | - M Bodí
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España
| | - E Domingo Chiva
- Servicio de Farmacia, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - S M Marrero Penichet
- Servicio de Farmacia, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España
| | - R Martín Muñoz
- Instituto para el Uso Seguro de los Medicamentos (ISMP-España), IBSAL-Hospital Universitario de Salamanca, Salamanca, España
| | - M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital de Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
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Aslan Y. Classification of medication related events according to World Health Organization classification system. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2019. [DOI: 10.32322/jhsm.612510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Márquez-Hernández VV, Fuentes-Colmenero AL, Cañadas-Núñez F, Di Muzio M, Giannetta N, Gutiérrez-Puertas L. Factors related to medication errors in the preparation and administration of intravenous medication in the hospital environment. PLoS One 2019; 14:e0220001. [PMID: 31339914 PMCID: PMC6655641 DOI: 10.1371/journal.pone.0220001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/06/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Medication errors have long been associated with low-quality medical care services and significant additional medical costs. OBJECTIVE The aim of this study was to culturally adapt and validate the questionnaire on knowledge, attitudes and behaviors in the administration of intravenous medication, as well as to explore these factors in a hospital setting. METHODS The study was divided into two phases: 1) validation and cross-cultural adaptation, and 2) cross-sectional study. A total of 276 hospital-based nursing professionals participated in the study. RESULTS A Cronbach's alpha value of 0.849 was found, indicating good internal consistency. In the multivariate analysis, statistically significant differences were found between knowledge and attitudes, demonstrating that having greater suitable knowledge correlates with having a more positive attitude. It was also discovered that having a positive attitude as well as the necessary knowledge increases the possibility of engaging in adequate behaviors. CONCLUSIONS The knowledge, attitudes and behavior questionnaire has a satisfactory internal consistency in order to be applied to the Spanish context. Implications for nursing management: Knowledge acquisition and positive attitude are both factors which promote adequate behavior, which in turn seems to have an impact on medication errors prevention. Health institutions must encourage continuous education for their employees.
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Affiliation(s)
- Verónica V. Márquez-Hernández
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
- Research Group for Health Sciences, University of Almería, Almería Spain
| | | | | | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Noemi Giannetta
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Lorena Gutiérrez-Puertas
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
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Castells Lao G, Rodríguez Reyes M, Roura Turet J, Prat Dot M, Soy Muner D, López Cabezas C. Compatibility of drugs administered as Y-site infusion in intensive care units: A systematic review. Med Intensiva 2018; 44:80-87. [PMID: 30262380 DOI: 10.1016/j.medin.2018.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/31/2018] [Accepted: 08/09/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To gather all published information about the stability of drugs commonly used in Intensive Care Units (ICU); evaluate the methodology of published data; and generate a compatibility table. DESIGN i) A systematic review was conducted searching the following databases: Medline, Stabilis, Handbook of Injectable Drugs and Micromedex. Articles published from 1990 to 2017 in English, Spanish and French were included. ii) Article quality was analyzed according to the stability studies practice guidelines. iii) A compatibility table was produced with data for 44 binary combinations of drugs frequently used in the ICU. SCOPE Spanish and international hospital ICU. RESULTS The systematic review included 29 studies (27 originals, 2 reviews). None of the included studies followed all the methodological requirements. However, 93% guaranteed correct reproducibility. Accordingly, drug stability knowledge was available for 50.3% of the studied admixtures, in which 77.1% of the binary combinations proved compatible and 16.8% proved incompatible. CONCLUSIONS This review provides new reliable evidence about the physicochemical stability of drugs commonly used in the critical care setting. The study contributes to the safe administration of intravenous drugs in critical patients with a view to avoiding adverse events in this frail population.
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Affiliation(s)
- G Castells Lao
- Área del Medicamento. Servicio de Farmacia. Hospital Clínic de Barcelona, Barcelona, España.
| | - M Rodríguez Reyes
- Área del Medicamento. Servicio de Farmacia. Hospital Clínic de Barcelona, Barcelona, España
| | - J Roura Turet
- Área del Medicamento. Servicio de Farmacia. Hospital Clínic de Barcelona, Barcelona, España
| | - M Prat Dot
- Área del Medicamento. Servicio de Farmacia. Hospital Clínic de Barcelona, Barcelona, España
| | - D Soy Muner
- Área del Medicamento. Servicio de Farmacia. Hospital Clínic de Barcelona, Barcelona, España
| | - C López Cabezas
- Área del Medicamento. Servicio de Farmacia. Hospital Clínic de Barcelona, Barcelona, España
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González-Méndez MI, López-Rodríguez L. Safety and quality in critical patient care. ENFERMERIA CLINICA 2017; 27:113-117. [PMID: 28274547 DOI: 10.1016/j.enfcli.2017.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/27/2022]
Abstract
The care quality has gradually been placed in the center of the health system, reaching the patient safety a greater role as one of the key dimensions of quality in recent years. The monitoring, measurement and improvement of safety and quality of care in the Intensive Care Unit represent a great challenge for the critical care community. Health interventions carry a risk of adverse events or events that can cause injury, disability and even death in patients. In Intensive Care Unit, the severity of the critical patient, communication barriers, a high number of activities per patient per day, the practice of diagnostic procedures and invasive treatments, and the quantity and complexity of the information received, among others, put at risk these units as areas for the occurrence of adverse events. This article presents some of the strategies and interventions proposed and tested internationally to optimize the care of critical patients and improve the safety culture in the Intensive Care Unit.
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Affiliation(s)
| | - Luís López-Rodríguez
- Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, España; Hospital Virgen del Rocío, Sevilla, España
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[Analysis of an incident notification system and register in a critical care unit]. ENFERMERIA INTENSIVA 2016; 27:112-9. [PMID: 27320867 DOI: 10.1016/j.enfi.2015.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/26/2015] [Accepted: 12/29/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To analyse the incident communicated through a notification system and register in a critical care unit. METHODOLOGY A cross-sectional descriptive study was conducted by performing an analysis of the records of incidents communicated anonymously and voluntarily from January 2007 to December 2013 in a critical care unit of adult patients with severe trauma. STUDY VARIABLES incident type and class, professional reports, and suggestions for improvement measures. A descriptive analysis was performed on the variables. RESULTS Out of a total of 275 incidents reported, 58.5% of them were adverse events. Incident distributed by classes: medication, 33.7%; vascular access-drainage-catheter-sensor, 19.6%; devices-equipment, 13.3%, procedures, 11.5%; airway tract and mechanical ventilation, 10%; nursing care, 4.1%; inter-professional communication, 3%; diagnostic test, 3%; patient identification, 1.1%, and transfusion 0.7%. In the medication group, administrative errors accounted for a total of 62%; in vascular access-drainage-catheter-sensor group, central venous lines, a total of 27%; in devices and equipment group, respirators, a total of 46.9%; in airway self-extubations, a total of 32.1%. As regards to medication errors, 62% were incidents without damage. Incident notification by profession: doctors, 43%, residents, 5.6%, nurses, 51%, and technical assistants, 0.4%. CONCLUSIONS Adverse events are the most communicated incidents. The events related to medication administration are the most frequent, although most of them were without damage. Nurses and doctors communicate the incidents with the same frequency. In order to highlight the low incident notification despite it being an anonymous and volunteer system, therefore, it is suggested to study measurements to increase the level of communication.
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Merino P, Bustamante E, Campillo-Artero C, Bartual E, Tuero G, Marí J. Patient safety certification in a Department of Intensive Care Medicine: our experience with standard UNE 179003:2013. Med Intensiva 2013; 38:297-304. [PMID: 24315791 DOI: 10.1016/j.medin.2013.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/09/2013] [Accepted: 10/15/2013] [Indexed: 10/25/2022]
Abstract
Systematic and structured methods must be used to ensure that healthcare risks are effectively managed. Spanish standard UNE 179003:2013 provides healthcare organizations with a framework and a systematic protocol for managing patient safety from a clinical and organizational perspective. Furthermore, it is useful in securing an efficient balance among health risk, health outcomes and costs. The UNE 179003:2013 certifies that a clinical service complies with rules and operating procedures aimed at reducing the incidence of adverse events. It also requires mandatory continuous improvement, given that the standard entails frequent monitoring of the risk management system through periodic audits. The aims of this paper are to describe the UNE 179003:2013 certification process in an Intensive Care Unit, propose a risk management program for critical patients, and offer some recommendations regarding its implementation.
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Affiliation(s)
- P Merino
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, España.
| | - E Bustamante
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, España
| | | | - E Bartual
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, España
| | - G Tuero
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, España
| | - J Marí
- Unidad de Calidad, Hospital Can Misses, Ibiza, España
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