Selected medical errors in the intensive care unit: results of the IATROREF study: parts I and II.

Abstract:

RATIONALE:Although intensive care units (ICUs) were created for patients with life-threatening illnesses, the ICU environment generates a high risk of iatrogenic events. Identifying medical errors (MEs) that serve as indicators for iatrogenic risk is crucial for purposes of reporting and prevention. OBJECTIVES:We describe the selection of indicator MEs, the incidence of such MEs, and their relationship with mortality. METHODS:We selected indicator MEs using Delphi techniques. An observational prospective multicenter cohort study of these MEs was conducted from March 27 to April 3, 2006, in 70 ICUs; 16 (23%) centers were audited. Harm from MEs was collected using specific scales. MEASUREMENTS AND MAIN RESULTS:Fourteen types of MEs were selected as indicators; 1,192 MEs were reported for 1,369 patients, and 367 (26.8%) patients experienced at least 1 ME (2.1/1,000 patient-days). The most common MEs were insulin administration errors (185.9/1,000 d of insulin treatment). Of the 1,192 medical errors, 183 (15.4%) in 128 (9.3%) patients were adverse events that were followed by one or more clinical consequences (n = 163) or that required one or more procedures or treatments (n = 58). By multivariable analysis, having two or more adverse events was an independent risk factor for ICU mortality (odds ratio, 3.09; 95% confidence interval, 1.30-7.36; P = 0.039). CONCLUSIONS:The impact of medical errors on mortality indicates an urgent need to develop prevention programs. We have planned a study to assess a program based on our results.

authors

Garrouste-Orgeas M,Timsit JF,Vesin A,Schwebel C,Arnodo P,Lefrant JY,Souweine B,Tabah A,Charpentier J,Gontier O,Fieux F,Mourvillier B,Troché G,Reignier J,Dumay MF,Azoulay E,Reignier B,Carlet J,Soufir L,OUTCOMEREA Stu

doi

10.1164/rccm.200812-1820OC

subject

Has Abstract

pub_date

2010-01-15 00:00:00

pages

134-42

issue

2

eissn

1073-449X

issn

1535-4970

pii

200812-1820OC

journal_volume

181

pub_type

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