Iatrogenic Complications in Adult Intensive Care Units

Giraud, T; Dhainaut, Jean-François; Vaxelaire, J. F.; Joseph, Thierry; Journois, Didier; Bleichner, G; Sollet, Jean-Pierre; Chevret, Sylvie; Monsallier, J F

doi:10.1097/00132586-199406000-00033

Cited by 48 publications

(75 citation statements)

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“…Recently, Beckman and colleagues described the development of an incident reporting system in ICU [10] and a descriptive taxonomy ........................................................................................................................................................................................................................................ of their first year of reporting [11]. Giraud and co-workers [17] undertook a more limited approach in that they prospectively evaluated iatrogenic complications in intensive care units without investigating possible preventative strategies.…”

Section: Discussionmentioning

confidence: 99%

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Critical incident reporting in the intensive care unit

et al. 1997

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SummaryCritical incident reporting was introduced into the intensive care unit (ICU) as part of the development of a quality assurance programme within our department. Over a 3-year period 281 critical incidents were reported. Factors relating to causation, detection and prevention of critical incidents were sought. Detection of a critical incident in over 50% of cases resulted from direct observation of the patient while monitoring systems accounted for a further 27%. No physiological changes were observed in 54% of critical incidents. The most common incidents reported concerned airway management and invasive lines, tubes and drains. Human error was a factor in 55% of incidents while violations of standard practice contributed to 28%. Critical incident reporting was effective in revealing latent errors in our 'system' and clarifying the role of human error in the generation of incidents. It has proven to be a useful technique to highlight problems previously undetected in our quality assurance programme. Improvements in quality of care following implementation of preventative strategies await further assessment.

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Section: Discussionmentioning

confidence: 99%

“…In the critical care literature an incidence of between 66% and 80% has been reported [7,11,17]. These discrepancies reflect different definitions of human error.…”

Section: Discussionmentioning

confidence: 99%

Critical incident reporting in the intensive care unit

et al. 1997

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“…Medical errors have been demonstrated to be major determinants in patient safety since the "to err is human" report published in 1999, 17 and errors related to mechanical ventilation occur with the greatest frequency. 2 Confusing human/machine interface aspects, designed without sufficient input from the end users, may lead to inadequate solutions in the clinical setting.…”

Section: Human/machine Interface Differences and The Potential Impactmentioning

confidence: 99%

“…These human errors are frequent and may be associated with high morbidity and mortality. 2,3 An optimal device for emergency care should provide adequate technical performance, combined with optimal ergonomics (ie, an easy-to-use and user-friendly human/machine interface). 4,5 Significant improvement in the technical performance of emergency and transport ventilators has been observed during the last decade, 6 and more recent devices have demonstrated technical performance similar to that of ICU ventilators.…”

Section: Introductionmentioning

confidence: 99%

A Comprehensive Approach for the Ergonomic Evaluation of 13 Emergency and Transport Ventilators

Marjanovic

L’Her

2016

Respir Care

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BACKGROUND: Mechanical ventilation is an important part of emergency medicine and is frequently used for transportation. Human errors during ventilator settings are frequent and may be associated with high morbidity/mortality. The aim of the study was to provide a complete ergonomic evaluation of emergency and transport ventilators, taking into account objective and subjective human-machine interface assessments and individual mental work load. METHODS: We performed a prospective bench ergonomic evaluation of 13 emergency and transport ventilators, using standardized conditions and a global methodological approach. The study was performed in an evaluation laboratory dedicated to respiratory care, and 12 emergency physicians unfamiliar with the tested devices were included in the evaluation. The ventilators were classified into 3 categories (simple, sophisticated, and ICU-like). Objective chronometric evaluations were conducted considering 9 tasks, and subjective evaluations were performed (ease of use, willingness to use, and user-friendliness of monitoring) using Likert scales. Mental work load evaluation was performed using the NASA Task Load Index scale. RESULTS: Overall task failure rate represented 4% of all attempts. Setting modifications, ventilation mode changes, and powering down durations were different between simple and other emergency and transport ventilator categories (P < .005). There was no difference between ventilator categories for the ease of use and userfriendliness of the monitoring. In contrast, the willingness to use was lower for simple devices, compared with sophisticated and ICU-like emergency and transport ventilators (2.9 ؎ 1.4 vs 3.9 ؎ 1.2, P ‫؍‬ .002 and 4.3 ؎ 1, P < .001). No differences were observed between devices regarding the mental work load, except for several specific devices in the sophisticated category. CONCLUSIONS: A comprehensive ergonomic evaluation provides valuable information while investigating operational friendliness in emergency and transport ventilators. The choice of a device not only depends on its technical characteristics but should take into account its clinical operational setting and ergonomics in order to decrease mental work load. Sophisticated emergency and transport ventilators should only be used by clinicians who demonstrate expertise in mechanical ventilation.

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“…It is known that few and low levels of registered nurse (RN) staff are associated with poor patient outcomes, such as pneumonia, urinary tract infections, lengthy stays, upper gastrointestinal bleeding, shock and high rates of general infections (2)(3)(4)(5)(6)(7)(8)(9)(10) . On average, in the US, the cost of nursing staff represents 63% of a hospital's labor costs (11) .…”

Section: Introductionmentioning

confidence: 99%

Estimating the nursing staff required in a new hospital

Rossetti

Gaidzinski

2011

Rev. Latino-Am. Enfermagem

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Opening a new hospital poses a complex and consequential set of challenges. One of these challenges is to estimate the nursing staff. The aim of this article is to report the entire process adopted to estimate the required nursing staff for a new Hospital in Brazil. The nursing staff was projected according to the Brazilian Federal Nursing Council (Cofen).We applied an equation to estimate nursing staff and compared the results with two other existing hospitals. A significant difference (p<0.05) was observed when comparing the Nurse-License Practice Nurse ratio recommended by Cofen between the new Hospital and other hospitals. This statistical difference is mostly due to reduced nurse staff in intensive care units. Almost one year after the hospital opened its doors, it is necessary to review nursing staff hours with the real information to reinforce the expenditure on these personnel and to evaluate the decisions made so far. Estimación de personal de enfermería en un hospital nuevoAbrir un nuevo hospital es un asunto complejo y sujeto a consecuencias. Uno de los desafíos es estimar el personal de enfermería. El objetivo de este trabajo es describir el proceso adoptado para estimar el personal de enfermería en un hospital nuevo en Brasil.El número de enfermeras del nuevo Hospital fue calculado de acuerdo con el método recomendado por el Consejo Federal de Enfermería de Brasil (Cofen). Los resultados se compararon con dos hospitales similares, ya en funcionamiento. Se encontró una diferencia significativa (p <0,05) con respecto a la relación entre enfermeras y auxiliares de enfermería recomendado por Cofen en los tres hospitales. Esta diferencia estadística se debe principalmente al menor número de enfermeras en las unidades de cuidados intensivos. Casi dos años después de su apertura es necesario revisar el número de enfermeras teniendo en cuenta la información real para justificar el coste de personal y evaluar las decisiones adoptadas hasta el momento.

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Iatrogenic Complications in Adult Intensive Care Units

Cited by 48 publications

References 0 publications

Critical incident reporting in the intensive care unit

Critical incident reporting in the intensive care unit

A Comprehensive Approach for the Ergonomic Evaluation of 13 Emergency and Transport Ventilators

Estimating the nursing staff required in a new hospital

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