Notificación de incidentes relacionados con la seguridad del paciente en los hospitales de Cataluña durante el período 2010-2013

Oliva, Glòria; Álava, Fernando; Navarro, Laura; Esquerra, Miquel; Lushchenkova, Oksana; Davins, Josep; Vallès, Roser

doi:10.1016/j.medcli.2014.07.012

Cited by 14 publications

(10 citation statements)

References 11 publications

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“…As in previous evidence, 12 Falls were the incident most frequently reported, it was one of the incidents perceived as less frequent. The opposite notification pattern can be observed in Health-care Associated Infections.…”

Section: Discussionsupporting

confidence: 74%

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A hospital incident reporting system (2016–2019): Learning from notifier's perception on incidents’ risk, severity and frequency of adverse events

Torre-Pérez

Granés²,

Prat-Marin³

et al. 2023

Journal of Healthcare Quality Research

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Section: Discussionsupporting

confidence: 74%

“…Notification details were collected on The Patient Safety Company ® (TPSC) platform. 19 TPSC platform is structured in different sections according to Hospital's institutes, 12 hereinafter referred to as departments. Some platform variables were calculated and recategorized for the analysis.…”

Section: Data Source and Variablesmentioning

confidence: 99%

A hospital incident reporting system (2016–2019): Learning from notifier's perception on incidents’ risk, severity and frequency of adverse events

Torre-Pérez

Granés²,

Prat-Marin³

et al. 2023

Journal of Healthcare Quality Research

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“…Regarding the types of reported incidents by degree of harm, the results obtained show a significant number of AE. When we looked for scientific productions to compare the results found in our study, we found numerous publications focused on the occurrence of reported AE in specific assistance modalities, 20–23 and no articles were found evaluating patient safety incidents in the entire health system of a country, as presented in this research.…”

Section: Discussionmentioning

confidence: 95%

National Patient Safety Program in Brazil: Incidents Reported Between 2014 and 2017

et al. 2018

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Method: A documentary study that used the records of the incidents published in the Reports of Adverse Events (AE) in Brazil. The following variables were selected: number of incidents by type, type of health service, hospital unit, and degree of harm. To find whether there was a significant difference across the Brazilian regions by notifications related to general incidents, AE, and deaths, the analysis of variance and the Tukey tests were used.Results: A total of 109,082 incidents were reported, of which 75,088 were AE, with 649 deaths. In relation to the types of incidents reported, there was a higher frequency in the categories other (30.04%) and failures during health care (26.72%). A total of 93.90% of the incidents occurred in hospitals, with 54,950 cases registered in hospitalization units and 30,141 cases in intensive care units. Statistically significant differences across the Brazilian regions were observed in the number of incidents (P = 0.004), AE (P = 0.004), and deaths (P = 0.024).Conclusions: A significant underreporting of incidents was found in Brazil, demonstrating only the tip of a giant iceberg. More than half of the incidents were reported as AE and were registered in hospitals, reiterating the importance of establishing public health policies at national, state, and municipal levels, with adequate supervision of the health service regarding the implementation of the Patient Safety Nuclei and the preparation of new protocols based on the most prevalent incidents.

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“…Training is one of the main contributory factors to a growing notification of errors. [24] Experts emphasize the need to develop educational programs that elucidate health errors by discussing scenarios to understand the causes of problems and proposals for improvement. [25] Regarding the occurrence of the adverse events/errors described, 35.6% of them occurred in the operating room, being that the most frequent errors were the incorrect identification of the patient and the incorrect identification of the surgical parts.…”

Section: Discussionmentioning

confidence: 99%

Safety culture in the context of operating room: Nurses' perception regarding notification of errors/adverse events

Vinagre

Marques

2018

JNEP

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The notification of errors/adverse events is one of the central aspects for the quality of care and patient safety. The purpose of this pilot study is to analyse the safety culture of the operating room in relation to the errors/adverse events and their notification, in the nurses’ perception. It is a quantitative, descriptive-exploratory pilot study. A survey “Nurses’ Perception regarding Notification of Errors/Adverse Events” was applied, consisting of 8 closed questions to an intentional non-probabilistic sample consisting of 43 nurses working in the operating room of a private hospital in Lisbon. The results showed that only 51.2% of the adverse events that caused damage to patients were always notified by the nurses. Of the various adverse events occurred, 60.5% were not reported, justified by “lack of time”. There was also a negative correlation between professional experience and the frequency of error notification (p < .05). The factors referred as those that contributed most to the occurrence of errors were, pressure to work quickly (100.0%), lack of human resources (86.0%), demotivation (86.0%), professional inexperience and hourly overload (83.7%), lack of knowledge (74.4%) and communication failures (65.1%). The perception of Patient Safety was assessed by the majority of participants as “acceptable”. In conclusion, it was evident the reduced notification of adverse events in the operation room so it becomes crucial to focus on the continuous training of health professionals, as well as work on the error, to increase a safety culture with quality.

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Notificación de incidentes relacionados con la seguridad del paciente en los hospitales de Cataluña durante el período 2010-2013

Cited by 14 publications

References 11 publications

A hospital incident reporting system (2016–2019): Learning from notifier's perception on incidents’ risk, severity and frequency of adverse events

A hospital incident reporting system (2016–2019): Learning from notifier's perception on incidents’ risk, severity and frequency of adverse events

National Patient Safety Program in Brazil: Incidents Reported Between 2014 and 2017

Safety culture in the context of operating room: Nurses' perception regarding notification of errors/adverse events

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