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

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.

[1]  D. Bates,et al.  Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. , 1999, JAMA.

[2]  B. Guidet,et al.  Prospective evaluation of self-extubations in a medical intensive care unit , 2005, Intensive Care Medicine.

[3]  Mark A. Moskowitz,et al.  Complications of care in a medical intensive care unit , 1990, Journal of General Internal Medicine.

[4]  Peter J Pronovost,et al.  The Johns Hopkins Hospital: identifying and addressing risks and safety issues. , 2004, Joint Commission journal on quality and safety.

[5]  Elie Azoulay,et al.  Impact of adverse events on outcomes in intensive care unit patients* , 2008, Critical care medicine.

[6]  J. Timsit,et al.  Impact of Unplanned Extubation and Reintubation after Weaning on Nosocomial Pneumonia Risk in the Intensive Care Unit: A Prospective Multicenter Study , 2002, Anesthesiology.

[7]  P. Metnitz,et al.  Patient safety in intensive care: results from the multinational Sentinel Events Evaluation (SEE) study , 2006, Intensive Care Medicine.

[8]  Eric Schneider,et al.  Views of practicing physicians and the public on medical errors. , 2002, The New England journal of medicine.

[9]  Anthony Delaney,et al.  Benefits and Risks of Tight Glucose Control in Critically Ill Adults: A Metaanalysis , 2009 .

[10]  T. Brennan,et al.  INCIDENCE OF ADVERSE EVENTS AND NEGLIGENCE IN HOSPITALIZED PATIENTS , 2008 .

[11]  L. Lorente,et al.  Accidental catheter removal in critically ill patients: a prospective and observational study , 2004, Critical care.

[12]  Susan Mayor,et al.  Doctors need more training in delivering breech babies , 2000, BMJ : British Medical Journal.

[13]  J. Chacko,et al.  Critical Incidents in a Multidisciplinary Intensive Care Unit , 2007, Anaesthesia and intensive care.

[14]  Liu Xinbing,et al.  Intensive insulin therapy for the critically ill patients with stress hyperglycemia , 2008 .

[15]  U. Janssens,et al.  Identification and characterization of errors and incidents in a medical intensive care unit , 2005, Acta anaesthesiologica Scandinavica.

[16]  J. Loeb,et al.  The JCAHO patient safety event taxonomy: a standardized terminology and classification schema for near misses and adverse events. , 2005, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[17]  Laurent Papazian,et al.  High level of burnout in intensivists: prevalence and associated factors. , 2007, American journal of respiratory and critical care medicine.

[18]  R. Albert,et al.  Disclosing errors and adverse events in the intensive care unit* , 2006, Critical care medicine.

[19]  S. Ridley,et al.  Prescription errors in UK critical care units , 2004, Anaesthesia.

[20]  H. Spapen.  N-acetylcysteine in clinical sepsis: a difficult marriage , 2004, Critical care.

[21]  P. Michel,et al.  hospitalsadverse events in acute care rates of adverse events and rates of Comparison of three methods for estimating , 2006 .

[22]  Susan M Paddock,et al.  Rates and types of events reported to established incident reporting systems in two US hospitals , 2007, Quality and Safety in Health Care.

[23]  D Teres,et al.  Critical care delivery in the intensive care unit: Defining clinical roles and the best practice model , 2001, Critical care medicine.

[24]  V. Ferraris,et al.  Outcome in critical care patients: A multivariate study , 1992, Critical care medicine.

[25]  J. Timsit,et al.  Pneumothorax in the Intensive Care Unit: Incidence, Risk Factors, and Outcome , 2006, Anesthesiology.

[26]  Victoria J. Fraser,et al.  Reporting of medical errors: An intensive care unit experience , 2004, Critical care medicine.

[27]  Pierre Lewalle,et al.  Towards an International Classification for Patient Safety: a Delphi survey , 2009, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[28]  Gilles Clermont,et al.  Perceptions of safety culture vary across the intensive care units of a single institution* , 2007, Critical care medicine.

[29]  P. Plsek,et al.  Real time patient safety audits: improving safety every day , 2005, Quality and Safety in Health Care.

[30]  M Schetz,et al.  Intensive insulin therapy in critically ill patients. , 2001, The New England journal of medicine.

[31]  M. Rudis,et al.  Position paper on critical care pharmacy services , 2000 .

[32]  S. Lemeshow,et al.  A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. , 1993, JAMA.

[33]  W B Runciman,et al.  ORGANISATIONAL MATTERS: NATIONAL INITIATIVES Lessons from the Australian Patient Safety Foundation: setting up a national patient safety surveillance system—is this the right model? , 2002 .

[34]  Peter J Pronovost,et al.  A system factors analysis of “line, tube, and drain” incidents in the intensive care unit* , 2005, Critical care medicine.

[35]  S. Chevret,et al.  Iatrogenic complications in adult intensive care units: A prospective two‐center study , 1993, Critical care medicine.

[36]  J. Eledjam,et al.  Risk factors of failure and immediate complication of subclavian vein catheterization in critically ill patients , 2002, Intensive Care Medicine.

[37]  L. Leape.  Reporting of adverse events. , 2002, The New England journal of medicine.

[38]  L. Kohn,et al.  To Err Is Human : Building a Safer Health System , 2007 .

[39]  D. Bates,et al.  Effect of reducing interns' work hours on serious medical errors in intensive care units. , 2004, The New England journal of medicine.

[40]  D. Bates,et al.  Preventable adverse drug events in hospitalized patients: a comparative study of intensive care and general care units. , 1997, Critical care medicine.

[41]  Rhona Flin,et al.  Communication skills and error in the intensive care unit , 2007, Current opinion in critical care.

[42]  D. E. Lawrence,et al.  APACHE—acute physiology and chronic health evaluation: a physiologically based classification system , 1981, Critical care medicine.

[43]  R Platt,et al.  Serious falls in hospitalized patients: correlates and resource utilization. , 1995, The American journal of medicine.

[44]  T. Brennan,et al.  The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. , 1991, The New England journal of medicine.

[45]  Rolf Rossaint,et al.  Intensive insulin therapy and pentastarch resuscitation in severe sepsis. , 2008, The New England journal of medicine.