新生儿重症监护病房中的医源性疾病：观察性与干预性、前瞻性、多中心研究。

Iatrogenesis in neonatal intensive care units: observational and interventional, prospective, multicenter study.

作者信息

Kugelman Amir, Inbar-Sanado Esther, Shinwell Eric S, Makhoul Imad R, Leshem Meiron, Zangen Shmuel, Wattenberg Orly, Kaplan Tanya, Riskin Arieh, Bader David

机构信息

Department of Neonatology, Bnai Zion Medical Center, 47 Golomb St, Haifa, 31048, Israel.

出版信息

Pediatrics. 2008 Sep;122(3):550-5. doi: 10.1542/peds.2007-2729.

DOI:10.1542/peds.2007-2729

PMID:18762525

Abstract

OBJECTIVES

The goals were to determine the incidence of iatrogenic events in NICUs and to determine whether awareness of iatrogenic events could influence their occurrence.

METHODS

We performed a prospective, observational, interventional, multicenter study including all consecutive infants hospitalized in 4 NICUs. In the first 3 months (observation period), the medical teams were unaware of the study; in the next 3 months (intervention period), they were made aware of daily ongoing monitoring of iatrogenic events by a designated "Iatrogenesis Advocate."

RESULTS

The numbers of infants admitted to the NICUs were comparable during the observation and intervention periods (328 and 369 infants, respectively). There was no difference between the 2 periods with respect to the number of infants of <1500 g, hospitalization days, or mean daily occupancy of the NICUs. Although the prevalence rates of iatrogenic events were comparable in the observation and intervention periods (18.0 and 18.2 infants with iatrogenic events per 100 hospitalized infants, respectively), the incidence rate decreased significantly during the intervention period (3.2 and 2.4 iatrogenic events per 100 hospitalization days of new admissions, respectively). Of all iatrogenic events, 7.9% were classified as life-threatening and 45.1% as harmful. There was no death related to an iatrogenic event. Eighty-three percent of iatrogenic events were considered preventable, of which 26.9% resulted from medical errors in ordering or delivery of medical care. Only 1.6% of all iatrogenic events were intercepted before reaching the infants, and only 47.0% of iatrogenic events were corrected. For younger and smaller infants, the rate of iatrogenic events was higher (57% at gestational ages of 24 to 27 weeks, compared with 3% at term) and the iatrogenic events were more severe and harmful. Increased length of stay was associated independently with more iatrogenic events.

CONCLUSIONS

Neonatal medical teams and parents should be aware of the burden of iatrogenesis, which occurs at a significant rate.

摘要

目的

本研究旨在确定新生儿重症监护病房（NICU）中医源性事件的发生率，并确定对医源性事件的认知是否会影响其发生。

方法

我们开展了一项前瞻性、观察性、干预性多中心研究，纳入了4个新生儿重症监护病房中所有连续入院的婴儿。在最初3个月（观察期），医疗团队对该研究不知情；在接下来的3个月（干预期），他们知晓有指定的“医源性事件倡导者”对医源性事件进行每日持续监测。

结果

观察期和干预期入住新生儿重症监护病房的婴儿数量相当（分别为328例和369例）。在<1500g婴儿数量、住院天数或新生儿重症监护病房的日均占用率方面，两个时期没有差异。虽然观察期和干预期医源性事件的患病率相当（每100例住院婴儿中分别有18.0例和18.2例发生医源性事件），但干预期的发生率显著下降（每100例新入院患者住院日中分别有3.2例和2.4例医源性事件）。在所有医源性事件中，7.9%被归类为危及生命，45.1%为有害。没有与医源性事件相关的死亡。83%的医源性事件被认为是可预防的，其中26.9%是由于医嘱或医疗护理实施中的医疗差错导致的。在所有医源性事件中，只有1.6%在影响婴儿之前被拦截，只有47.0%的医源性事件得到纠正。对于更小、更年幼的婴儿，医源性事件的发生率更高（孕龄24至27周时为57%，足月儿为3%），且医源性事件更严重、危害更大。住院时间延长独立地与更多医源性事件相关。