Sirgo Rodríguez G, Olona Cabases M, Martin Delgado M C, Esteban Reboll F, Pobo Peris A, Bodí Saera M
Intensive Care Unit, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain.
Preventive Medicine Department, Hospital Universitari Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain.
Med Intensiva. 2014 Nov;38(8):473-82. doi: 10.1016/j.medin.2013.11.008. Epub 2014 Feb 5.
Adverse events significantly impact upon mortality rates and healthcare costs.
To design a checklist of safety measures based on relevant scientific literature, apply random checklist measures to critically ill patients in real time (safety audits), and determine its utility and feasibility.
A list of safety measures based on scientific literature was drawn up by investigators. Subsequently, a group of selected experts evaluated these measures using the Delphi methodology. Audits were carried out on 14 days over a period of one month. Each day, 50% of the measures were randomly selected and measured in 50% of the randomized patients. Utility was assessed by measuring the changes in clinical performance after audits, using the variable improvement proportion related to audits. Feasibility was determined by the successful completion of auditing on each of the days on which audits were attempted.
The final verified checklist comprised 37 measures distributed into 10 blocks. The improvement proportion related to audits was reported in 83.78% of the measures. This proportion was over 25% in the following measures: assessment of the alveolar pressure limit, checking of mechanical ventilation alarms, checking of monitor alarms, correct prescription of the daily treatment orders, daily evaluation of the need for catheters, enteral nutrition monitoring, assessment of semi-recumbent position, and checking that patient clinical information is properly organized in the clinical history. Feasibility: rounds were completed on the 14 proposed days.
Audits in real time are a useful and feasible tool for modifying clinical actions and minimizing errors.
不良事件对死亡率和医疗成本有重大影响。
根据相关科学文献设计一份安全措施清单，对重症患者实时应用随机清单措施（安全审核），并确定其效用和可行性。
研究人员根据科学文献制定了一份安全措施清单。随后，一组选定的专家使用德尔菲法对这些措施进行评估。在一个月的时间内进行了14天的审核。每天，随机选择50%的措施，并在50%的随机分组患者中进行测量。通过使用与审核相关的变量改善比例来衡量审核后临床性能的变化，从而评估效用。通过在尝试审核的每一天成功完成审核来确定可行性。
最终验证的清单包括37项措施，分为10个板块。83.78%的措施报告了与审核相关的改善比例。在以下措施中，该比例超过25%：评估肺泡压力极限、检查机械通气警报、检查监测器警报、正确开具每日治疗医嘱、每日评估导管需求、肠内营养监测、评估半卧位姿势以及检查患者临床信息在病历中是否妥善整理。可行性：在提议进行审核的14天内完成了查房。
实时审核是修改临床行为和减少错误的有用且可行的工具。
