Murphy T, Bender J, Taub M, Tucker R, Laptook A
Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA.
J Perinatol. 2016 Aug;36(8):676-80. doi: 10.1038/jp.2016.50. Epub 2016 Apr 7.
The aim of this study is to identify, quantify and disseminate a novel set of safety indicators for monitoring the occurrence of preventable harm in the neonatal intensive care unit (NICU).
Literature review and experiences in an academic, level IV NICU identified prevalent, preventable safety events: hospital-acquired infections (catheter-associated bloodstream infection, ventilator-associated pneumonia), unscheduled extubations, intravenous infiltrates requiring intervention, first week readmissions, serious adverse drug events and miscellaneous events (unanticipated harm or serious near misses). Negative binominal regression evaluated the event incidence trends.
Of 226 preventable harm events occurring between March 2013 and January 2015, the most common were unscheduled extubations (98; 2/100 ventilator days) and intravenous infiltrates (62; 2.7/100 admissions). No trends were detected (rate ratio: 0.99; confidence limits: 0.96 to 1.01; P=0.38).
The Neonatal Preventable Harm Index represents a novel and transparent means to monitor serious safety events and direct harm prevention strategies in the NICU.
本研究旨在识别、量化并传播一套全新的安全指标，用于监测新生儿重症监护病房（NICU）中可预防伤害的发生情况。
通过文献综述以及在一家学术性四级NICU的经验，确定常见的、可预防的安全事件：医院获得性感染（导管相关血流感染、呼吸机相关性肺炎）、意外拔管、需要干预的静脉输液外渗、首周再入院、严重药物不良事件以及其他事件（意外伤害或严重的险些发生的失误）。负二项回归分析评估事件发生率趋势。
在2013年3月至2015年1月期间发生的226起可预防伤害事件中，最常见的是意外拔管（98起；每100个呼吸机日发生2起）和静脉输液外渗（62起；每100次入院发生2.7起）。未检测到趋势（率比：0.99；置信区间：0.96至1.01；P = 0.38）。
新生儿可预防伤害指数是一种全新且透明的手段，用于监测NICU中的严重安全事件并指导伤害预防策略。
