Gqaleni Thusile M, Bhengu Busisiwe R
School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
Health SA. 2020 Mar 31;25:1263. doi: 10.4102/hsag.v25i0.1263. eCollection 2020.
Patient Safety Incidents occur frequently in critical care units, contribute to patient harm, compromise quality of patient care and increase healthcare costs. It is essential that Patient Safety Incidents in critical care units are continually measured to plan for quality improvement interventions.
To analyse Patient Safety Incident reporting system, including the evidence of types, frequencies, and patient outcomes of reported incidents in critical care units.
The study was conducted in the critical care units of ten hospitals of eThekwini district, in KwaZulu-Natal, South Africa.
A quantitative approach using a descriptive cross sectional survey was adopted to collect data from the registered nurses working in critical care units of randomly selected hospitals. Self-administered questionnaires were distributed to 270 registered nurses of which 224 (83%) returned completed questionnaires. A descriptive statistical analysis was initially conducted, then the Pearson Chi-square test was performed between the participating hospitals.
One thousand and seventeen ( = 1017) incidents in ten hospitals were self-reported. Of these incidents, 18% ( = 70) were insignificant, 35% ( = 90) minor, 25% ( = 75) moderate, 12% ( = 32) major and 10% ( = 26) catastrophic. Patient Safety Incidents were classified into six categories: (a) Hospital-related incidents (42% [ = 416]); (b) Patient care-related incidents (30% [ = 310]); (c) (Death 12% [ = 124]); (d) Medication-related incidents, (7% [ = 75]); (e) Blood product-related incidents (5% [ = 51]) and (f) Procedure-related incidents (4% [ = 41]).
This study's findings indicating 1017 Patient Safety Incidents of predominantly serious nature, (47% considering moderate, major and catastrophic) are a cause for concern.
患者安全事件在重症监护病房频繁发生，会对患者造成伤害，损害患者护理质量并增加医疗成本。持续衡量重症监护病房的患者安全事件对于规划质量改进干预措施至关重要。
分析患者安全事件报告系统，包括重症监护病房报告事件的类型、频率及患者结局的证据。
该研究在南非夸祖鲁 - 纳塔尔省伊泰夸尼地区十家医院的重症监护病房进行。
采用描述性横断面调查的定量方法，从随机选择医院的重症监护病房工作的注册护士中收集数据。向270名注册护士发放了自填式问卷，其中224名（83%）返回了完整问卷。首先进行描述性统计分析，然后在参与医院之间进行Pearson卡方检验。
十家医院共自我报告了1017起事件。在这些事件中，18%（70起）为无显著影响事件，35%（90起）为轻微事件，25%（75起）为中度事件，12%（32起）为重大事件，10%（26起）为灾难性事件。患者安全事件分为六类：（a）医院相关事件（42%[416起]）；（b）患者护理相关事件（30%[310起]）；（c）死亡事件（12%[124起]）；（d）药物相关事件（7%[75起]）；（e）血液制品相关事件（5%[51起]）；（f）操作相关事件（4%[41起]）。
本研究结果表明，1017起主要为严重性质的患者安全事件（47%为中度、重大和灾难性事件）令人担忧。
