Adverse events in critical care:Search and active detection through the Trigger Tool

摘要

AIM To investigate the incidence of disadvantageous events by using the Global Trigger Tool in an intensive care unit(ICU).METHODS A retrospective descriptive study was performed in a 12-bed university ICU in the city of Medellin,Colombia.Clinical charts of hospitalized patients were reviewed,between January 1 and December 31,2016,with the following inclusion criteria:subjects aged over 18 years,with at least 24 h of hospitalization and who had a complete medical history that could be accessed.Interventions:Trained reviewers conducted a retrospective examination of medical charts searching for clue events that elicit investigation,in order to detect an unfavorable event.Measurements:Information was processed through SPSS software version 21;for numerical variables,the mean was reported with standard deviation(SD).Percentages were calculated for qualitative variables.RESULTS Two hundred and forty-four triggers occurred,with 82.4%of subjects having presented with at least one and an average of 3.37(SD 3.47).A total of 178 adverse events(AEs)took place in 48 individuals,with an incidence of 52.1%.On average,four events per patient were recorded,and for each unfortunate event,1.98 triggers were presented.The most frequent displeasing issues were:pressure ulcers(17.6%),followed by complications or reactions to medical devices(4.3%),and lacerations or skin defects(3.7%);the least frequent was delayed diagnosis or treatment(0.56%).Thirty-eight point four percent of mishap events caused temporary damage that required intervention,and 48.9%of AEs were preventable.Comparison between AEs and admission diagnoses found that hypertension and sepsis were the only diagnoses that had statistical significance(P=0.042 and 0.022,respectively).CONCLUSION Almost half of the unfavorable issues were classified as avoidable,which leaves a very wide field of work in terms of preventative activities.