Article Text

IATROGENIC EVENTS IN ADMITTED NEONATES: IMPACT OF CORRECTIVE ACTIONS AND CONTINUOUS MONITORING
  1. I Ligi1,
  2. V Millet1,
  3. L Fayol1,
  4. F Arnaud1,
  5. S Tardieu2,
  6. R Sambuc2,
  7. U Simeoni1
  1. 1Division of Neonatology, la Conception Hospital, Marseille, France
  2. 2Medical Evaluation Department, Assistance Publique-Hopitaux de Marseille, Public Health Department, EA 3279, Faculte de Medecine, Universite de la Mediterranee, Marseille, France

Abstract

Iatrogenic events (IE) are increasingly recognized as an important problem in all people admitted to hospital. Hospitalized neonates are particularly vulnerable to IE.

Objectives To assess the impact of corrective actions superimposed on prospective continuous monitoring in reducing IE in admitted neonates.

Methods We undertook an observational, prospective study including all neonates admitted in the Division of Neonatology of an academic, tertiary neonatal centre in southern France. IE were defined as any event that compromised the safety margin for the patient, in the presence or absence of harm. The report of IE was voluntary, anonymous and non-punitive. Following a first study from January to September 2005, we defined a prioritized list of opportunities for improvement: reduction of nosocomial infections, limitation of invasive procedures, reduction of infusion pump programming and calculation errors, minimization of cutaneous injury. Corrective actions and prevention strategies were defined and undertaken. The second period of assessment extended from September 2007 to February 2008.

Results The incidence of IE decreased from 69 to 49 per 100 admissions and their severity from 20 to 12.7 per 100 admissions. The incidence of nosocomial infections was reduced from 14.2 to 11.4 per 1000 catheter days. Medication events were less frequent (8.8 versus 5.1 per 100 admissions). Infusion pump programming errors became scarce but we noticed an increase in prescription errors. Cutaneous injuries were stable.

Conclusions Prospective continuous monitoring is an effective method to assess the impact of corrective actions and to improve quality of health care in hospitalized neonates.

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