The error in neonatal intensive care: a multicenter prospective study. De Franco, S., Rizzollo, S., Angellotti, P., Guala, A., Stival, G., & Ferrero, F. Minerva Pediatrica, 66(1):1--6, February, 2014. 00003 abstract bibtex AIM: During a nursing conference of the Northeaster Piedmont Neonatal Intensive and Subintensive Neonatal Units the error in pediatrics and neonatology was discussed and a follow-up work was proposed with the aim to understand how many, what type of errors and what kind of adverse event they cause in our clinical practice. METHODS: Through an anonymous "detection sheet" we detected the errors made between March 1 and April 30, 2010 in a NICU and 2 Subintensive therapies. The total number of patients was 166 for 2398 days of hospitalization. RESULTS: The total number of errors was 72, with a error of 0.43/patient. Forty-six patients had experienced at least 1 error (28% of patients) and more than a 16 (10% of our patients). There is a statistically significant correlation between days of hospitalization and the number of errors occurred (r=0.63 Sperman's correlation, P\textless0.01); 48% and 53% of the errors in the NICU and Subintensive CU were related to medication administration. CONCLUSION: The severe damage in the NICU was caused by errors more frequently related to vascular access while the only mistake that led to a serious incident in subintensive CU was determined by a monitoring error. Errors were most frequently attributed to inattention-distraction, less frequently have been attributed to a lack of experience or a state of excessive fatigue. The data of our study were made available to all staff in order to make operators more aware of the importance of working safely.
@article{de_franco_error_2014,
title = {The error in neonatal intensive care: a multicenter prospective study},
volume = {66},
issn = {0026-4946},
shorttitle = {The error in neonatal intensive care},
abstract = {AIM: During a nursing conference of the Northeaster Piedmont Neonatal Intensive and Subintensive Neonatal Units the error in pediatrics and neonatology was discussed and a follow-up work was proposed with the aim to understand how many, what type of errors and what kind of adverse event they cause in our clinical practice.
METHODS: Through an anonymous "detection sheet" we detected the errors made between March 1 and April 30, 2010 in a NICU and 2 Subintensive therapies. The total number of patients was 166 for 2398 days of hospitalization.
RESULTS: The total number of errors was 72, with a error of 0.43/patient. Forty-six patients had experienced at least 1 error (28\% of patients) and more than a 16 (10\% of our patients). There is a statistically significant correlation between days of hospitalization and the number of errors occurred (r=0.63 Sperman's correlation, P{\textless}0.01); 48\% and 53\% of the errors in the NICU and Subintensive CU were related to medication administration.
CONCLUSION: The severe damage in the NICU was caused by errors more frequently related to vascular access while the only mistake that led to a serious incident in subintensive CU was determined by a monitoring error. Errors were most frequently attributed to inattention-distraction, less frequently have been attributed to a lack of experience or a state of excessive fatigue. The data of our study were made available to all staff in order to make operators more aware of the importance of working safely.},
language = {eng},
number = {1},
journal = {Minerva Pediatrica},
author = {De Franco, S. and Rizzollo, S. and Angellotti, P. and Guala, A. and Stival, G. and Ferrero, F.},
month = feb,
year = {2014},
pmid = {24608576},
note = {00003 },
keywords = {Humans, Infant, Newborn, Intensive Care, Neonatal, Medical Errors, Prospective Studies},
pages = {1--6}
}
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METHODS: Through an anonymous \"detection sheet\" we detected the errors made between March 1 and April 30, 2010 in a NICU and 2 Subintensive therapies. The total number of patients was 166 for 2398 days of hospitalization. RESULTS: The total number of errors was 72, with a error of 0.43/patient. Forty-six patients had experienced at least 1 error (28% of patients) and more than a 16 (10% of our patients). There is a statistically significant correlation between days of hospitalization and the number of errors occurred (r=0.63 Sperman's correlation, P\\textless0.01); 48% and 53% of the errors in the NICU and Subintensive CU were related to medication administration. CONCLUSION: The severe damage in the NICU was caused by errors more frequently related to vascular access while the only mistake that led to a serious incident in subintensive CU was determined by a monitoring error. Errors were most frequently attributed to inattention-distraction, less frequently have been attributed to a lack of experience or a state of excessive fatigue. The data of our study were made available to all staff in order to make operators more aware of the importance of working safely.","language":"eng","number":"1","journal":"Minerva Pediatrica","author":[{"propositions":[],"lastnames":["De","Franco"],"firstnames":["S."],"suffixes":[]},{"propositions":[],"lastnames":["Rizzollo"],"firstnames":["S."],"suffixes":[]},{"propositions":[],"lastnames":["Angellotti"],"firstnames":["P."],"suffixes":[]},{"propositions":[],"lastnames":["Guala"],"firstnames":["A."],"suffixes":[]},{"propositions":[],"lastnames":["Stival"],"firstnames":["G."],"suffixes":[]},{"propositions":[],"lastnames":["Ferrero"],"firstnames":["F."],"suffixes":[]}],"month":"February","year":"2014","pmid":"24608576","note":"00003 ","keywords":"Humans, Infant, Newborn, Intensive Care, Neonatal, Medical Errors, Prospective Studies","pages":"1--6","bibtex":"@article{de_franco_error_2014,\n\ttitle = {The error in neonatal intensive care: a multicenter prospective study},\n\tvolume = {66},\n\tissn = {0026-4946},\n\tshorttitle = {The error in neonatal intensive care},\n\tabstract = {AIM: During a nursing conference of the Northeaster Piedmont Neonatal Intensive and Subintensive Neonatal Units the error in pediatrics and neonatology was discussed and a follow-up work was proposed with the aim to understand how many, what type of errors and what kind of adverse event they cause in our clinical practice.\nMETHODS: Through an anonymous \"detection sheet\" we detected the errors made between March 1 and April 30, 2010 in a NICU and 2 Subintensive therapies. The total number of patients was 166 for 2398 days of hospitalization.\nRESULTS: The total number of errors was 72, with a error of 0.43/patient. Forty-six patients had experienced at least 1 error (28\\% of patients) and more than a 16 (10\\% of our patients). There is a statistically significant correlation between days of hospitalization and the number of errors occurred (r=0.63 Sperman's correlation, P{\\textless}0.01); 48\\% and 53\\% of the errors in the NICU and Subintensive CU were related to medication administration.\nCONCLUSION: The severe damage in the NICU was caused by errors more frequently related to vascular access while the only mistake that led to a serious incident in subintensive CU was determined by a monitoring error. Errors were most frequently attributed to inattention-distraction, less frequently have been attributed to a lack of experience or a state of excessive fatigue. 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