Overview of medical errors and adverse events

Garrouste-Orgeas, Maité; Philippart, François; Bruel, Cédric; Max, Adeline; Lau, Nicolas; Misset, B

doi:10.1186/2110-5820-2-2

Annals of Intensive Care

Table 1 List of safety indicators

From: Overview of medical errors and adverse events

Process indicators
Mechanical ventilation
Semi-recumbent position during mechanical ventilation [72, 73]
Overinflation of the endotracheal balloon [14]
Sedation
Appropriate sedation [72, 74]
Screening for ventilator weaning readiness [73]
Sedation interruption [73]
Sedation monitoring [73]
Medication
Medication administered to wrong patient [14]
Error administering anticoagulant medication [14]
Error prescribing anticoagulant medication [14]
Error administering vasoactive drugs [14]
Error administering insulin [14]
Death or serious disability associated with hypoglycaemia [75]
IV lines
Screening for readiness for removal of central venous catheter [72]
Management
Appropriate use of prophylaxis against gastrointestinal haemorrhage in patients receiving mechanical ventilation [72, 73]
Appropriate use of thromboembolism prophylaxis [72, 73]
Appropriate use of early enteral nutrition [72]
Early management of severe sepsis, septic shock [72]
Surgical intervention in traumatic brain injury with subdural and/or epidural brain trauma [72]
Monitoring of intracranial pressure in severe traumatic brain injury with abnormal CT findings [72]
Delay in surgical treatment [14]
Change of route for quinolones IV/PO [72]
Screening for MRSA on admission [76]
Pain management in un sedated patients [72]
Events during ICU transport [73]
Complications
Pneumonia associated with mechanical ventilation [72]
Accidental extubation [23, 73, 76]
Accidental removal of a central venous catheter
Catheter-related bloodstream infections [76] Pneumothorax related to insertion of a central venous catheter [40, 76]
Death or serious disability associated with intravascular air embolism [75]
Fall [14]
Death or serious disability associated with a haemolytic reaction due to the administration of ABO-incompatible blood or blood product [75]
Percentage of resistant organisms [74]
Pressure sores [73]
Outcome indicators
ICU mortality rate [74]
Hospital mortality rate [73]
Percentage of ICU patients with ICU stays longer than 7 days [74]
Mean ICU length of stay [74]
Mean days on mechanical ventilation [74]
Rate of re-admissions < 72 hours [73]
Family satisfaction [73]
Structural indicators
Institutional variables
Process for ensuring staff competencies
Transitional period to integrate new healthcare workers
Clear task identification
Absenteeism, magnitude of personnel turn-over
Adverse-event reporting system
Task variables
Availability of protocols
Policy to prevent medication errors
Policy to register outcomes
Team variables
Adequacy of staffing
Nurse-to-patient ratio
Availability of an intensive care practitioner 24 h a day
Pharmacist present during ICU rounds [77])
Communication or conflicts among team members [78]

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