Objective: To determine the incidence and incidence density of adverse events (AEs) in Spanish hospitals (including the pre-hospitalisation period). Method: Retrospective cohort study. Results: The incidence of patients with AEs relating directly to hospital care was 8.4% (95% CI 7.7% to 9.1%) and rose 9.3% (95% CI 8.6% to 10.1%), including those from the pre-hospitalisation period. The incidence density was 1.2 AEs per 100 patient-days (95% CI 1.1 to 1.3). The incidence of moderate and serious AEs was 5.6 AEs per 1000 patient-days (95% CI 4.9% to 6.3%). In 66.3% of AEs, additional procedures were required and in 69.9% additional treatments were required. In total 42.8% of AEs were considered as avoidable. Of the subjects with some intrinsic risk factors, 13.2% developed AEs compared with 5.2% of the subjects who had no risk factors (p Conclusions: The incidence of patients with AE related to medical assistance in Spanish hospitals was relevant and similar to those found in the studies from Canada and New Zealand that had been conducted with comparable methodology. Patient vulnerability has been identified therein as playing a major role in generating healthcare-related AEs. These and other recent results indicate the need for AEs to be considered a public health priority in Europe.

https://jech.bmj.com/content/jech/62/12/1022.full.pdf?62%2F12%2F1022=

Incidence of adverse events related to health care in Spain: results of the Spanish National Study of Adverse Events

Objective. To determine the impact and preventability of adverse events (AEs) associated with health care in Spanish hospitals. Design. Retrospective cohort study. Setting. Twenty-four Spanish hospitals. Participants. Patients of any age with a clinical record indicating an inpatient stay of .24 h and a discharge between 4 and 10 June 2005 (n ¼ 5908). Intervention. None. Main Outcome Measures. Percentage of AEs considered preventable. Results. We were able to identify 525 patients suffering AEs associated directly with medical care, who accumulated 655 AEs with 43% of these AEs considered preventable. Overall, 45% (295 AEs) were considered minor, 39% (255 AEs) moderate and 16% (105 AEs) severe. There were no significant differences in AE severity by hospital size, but AEs associated with surgical services were more likely to be severe than those associated with medical services. Some 31.4% of AEs resulted in a longer stay and 23.4% led to hospital admission. AEs associated with medical care caused 6.1 additional days per patient. Of the patients, 66.3% required additional procedures and 69.9% required additional treatments. Incidence of death in patients with AEs was 4.4% (CI 95%: 2.8 – 6.5). Age over 65 was associated with a higher incidence of preventable AEs. The highest percentages of preventable AEs were related to diagnosis (84.2%), to nosocomial infections (56.6%) and to care (56%). Conclusions. In Spanish hospitals, AEs associated with health care cause distress, disability, death, lengthen hospital stay and cause increased consumption of health-care resources. A relatively high percentage of AEs in Spain may be preventable with improvements in medical care.

/pdf/impact-and-preventability-of-adverse-events-in-spanish-2xsgrtmt8u.pdf

Impact and preventability of adverse events in Spanish public hospitals: results of the Spanish National Study of Adverse Events (ENEAS).

– Healthcare risk epidemiology identifies medication error as the commonest cause of adverse effects on patients. Medication error can occur at any phase of the complex medication process so prevalence rates need to be estimated at each drug treatment phase: prescription, transcription and administration along with their clinical repercussions. This paper aims to investigate this issue., – Medication errors were recorded on an ad hoc sheet and staff were observed handling medications. Recorded errors were later classified and their clinical repercussions determined by experts., – In total 757 inpatients and 5,466 drug prescriptions were studied. The prescription error rate was 4.79 percent (95 percent CI 4.21‐5.36). The most frequent error in this phase was failing to observe international prescribing standards. The highest error rate was found in transcription (14.61 percent, 95 percent CI 13.67‐15.54). Almost 1,900 dose administrations were observed. There was a 9.32 percent error rate (95 percent CI 7.98‐10.67). The commonest error in this phase was omission. Most were transcription errors, which were detected before harm was done., – The dispensation phase is absent., – Errors can be reduced if they are understood. Education and training based on the study's findings can reduce medication errors., – The paper highlights ways to reduce errors in the medication process.

Medication error prevalence.

Diseases of medical progress.

FUNDAMENTO Y OBJETIVO: La percepcion de seguridad clinica que poseen los pacientes ha sido poco estudiada. En este estudio se describe la frecuencia de errores clinicos desde el punto de vista del paciente, su percepcion de seguridad y su relacion con la informacion recibida. MATERIAL Y METODOS: Estudio descriptivo basado en una encuesta postal tras 20 dias del alta a 336 pacientes quirurgicos (tasa corregida de respuesta del 75,58%, error del 5,7% para un nivel de confianza del 95%). RESULTADOS: Un 13,05% (intervalo de confianza [IC] del 95%, 9,16- 16,95%) informaron sufrir un error clinico. Un 10,5% con complicaciones graves. Esta experiencia disminuye la percepcion de seguridad en tratamientos futuros (2 1,2 = 30,84; p = 0,0001). Un 11,9% (IC del 95%, 7,2-16,6%) consideraron que el riesgo de ser victima de un error medico con consecuencias graves es alto, aunque menor al de sufrir un accidente de trafico, robo/atraco o presentar una enfermedad grave. Ver noticias en los medios sobre errores disminuye la percepcion de seguridad (p < 0,001). Los pacientes que valoran positivamente la informacion recibida sobre tratamiento y que pueden formular preguntas al medico son quienes menos errores informan (p < 0,001). CONCLUSIONES: Un 1,37% de pacientes quirurgicos informan de errores con consecuencias graves, mientras que 12 de cada 100 creen que el riesgo de un error con consecuencias graves es elevado. Tras un error se incrementa la desconfianza. Mejorar la comunicacion con el paciente contribuye a reducir errores, lo que refuerza el papel de los programas para incrementar la seguridad que fomentan un papel mas activo en el paciente

Eva Elisa Álvarez

Papers

La asistencia sanitaria como factor de riesgo: los efectos adversos ligados a la práctica clínica