Boken presenterer en helhetlig strategi for hvordan myndigheter, helsepersonell, industri og forbrukere kan redusere medisinske feil.

/pdf/to-err-is-human-building-a-safer-health-system-1nfl34wxl6.pdf

To Err Is Human Building a Safer Health System

Objective.—To estimate the incidence of serious and fatal adverse drug reactions
(ADR) in hospital patients.Data Sources.—Four electronic databases were searched from 1966 to 1996.Study Selection.—Of 153, we selected 39 prospective studies from US hospitals.Data Extraction.—Data extracted independently by 2 investigators were analyzed by a random-effects
model. To obtain the overall incidence of ADRs in hospitalized patients, we
combined the incidence of ADRs occurring while in the hospital plus the incidence
of ADRs causing admission to hospital. We excluded errors in drug administration,
noncompliance, overdose, drug abuse, therapeutic failures, and possible ADRs.
Serious ADRs were defined as those that required hospitalization, were permanently
disabling, or resulted in death.Data Synthesis.—The overall incidence of serious ADRs was 6.7% (95% confidence interval
[CI], 5.2%-8.2%) and of fatal ADRs was 0.32% (95% CI, 0.23%-0.41%) of hospitalized
patients. We estimated that in 1994 overall 2216000 (1721000-2711000) hospitalized
patients had serious ADRs and 106000 (76000-137000) had fatal ADRs, making
these reactions between the fourth and sixth leading cause of death.Conclusions.—The incidence of serious and fatal ADRs in US hospitals was found to
be extremely high. While our results must be viewed with circumspection because
of heterogeneity among studies and small biases in the samples, these data
nevertheless suggest that ADRs represent an important clinical issue.

/pdf/incidence-of-adverse-drug-reactions-in-hospitalized-patients-9vevgtzyvn.pdf

Incidence of Adverse Drug Reactions in Hospitalized Patients: A Meta-analysis of Prospective Studies

The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P = 0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001). Conclusions Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals.

/pdf/a-surgical-safety-checklist-to-reduce-morbidity-and-pw0mo35zs1.pdf

A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population

Guideline for Prevention of Surgical Site Infection, 1999 ☆ ☆☆ ★ ★★

The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention (CDC)'s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.Part I, “Surgical Site Infection: An Overview,” describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis.

/pdf/guideline-for-prevention-of-surgical-site-infection-1999-2k3en33kqw.pdf

Guideline for Prevention of Surgical Site Infection, 1999

Objective. —To determine the excess length of stay, extra costs, and mortality attributable to adverse drug events (ADEs) in hospitalized patients. Design. —Matched case-control study. Setting. —The LDS Hospital, a tertiary care health care institution. Patients. —All patients admitted to LDS Hospital from January 1, 1990, to December 31,1993, were eligible. Cases were defined as patients with ADEs that occurred during hospitalization; controls were selected according to matching variables in a stepwise fashion. Methods. —Controls were matched to cases on primary discharge diagnosis related group (DRG), age, sex, acuity, and year of admission; varying numbers of controls were matched to each case. Matching was successful for 71% of the cases, leading to 1580 cases and 20197 controls. Main Outcome Measures. —Crude and attributable mortality, crude and attributable length of stay, and cost of hospitalization. Results. —ADEs complicated 2.43 per 100 admissions to the LDS Hospital during the study period. The crude mortality rates for the cases and matched controls were 3.5% and 1.05%, respectively (P Conclusion. —The attributable lengths of stay and costs of hospitalization for ADEs are substantial. An ADE is associated with a significantly prolonged length of stay, increased economic burden, and an almost 2-fold increased risk of death.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=413536&pdfFileName=jama_277_4_031.pdf

Adverse drug events in hospitalized patients : Excess length of stay, extra costs, and attributable mortality.

Background. Randomized, controlled trials have shown that prophylactic antibiotics are effective in preventing surgical-wound infections. However, it is uncertain how the timing of antibiotic administration affects the risk of surgical-wound infection in actual clinical practice. Methods. We prospectively monitored the timing of antibiotic prophylaxis and studied the occurrence of surgical-wound infections in 2847 patients undergoing elective clean or "clean—contaminated" surgical procedures at a large community hospital. The administration of antibiotics 2 to 24 hours before the surgical incision was defined as early; that during the 2 hours before the incision, as preoperative; that during the 3 hours after the incision, as perioperative; and that more than 3 but less than 24 hours after the incision, as postoperative. Results. Of the 1708 patients who received the prophylactic antibiotics preoperatively, 10 (0.6 percent) subsequently had surgical-wound infections. Of the 282 patients who recei...

https://www.nejm.org/doi/pdf/10.1056/NEJM199201303260501

The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection.

Background and Methods Optimal decisions about the use of antibiotics and other antiinfective agents in critically ill patients require access to a large amount of complex information. We have developed a computerized decision-support program linked to computer-based patient records that can assist physicians in the use of antiinfective agents and improve the quality of care. This program presents epidemiologic information, along with detailed recommendations and warnings. The program recommends antiinfective regimens and courses of therapy for particular patients and provides immediate feedback. We prospectively studied the use of the computerized antiinfectives-management program for one year in a 12-bed intensive care unit. Results During the intervention period, all 545 patients admitted were cared for with the aid of the antiinfectives-management program. Measures of processes and outcomes were compared with those for the 1136 patients admitted to the same unit during the two years before the interve...

A Computer-Assisted Management Program for Antibiotics and Other Antiinfective Agents

OBJECTIVE\nTo determine the excess length of stay, extra costs, and mortality attributable to adverse drug events (ADEs) in hospitalized patients.\n\n\nDESIGN\nMatched case-control study.\n\n\nSETTING\nThe LDS Hospital, a tertiary care health care institution.\n\n\nPATIENTS\nAll patients admitted to LDS Hospital from January 1, 1990, to December 31, 1993, were eligible. Cases were defined as patients with ADEs that occurred during hospitalization; controls were selected according to matching variables in a stepwise fashion.\n\n\nMETHODS\nControls were matched to cases on primary discharge diagnosis related group (DRG), age, sex, acuity, and year of admission; varying numbers of controls were matched to each case. Matching was successful for 71% of the cases, leading to 1580 cases and 20,197 controls.\n\n\nMAIN OUTCOME MEASURES\nCrude and attributable mortality, crude and attributable length of stay, and cost of hospitalization.\n\n\nRESULTS\nADEs complicated 2.43 per 100 admissions to the LDS Hospital during the study period. The crude mortality rates for the cases and matched controls were 3.5% and 1.05%, respectively (P<.001). The mean length of hospital stay significantly differed between the cases and matched controls (7.69 vs 4.46 days; P<.001) as did the mean cost of hospitalization ($10,010 vs $5355; P<.001). The extra length of hospital stay attributable to an ADE was 1.74 days (P<.001). The excess cost of hospitalization attributable to an ADE was $2013 (P<.001). A linear regression analysis for length of stay and cost controlling for all matching variables revealed that the occurrence of an ADE was associated with increased length of stay of 1.91 days and an increased cost of $2262 (P<.001). In a similar logistic regression analysis for mortality, the increased risk of death among patients experiencing an ADE was 1.88 (95% confidence interval, 1.54-2.22; P<.001).\n\n\nCONCLUSION\nThe attributable lengths of stay and costs of hospitalization for ADEs are substantial. An ADE is associated with a significantly prolonged length of stay, increased economic burden, and an almost 2-fold increased risk of death.

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Papers

Adverse drug events in hospitalized patients : Excess length of stay, extra costs, and attributable mortality.

The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection.

A Computer-Assisted Management Program for Antibiotics and Other Antiinfective Agents

Adverse Drug Events in Hospitalized Patients: Excess Length of Stay, Extra Costs, and Attributable Mortality

The Timing of Prophylactic Administration of Antibiotics and the Risk of Surgical-Wound Infection