Adverse events (AEs) seriously affect patient safety and quality of care, and remain a pressing global issue. This study had three objectives: (1) to describe the proportions of patients affected by in-hospital AEs; (2) to explore the types and consequences of observed AEs; and (3) to estimate the preventability of in-hospital AEs. We applied a scoping review method and concluded a comprehensive literature search in PubMed and CINAHL in May 2017 and in February 2018. Our target was retrospective medical record review studies applying the Harvard method–or similar methods using screening criteria–conducted in acute care hospital settings on adult patients (≥18 years). We included a total of 25 studies conducted in 27 countries across six continents. Overall, a median of 10% patients were affected by at least one AE (range: 2.9–21.9%), with a median of 7.3% (range: 0.6–30%) of AEs being fatal. Between 34.3 and 83% of AEs were considered preventable (median: 51.2%). The three most common types of AEs reported in the included studies were operative/surgical related, medication or drug/fluid related, and healthcare-associated infections. Evidence regarding the occurrence of AEs confirms earlier estimates that a tenth of inpatient stays include adverse events, half of which are preventable. However, the incidence of in-hospital AEs varied considerably across studies, indicating methodological and contextual variations regarding this type of retrospective chart review across health care systems. For the future, automated methods for identifying AE using electronic health records have the potential to overcome various methodological issues and biases related to retrospective medical record review studies and to provide accurate data on their occurrence.

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The occurrence, types, consequences and preventability of in-hospital adverse events – a scoping review

Background The aim of this systematic review is to quantify potentially preventable patient harm from the frequency, severity, and preventability of the consequences and causes of surgical adverse events to help target patient safety improvement efforts. Data Sources Two authors independently reviewed articles retrieved from systematic searches of the Cochrane library, MEDLINE, Embase, PsycINFO, and Cumulative Index to Nursing & Allied Health Literature databases for inclusion and exclusion criteria, methodology, and end points. All retrospective record review studies of adverse events were included. The primary end point was the frequency of general surgery adverse events. The secondary end points were the severity and preventability of consequences and causes. Conclusions Fourteen record review studies incorporating 16,424 surgical patients were included. Adverse events occurred in 14.4% of patients (interquartile range [IQR], 12.5% to 20.1%), and potentially preventable adverse events occurred in 5.2% (IQR, 4.2% to 7.0%). The consequences of 3.6% of adverse events (IQR, 3.1% to 4.4%) were fatal, those of 10.4% (IQR, 8.5% to 12.3%) were severe, those of 34.2% (IQR, 29.2% to 39.2%) were moderate, and those of 52.5% (IQR, 49.8% to 55.3%) were minor. Errors in nonoperative management caused more frequent adverse events than errors in surgical technique.

http://lib.ajaums.ac.ir/booklist/1-s2.0-s000296101300175x-main.pdf

Surgical adverse events: a systematic review

Objective: To analyze the features of preventable adverse events (AEs) in hospitals inpatient
in the State of Rio de Janeiro, in Brazil, in order to identify elements that serve as a substrate
for priority actions aimed at improving patient safety.
Methods: Analysis of data from a baseline retrospective cohort study to assess the incidence
of AEs in a sample of records in three teaching hospitals in the State of Rio de Janeiro to
describe the features of preventable AEs.
Results: In a sample of 1,103 patients, were identified 65 preventable AEs of 56 patients who
suffered preventable AEs. The healthcare associated infections (HAI) accounted for 24.6% of
preventable AEs; surgical complications and/or anesthetic, 20.0%; damages arising from
delay or failure in diagnosis and/or treatment, 18.4%, pressure ulcers, 18.4%; damage
from complications of venipuncture, 7.7%; damage due to falls, 6.2%; damage as a result
of the use of drugs, 4.6%. The preventable AEs were responsible for additional 373 days of
hospital stay.
Conclusion: The HAI is the major preventable AEs, as observed in other developing countries.
Despite the limitations of the study, the characterization of preventable AEs indicates
that known and effective actions available to reduce HAI, such as hand hygiene, to prevent
pressure ulcers, to encourage adherence to protocol and clinical guidelines and to create
continuing education programs for health professionals, should compose the list of priorities
of hospital managers and health professionals involved in the care of hospitalized
patients.

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Características de eventos adversos evitáveis em hospitais do Rio de Janeiro

Medication errors and adverse drug events are universal problems contributing to patient harm but the magnitude of these problems in Africa remains unclear. The objective of this study was to systematically investigate the literature on the extent of medication errors and adverse drug events, and the factors contributing to medication errors in African hospitals. We searched PubMed, MEDLINE, EMBASE, Web of Science and Global Health databases from inception to 31 August, 2017 and hand searched the reference lists of included studies. Original research studies of any design published in English that investigated adverse drug events and/or medication errors in any patient population in the hospital setting in Africa were included. Descriptive statistics including median and interquartile range were presented. Fifty-one studies were included; of these, 33 focused on medication errors, 15 on adverse drug events, and three studies focused on medication errors and adverse drug events. These studies were conducted in nine (of the 54) African countries. In any patient population, the median (interquartile range) percentage of patients reported to have experienced any suspected adverse drug event at hospital admission was 8.4% (4.5–20.1%), while adverse drug events causing admission were reported in 2.8% (0.7–6.4%) of patients but it was reported that a median of 43.5% (20.0–47.0%) of the adverse drug events were deemed preventable. Similarly, the median mortality rate attributed to adverse drug events was reported to be 0.1% (interquartile range 0.0–0.3%). The most commonly reported types of medication errors were prescribing errors, occurring in a median of 57.4% (interquartile range 22.8–72.8%) of all prescriptions and a median of 15.5% (interquartile range 7.5–50.6%) of the prescriptions evaluated had dosing problems. Major contributing factors for medication errors reported in these studies were individual practitioner factors (e.g. fatigue and inadequate knowledge/training) and environmental factors, such as workplace distraction and high workload. Medication errors in the African healthcare setting are relatively common, and the impact of adverse drug events is substantial but many are preventable. This review supports the design and implementation of preventative strategies targeting the most likely contributing factors.

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Adverse Drug Events and Medication Errors in African Hospitals: A Systematic Review.

Objectives

This study aimed to examine the performance of the Global Trigger Tool and to investigate characteristics associated with the occurrence of adverse events (AEs).



Study design

Retrospective medical record review.



Setting

A tertiary teaching hospital, Korea.



Method

We employed two-stage review of a random sample of 630 charts for patients discharged between January and June 2011. Two quality improvement specialists reviewed the presence of AEs using 53 triggers developed by the Institute for Healthcare Improvement. Two physicians reviewed and validated the findings of adverse events. Positive predictive values for individual triggers were calculated. Logistic regression analysis was performed to determine factors associated with AEs.



Results

Of 629 patients, 45 (7%) experienced at least one AE during their hospitalization. Among the observed AEs, 61% were preventable. The frequent types of AEs were ‘procedure-related’ and ‘medication-related’. Six triggers had positive predictive values of greater than 50.0%: ‘health care-associated infection’, ‘any procedure complication’, ‘medication: other’, ‘return to surgery’, ‘occurrence of any operative complication’ and ‘intubation/reintubation’. Significant factors associated with the occurrence of AEs were length of stay (OR 1.13; 95% CI 1.07 to 1.20) and the number of triggers (OR 1.49; 95% CI 1.11 to 1.98).



Conclusion

The Global Trigger Tool was useful for the detection of adverse events in a Korean hospital setting. Triggers with high positive predictive values should have priority for incorporation into routine screening systems. Furthermore, patients who stay longer in the hospital need to be closely monitored using triggers to improve patient safety.

Characteristics associated with the occurrence of adverse events: a retrospective medical record review using the Global Trigger Tool in a fully digitalized tertiary teaching hospital in Korea.

Background. Despite the worldwide growing attention to patient safety, Tunisia has no data on the magnitude and consequences of hospital adverse events (AEs).

Riham El-Asady

Papers

Adverse events in a Tunisian hospital: results of a retrospective cohort study