Iatrogenic occurrences at the intensive care unit: impact on the patients' severity and on the nursing workload
© BioMed Central Ltd. 2004
Published: 15 March 2004
This descriptive exploratory study had the objectives to characterize the iatrogenic occurrences and to evaluate its impact on clinical conditions of the patients and on the nursing workload at the intensive care unit (ICU). Data were prospectively collected during a 3-month period, in two general ICUs of a hospital in the city of São Paulo, using a file card to record the occurrences. Patient's severity and nursing workload were evaluated, respectively, by means of the Simplified Acute Physiology Score (SAPS II) and the Therapeutic Intervention Scoring System-28 (TISS-28). The population of the study consisted of 212 patients, of which 47 (22.0%) were victims of 80 iatrogenic occurrences during their stay at the ICU. Among the victim patients, 57% suffered one occurrence, 28.0% two occurrences and 15.0% three or four occurrences. Regarding the type of event, 27.0% were related to pressure ulcer, followed by 24.0% and 20.0%, respectively, regarding handling of the orotracheal cannula and two blood catheters. The others, occurred during administration of medicaments (13.0%), care with probes (10.0%) drains (5.0%) and handling of equipment (1.0%). Occurrences related to substructure were not found. Regarding the impact of occurrences on the patient's severity and on the nursing workload, no statistically significant difference was found in the mean between the SAPS II and TISS-28 scores of victim and nonvictim patients of occurrences, during admission to the ICU. When comparing severity and nursing workload in victim patients, before and after the event, a difference was observed only in the mean scores of the TISS-28 (P < 0.001). Regarding this analysis with the different types of occurrences, a statistically significant difference was found both in the SAPS II (P < 0.042) and TISS-28 (P < 0.001) scores in the occurrences regarding handling of the orotracheal cannula. The results of this investigation reinforce the need for investments to help qualify professionals to work with the critical patients as a major measurement for safety nursing assistance and quality in the ICU.