Complications of care in a neonatal–paediatric intensive care: first results of a prospective observational survey

Background

Adverse events can increase the mortality or morbidity of patients hospitalized in ICUs. Their frequency in paediatric or neonatal ICUs is between 8% and 45%. A survey of these complications is an indicator to improve quality of care.

Objectives

To evaluate by a prospective observational survey over a 1-year period the frequency of iatrogenic complications in a multidisciplinary paediatric and neonatal intensive care unit; to examine their type, severity, associate factors that favour their occurrence, and the role of medical staff and parents in precipitation or detection of iatrogenic complications.

Patients

All consecutive admissions of patients over a 1-year period from October 2004 to October 2005 in a paediatric and neonatal intensive care unit.

Preliminary results

After 1 month, 71 children were admitted, 53% in neonatal and 47% in paediatric ICUs. Seventy-five per cent of all admissions were for medical reasons, 20% after surgery and 5% following trauma. There were 42 iatrogenic complications in 31 patients (44% of admissions). Peripheral venous catheter complications represented the major adverse event (50%) with 81% of diffusion followed by skin oedema; respiratory events involved 24% of complications and included accidental extubations (69%) and laryngeal dyspnea (16%); bedsore were found in 18% of adverse events; 7% of them are secondary to the arterial or central venous catheter. Forty-six per cent were major, 7% were moderate and 47% were minor. No death was directly due to complications. Human error was implicated in 46% of cases; 46% of iatrogenic complications did not have any explanation. They were related mostly to insufficient surveillance. Precipitating staff members were nurses in 73% of times, especially for minor events. They detected the majority of the complications (81%).

Conclusion

As in adult ICUs, iatrogenic complications are frequent in paediatric and neonatal ICUs. Knowledge of adverse events frequency is a precious source for quality improvement.