title: Iatrogenic events in neonates: beneficial effects of prevention strategies and continuous monitoring.
abstract: OBJECTIVE
  To assess the impact of continuous incident reporting and subsequent prevention strategies on the incidence of severe iatrogenic events and targeted priorities in admitted neonates.
  
  
  METHODS
  We performed preintervention (January 1 to September 1, 2005) and postintervention (January 1, 2008, to January 1, 2009) prospective investigations based on continuous incident reporting. Patient-safety initiatives were implemented for a period of 2 years. The main outcome was a reduction in the incidence of severe iatrogenic events. Secondary outcomes were improvements in 5 targeted priorities: catheter-related infections; invasive procedures; unplanned extubations; 10-fold drug infusion-rate errors; and severe cutaneous injuries.
  
  
  RESULTS
  The first and second study periods included totals of 388 and 645 patients (median gestational ages: 34 and 35 weeks, respectively; P = .015). In the second period the incidence of severe iatrogenic events was significantly reduced from 7.6 to 4.8 per 1000 patient-days (P = .005). Infections related to central catheters decreased significantly from 13.9 to 8.2 per 1000 catheter-days (P < .0001), as did exposure to central catheters, which decreased from 359 to 239 days per 1000 patient-days (P < .0001). Tenfold drug-dosing errors were reduced significantly (P = .022). However, the number of unplanned extubations increased significantly from 5.6 to 15.5 per 1000 ventilation-days (P = .03).
  
  
  CONCLUSIONS
  Prospective, continuous incident reporting followed by the implementation of prevention strategies are complementary procedures that constitute an effective system to improve the quality of care and patient safety.
authors.affiliation: Division of Neonatology, La Conception Hospital, AP-HM, 147 Boulevard Baille, 13385 Marseille, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ligi
authors.forename: Véronique
authors.initials: V
authors.lastname: Millet
authors.forename: Catherine
authors.initials: C
authors.lastname: Sartor
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Jouve
authors.forename: Sophie
authors.initials: S
authors.lastname: Tardieu
authors.forename: Roland
authors.initials: R
authors.lastname: Sambuc
authors.forename: Umberto
authors.initials: U
authors.lastname: Simeoni
mesh_terms: D005260:Female; D005602:France / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology / Q000517:prevention & control*; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D008991:Monitoring, Physiologic / Q000379:methods*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012308:Risk Management / Q000379:methods*