The occurrence of adverse events potentially attributable to nursing care in medical units: cross sectional record review.
BACKGROUND
Ensuring the safety of hospitalized patients remains a major challenge for healthcare systems, and nursing services are at the center of hospital care. Yet our knowledge about safety of nursing care is quite limited. In fact, most earlier studies examined one, or at most two, indicators, thus presenting an incomplete picture of safety at an institutional or broader level. Furthermore, methodologies have differed from one study to another, making benchmarking difficult.


OBJECTIVE
The aim of this study was to describe the frequencies of six adverse events widely considered in the literature to be nursing-sensitive outcomes and to estimate the degree to which these events could be attributed to nursing care.


METHODS
Cross-sectional review of charts of 2699 patients hospitalized on 22 medical units in 11 hospitals in Quebec, Canada. The events included: pressure sores, falls, medication administration errors, pneumonias, urinary infections, and inappropriate use of restraints. Experienced nurse reviewers abstracted patients' charts based on a grid developed for the study.


RESULTS
Patient-level risk for at least one of these six adverse events was 15.3%, ranging from 9% to 28% across units. Of the 412 patients who experienced an event, 30% experienced two or more, for a total of 568 events. The risk of experiencing an adverse event with consequences was 6.2%, with a unit-level range from 3.2% to 13.5%. Abstractors concluded that 76.8% of the events were attributable to nursing care.


CONCLUSIONS
While the measurement approach adopted here has limitations stemming from reliance on review of documentation, it provided a practical means of assessing several nursing-sensitive adverse events simultaneously. Given that patient safety issues are so complex, tracking their prevalence and impact is important, as is finding means of evaluating progress in reducing them.
Faculty of Nursing, University of Montreal, Canada. Electronic address: Danielle.damour@umontreal.ca.
Danielle
D
D'Amour
Faculty of Nursing, University of Montreal, Canada.
Carl-Ardy
CA
Dubois
Université du Québec en Outaouais, Canada.
Eric
E
Tchouaket
Susan E. French Chair in Nursing Research, McGill University, Montreal, Canada.
Sean
S
Clarke
Department of Health Administration, Faculty of Medicine, University of Montreal, Canada.
Régis
R
Blais
D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009732:Nursing Care; D061214:Patient Safety; D011787:Quality of Health Care; D011792:Quebec
Adverse events; Falls; Inappropriate use of restraints; Medication administration errors; Nursing-sensitive outcomes; Patient safety; Pneumonia; Pressure sores; Urinary infections