Patient safety in South Africa: PICU adverse event registration*.
OBJECTIVE
Adverse event registration is a means to improve patient safety in a PICU. So far it has been used in European and North American countries mainly. We studied adverse events in a South African setting with the aims to 1) assess rates and types of adverse events with two different registration methods and 2) describe characteristics of patients experiencing adverse events.


METHODS
This study consisted of 1) a retrospective audit of randomly selected patient records and 2) a prospective observational study of real-time registration of AEs during ward rounds. Adverse events were identified using the Child Health Corporation of America - Pediatric Pharmacy Advocacy Group PICU trigger tool.


METHODS
A multidisciplinary 20 bed PICU at the Red Cross War Memorial Children's Hospital in Cape Town.


METHODS
The retrospective section of the study involved 80 randomly selected patients who had been discharged from the PICU, and the prospective study involved patients who were present in the PICU between March and June 2012.


METHODS
None.


RESULTS
The retrospective audit identified 260 adverse events in 61 patients (50.8 per 100 patient days). Nineteen patients (24%) did not have any adverse events. Catheter complications, hypoglycemia, and endotracheal tube malpositioning requiring repositioning were most frequent. Prospective registration during 58 ward rounds revealed 272 adverse events in 236 patients (27.2 per 100 patient days), particularly catheter complications, nosocomial infection, and surgical complications. Hundred thirty-two patients of the total 236 patients (56%) did not experience an adverse event. Patients experiencing adverse events underwent mechanical ventilation significantly more frequently. Length of stay was significantly associated with number of adverse events.


CONCLUSIONS
The trigger tool method identifies a higher adverse event rate compared with real-time registration. Each method has a unique contribution to yield types of adverse events.
1Department of Pediatric Intensive Care, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands. 2Department of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 3Department of Pediatrics, Subdivision of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 4Department of Pediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa. 5Department of Pediatric Intensive Care, Red Cross War Memorial Children's Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
Jentien M
JM
Vermeulen
Monique
M
van Dijk
Cynthia
C
van der Starre
Roelie M
RM
Wösten-van Asperen
Andrew Charles
AC
Argent
D057785:Catheters / Q000009:adverse effects; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000592:standards* / Q000706:statistics & numerical data*; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D061214:Patient Safety / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012042:Registries; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology