title: A study of cases reported as incidents in a public hospital from 2011 to 2014.
abstract: OBJECTIVE
  Analyzing incidents reported in a public hospital in the Federal District, Brasilia, according to the characteristics and outcomes involving patients.
  
  
  METHODS
  A descriptive and retrospective study of incidents reported between January 2011 and September 2014.
  
  
  RESULTS
  209 reported incidents were categorized as reportable occurrences (n = 22, 10.5%), near misses (n = 16, 7.7%); incident without injury (n = 4, 1.9%) and incident with injury (adverse events) (n = 167, 79.9%). The average age of patients was 44 years and the hospitalization time until the moment of the incident was on average 38.5 days. Nurses were the healthcare professionals who most reported the incidents (n = 55, 67%). No outcomes resulted in death.
  
  
  CONCLUSIONS
  Incidents related to blood/hemoderivatives, medical devices/equipment, patient injuries and intravenous medication/fluids were the most frequent. Standardizing the reporting processes and enhancing participation by professionals in managing incidents is recommended.
  
  
  OBJECTIVE
  Analisar os incidentes notificados em um hospital público do Distrito Federal, segundo as características e os desfechos quando envolveram pacientes.
  Estudo descritivo e retrospectivo dos incidentes notificados entre janeiro de 2011 e setembro de 2014.
  
  
  RESULTS
  Notificados 209 incidentes categorizados em ocorrência comunicável (n = 22, 10,5%), quase evento (n = 16, 7,7%), incidente sem dano (n = 4, 1,9%) e incidente com dano (eventos adversos) (n = 167, 79,9%). A idade média dos pacientes foi de 44 anos e o tempo da internação até o momento do incidente teve média de 38,5 dias. Os enfermeiros foram os que mais notificaram (n = 55, 67%). Nenhum desfecho resultou em morte.
  Os incidentes relacionados a sangue/hemoderivados, dispositivos/equipamento médico, acidentes do doente e medicação/fluidos endovenosos foram os mais frequentes. Recomenda-se padronizar os processos de notificação e potencializar a participação dos profissionais no manejo dos incidentes.
authors.affiliation: Escola Superior de Ciências da Saúde, Programa de Pós-Graduação Stricto Senso, Brasília, DF, Brazil.|Universidade Católica de Brasília, Brasília, DF, Brazil.
authors.forename: Leila Bernarda Donato
authors.initials: LB
authors.lastname: Göttems
authors.affiliation: Universidade Católica de Brasília, Brasília, DF, Brazil.
authors.forename: Maria do Livramento Gomes Dos
authors.initials: MD
authors.lastname: Santos
authors.affiliation: Centro Universitário do Distrito Federal, Brasília, DF, Brazil.
authors.forename: Paloma Aparecida
authors.initials: PA
authors.lastname: Carvalho
authors.affiliation: Escola Superior de Ciências da Saúde, Brasília, DF, Brazil.
authors.forename: Fábio Ferreira
authors.initials: FF
authors.lastname: Amorim
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012308:Risk Management / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult