Homicidios intencionales en la salud. Un tema huérfano de la seguridad asistencial <span class="so-article-trans-title" dir="auto"> Translated title: Intentional homicides in health. An ignored topic in healthcare security </span> <span class="so-article-trans-title" dir="auto"> Translated title: Homicídios dolosos em saúde. Uma questão órfã de segurança de saúde </span>

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Abstract

Resumen: Los homicidios intencionales cometidos por los trabajadores sanitarios durante el desempeño de sus tareas son eventos muy poco frecuentes. Su importancia reside en que a través de su análisis se exponen las debilidades estructurales y funcionales de los sistemas de salud. Sus efectos nocivos no se limitan a las víctimas y sus familias, sino que resulta dañada la confiabilidad del sistema sanitario en su conjunto. El presente artículo resume las características de estos ataques, haciendo énfasis en las estrategias de la seguridad asistencial que pueden interceptar a los ofensores.

Translated abstract

Abstract: Intentional homicides committed by health workers in the course of their duties are very rare events. Its importance resides in the fact that the structural and functional weaknesses of health systems are exposed through its analysis. Moreover, their harmful effects are not limited to the victims and their families, since the reliability of the health system as a whole is damaged. This article summarizes the characteristics of these attacks, emphasizing the strategies of healthcare security that can intercept offenders.

Translated abstract

Resumo: Homicídios dolosos cometidos por profissionais de saúde no exercício de suas funções são eventos muito raros. A sua importância reside no fato de, através da sua análise, expor as fragilidades estruturais e funcionais dos sistemas de saúde. Seus efeitos nocivos não se limitam às vítimas e suas famílias, e faz com que a confiabilidade no sistema de saúde como um todo fique prejudicada. Este artigo resume as características desses ataques, enfatizando as estratégias de segurança da saúde que podem interceptar os infratores.

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Most cited references 22

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The preliminary development and testing of a global trigger tool to detect error and patient harm in primary-care records.

P Bowie, Pablo H. C. G. de Sá (2009)

A multi-method strategy has been proposed to understand and improve the safety of primary care. The trigger tool is a relatively new method that has shown promise in American and secondary healthcare settings. It involves the focused review of a random sample of patient records using a series of "triggers" that alert reviewers to potential errors and previously undetected adverse events. To develop and test a global trigger tool to detect errors and adverse events in primary-care records. Trigger tool development was informed by previous research and content validated by expert opinion. The tool was applied by trained reviewers who worked in pairs to conduct focused audits of 100 randomly selected electronic patient records in each of five urban general practices in central Scotland. Review of 500 records revealed 2251 consultations and 730 triggers. An adverse event was found in 47 records (9.4%), indicating that harm occurred at a rate of one event per 48 consultations. Of these, 27 were judged to be preventable (42%). A further 17 records (3.4%) contained evidence of a potential adverse event. Harm severity was low to moderate for most patients (82.9%). Error and harm rates were higher in those aged > or =60 years, and most were medication-related (59%). The trigger tool was successful in identifying undetected patient harm in primary-care records and may be the most reliable method for achieving this. However, the feasibility of its routine application is open to question. The tool may have greater utility as a research rather than an audit technique. Further testing in larger, representative study samples is required.

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Organizational silence and hidden threats to patient safety.

Kerm Henriksen, E T Dayton (2006)

Organizational silence refers to a collective-level phenomenon of saying or doing very little in response to significant problems that face an organization. The paper focuses on some of the less obvious factors contributing to organizational silence that can serve as threats to patient safety. Converging areas of research from the cognitive, social, and organizational sciences and the study of sociotechnical systems help to identify some of the underlying factors that serve to shape and sustain organizational silence. These factors have been organized under three levels of analysis: (1) individual factors, including the availability heuristic, self-serving bias, and the status quo trap; (2) social factors, including conformity, diffusion of responsibility, and microclimates of distrust; and (3) organizational factors, including unchallenged beliefs, the good provider fallacy, and neglect of the interdependencies. Finally, a new role for health care leaders and managers is envisioned. It is one that places high value on understanding system complexity and does not take comfort in organizational silence.

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Serial murder by healthcare professionals.

Beatrice Yorker, Kenneth W. Kizer, Paula Lampe … (2006)

The prosecution of Charles Cullen, a nurse who killed at least 40 patients over a 16-year period, highlights the need to better understand the phenomenon of serial murder by healthcare professionals. The authors conducted a LexisNexis search which yielded 90 criminal prosecutions of healthcare providers that met inclusion criteria for serial murder of patients. In addition we reviewed epidemiologic studies, toxicology evidence, and court transcripts, to provide data on healthcare professionals who have been prosecuted between 1970 and 2006. Fifty-four of the 90 have been convicted; 45 for serial murder, four for attempted murder, and five pled guilty to lesser charges. Twenty-four more have been indicted and are either awaiting trial or the outcome has not been published. The other 12 prosecutions had a variety of legal outcomes. Injection was the main method used by healthcare killers followed by suffocation, poisoning, and tampering with equipment. Prosecutions were reported from 20 countries with 40% taking place in the United States. Nursing personnel comprised 86% of the healthcare providers prosecuted; physicians 12%, and 2% were allied health professionals. The number of patient deaths that resulted in a murder conviction is 317 and the number of suspicious patient deaths attributed to the 54 convicted caregivers is 2113. These numbers are disturbing and demand that systemic changes in tracking adverse patient incidents associated with presence of a specific healthcare provider be implemented. Hiring practices must shift away from preventing wrongful discharge or denial of employment lawsuits to protecting patients from employees who kill.

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Author and article information

Journal

Journal ID (publisher-id): rmu

Title: Revista Médica del Uruguay

Abbreviated Title: Rev. Méd. Urug.

Publisher: Sindicato Médico del Uruguay (Montevideo, , Uruguay )

ISSN (Print): 0303-3295

ISSN (Electronic): 1688-0390

Publication date (Print and electronic): September 2021

Volume: 37

Issue: 3

Electronic Location Identifier: e501

Affiliations

[2] Montevideo orgnameHospital Maciel Uruguay

[1] Montevideo orgnameServicio Médico Integral Uruguay carlosvivasespen@ 123456gmail.com

Article

Publisher ID: S1688-03902021000301501 Publisher ID: S1688-0390(21)03700301501

DOI: 10.29193/rmu.37.3.9

SO-VID: 71aad861-1edb-4169-89b7-0c1ac383cb0c

License:

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

History

Date received : 18 November 2020

Date accepted : 24 March 2021

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Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 0

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Homicidios intencionales en la salud. Un tema huérfano de la seguridad asistencial Translated title: Intentional homicides in health. An ignored topic in healthcare security Translated title: Homicídios dolosos em saúde. Uma questão órfã de segurança de saúde

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Most cited references 22

The preliminary development and testing of a global trigger tool to detect error and patient harm in primary-care records.

Organizational silence and hidden threats to patient safety.

Serial murder by healthcare professionals.

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