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      Evento adverso no idoso em Unidade de Terapia Intensiva Translated title: Adverse event in elderly patients in Intensive Care Unit Translated title: Evento adverso en personas de edad avanzada en Unidad de Terapia Intensiva

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          Abstract

          Objetiva identificar a produção científica, na América Latina, sobre segurança do idoso na UTI e os eventos adversos trazidos pela literatura. Revisão sistemática quantitativa. A coleta, feita no banco de dados do LILACS e SCIELO, considerou descritores indexados e respeitou critérios de inclusão e exclusão. Foram selecionados vinte trabalhos para análise. Em sua maioria, esses trabalhos foram realizados após o ano de 2000, no Brasil, por profissionais enfermeiros e médicos, tratando principalmente de erros com medicação, retiradas acidentais de sondas e cateteres, infecção nosocomial, erro na técnica de procedimento e ocorrência de úlceras por pressão. A produção cientifica sobre a temática ainda é recente na América Latina, sendo preciso atentar para a população idosa nessas unidades, voltando-se para possíveis riscos a que estão expostos.

          Translated abstract

          This study aims to identify the scientific production in Latin America about the safety of aged people in the ICU and adverse events dealt in the literature. It is a systematic revision, with indexed key words. The inclusion and exclusion criteria were respected. Twenty papers were selected for analysis. Most of them were carried out after the year 2000, in Brazil, by professional nurses and physicians, dealing mostly with adverse events connected to mistakes with medicines, accidental remove of probes and catheters, nosocomial infections, errors in the procedure techniques and occurrence of pressure sores. In the selected papers there were no mentions to adverse events related to behavior changes. The scientific production about the theme is still recent in Latin America, tending to increase. Its necessary to increase the focus to the aged population in these units, taking into account the possible risk to which they are exposed.

          Translated abstract

          El estudio objetiva identificar la producción científica en Latinoamérica sobre la seguridad de las personas mayores en la UTI y los tipos de eventos adversos relatados en la literatura. Trata-se de una revisión sistemática cuantitativa. La colección de datos fue hecha en el banco de datos del LILACS y en la Biblioteca SCIELO, considerándose los países de Latinoamérica a partir de descriptores indexados y respectó criterios de inclusión y exclusión. Fueron seleccionados 20 trabajos para análisis. La mayoría de estos fue realizada después del año 2000, en Brasil, en el Estado de São Paulo, por profesionales enfermeros y médicos, en tratamiento principalmente de eventos adversos conectados a errores con medicación, remoción accidental de sondas y catéteres, infecciones nosocomiales, error en la técnica de procedimiento y de ocurrencia de úlceras de presión. La producción científica sobre la temática és aún reciente en Latinoamérica, tendiendo a aumento. Es necesario ampliar el la mirada para la populación de personas mayores en esas unidades, considerando los posibles riesgos a los que están expuestos.

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          Most cited references33

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          Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I.

          As part of an interdisciplinary study of medical injury and malpractice litigation, we estimated the incidence of adverse events, defined as injuries caused by medical management, and of the subgroup of such injuries that resulted from negligent or substandard care. We reviewed 30,121 randomly selected records from 51 randomly selected acute care, nonpsychiatric hospitals in New York State in 1984. We then developed population estimates of injuries and computed rates according to the age and sex of the patients as well as the specialties of the physicians. Adverse events occurred in 3.7 percent of the hospitalizations (95 percent confidence interval, 3.2 to 4.2), and 27.6 percent of the adverse events were due to negligence (95 percent confidence interval, 22.5 to 32.6). Although 70.5 percent of the adverse events gave rise to disability lasting less than six months, 2.6 percent caused permanently disabling injuries and 13.6 percent led to death. The percentage of adverse events attributable to negligence increased in the categories of more severe injuries (Wald test chi 2 = 21.04, P less than 0.0001). Using weighted totals, we estimated that among the 2,671,863 patients discharged from New York hospitals in 1984 there were 98,609 adverse events and 27,179 adverse events involving negligence. Rates of adverse events rose with age (P less than 0.0001). The percentage of adverse events due to negligence was markedly higher among the elderly (P less than 0.01). There were significant differences in rates of adverse events among categories of clinical specialties (P less than 0.0001), but no differences in the percentage due to negligence. There is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care.
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            The incidence of adverse events in Swedish hospitals: a retrospective medical record review study

            Objectives To estimate the incidence, nature and consequences of adverse events and preventable adverse events in Swedish hospitals. Design A three-stage structured retrospective medical record review based on the use of 18 screening criteria. Setting Twenty-eight Swedish hospitals. Population A representative sample (n = 1967) of the 1.2 million Swedish hospital admissions between October 2003 and September 2004. Main Outcome Measures Proportion of admissions with adverse events, the proportion of preventable adverse events and the types and consequences of adverse events. Results In total, 12.3% (n = 241) of the 1967 admissions had adverse events (95% CI, 10.8–13.7), of which 70% (n = 169) were preventable. Fifty-five percent of the preventable events led to impairment or disability, which was resolved during the admission or within 1 month from discharge, another 33% were resolved within 1 year, 9% of the preventable events led to permanent disability and 3% of the adverse events contributed to patient death. Preventable adverse events led to a mean increased length of stay of 6 days. Ten of the 18 screening criteria were sufficient to detect 90% of the preventable adverse events. When extrapolated to the 1.2 million annual admissions, the results correspond to 105 000 preventable adverse events (95% CI, 90 000–120 000) and 630 000 days of hospitalization (95% CI, 430 000–830 000). Conclusions This study confirms that preventable adverse events were common, and that they caused extensive human suffering and consumed a significant amount of the available hospital resources.
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              The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada.

              Research into adverse events (AEs) has highlighted the need to improve patient safety. AEs are unintended injuries or complications resulting in death, disability or prolonged hospital stay that arise from health care management. We estimated the incidence of AEs among patients in Canadian acute care hospitals. We randomly selected 1 teaching, 1 large community and 2 small community hospitals in each of 5 provinces (British Columbia, Alberta, Ontario, Quebec and Nova Scotia) and reviewed a random sample of charts for nonpsychiatric, nonobstetric adult patients in each hospital for the fiscal year 2000. Trained reviewers screened all eligible charts, and physicians reviewed the positively screened charts to identify AEs and determine their preventability. At least 1 screening criterion was identified in 1527 (40.8%) of 3745 charts. The physician reviewers identified AEs in 255 of the charts. After adjustment for the sampling strategy, the AE rate was 7.5 per 100 hospital admissions (95% confidence interval [CI] 5.7- 9.3). Among the patients with AEs, events judged to be preventable occurred in 36.9% (95% CI 32.0%-41.8%) and death in 20.8% (95% CI 7.8%-33.8%). Physician reviewers estimated that 1521 additional hospital days were associated with AEs. Although men and women experienced equal rates of AEs, patients who had AEs were significantly older than those who did not (mean age [and standard deviation] 64.9 [16.7] v. 62.0 [18.4] years; p = 0.016). The overall incidence rate of AEs of 7.5% in our study suggests that, of the almost 2.5 million annual hospital admissions in Canada similar to the type studied, about 185 000 are associated with an AE and close to 70 000 of these are potentially preventable.
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                Author and article information

                Journal
                reben
                Revista Brasileira de Enfermagem
                Rev. Bras. Enferm.
                Associação Brasileira de Enfermagem (Brasília, DF, Brazil )
                0034-7167
                1984-0446
                June 2013
                : 66
                : 3
                : 429-436
                Affiliations
                [01] Salvador BA orgnameUniversidade Federal da Bahia orgdiv1Escola de Enfermagem orgdiv2Departamento de Enfermagem Médico-Cirúrgica e Administração em Enfermagem Brasil
                [02] Salvador BA orgnameUniversidade Federal da Bahia orgdiv1Escola de Enfermagem orgdiv2Curso de Residência em Enfermagem Intensiva Brasil
                Article
                S0034-71672013000300019 S0034-7167(13)06600300019
                10.1590/S0034-71672013000300019
                b64a6935-9a83-4163-8d9c-082560b7d7b6

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

                History
                : 27 February 2011
                : 01 May 2013
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 34, Pages: 8
                Product

                SciELO Revista de Enfermagem

                Categories
                Revisão

                Unidade de Terapia Intensiva,Unidad de Terapia Intensiva,Doença Iatrogênica,Idoso,Literatura de Revisão como Assunto,Persona Mayor,Enfermedad Iatrogénica,Review Literature as Topic,Intensive Care Units,Iatrogenic Disease,Aged,Literatura de Revisión como Sujeto

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