بروز حوادث ناخواسته و عوامل خطر مرتبط با آن در انتقال بیماران از بخش‌های مراقبت ویژه

نویسندگان
مهدی اسدیان 1
محمدرضا حیدری 2
حمیدرضا دولت خواه 3
1 دنشجوی کارشناسی ارشد پرستاری مراقبت ویژه، گروه پرستاری، دانشکده پرستاری و مامایی،دانشگاه شاهد، تهران، ایران
2 استادیار،گروه پرستاری، دانشکده پرستاری و مامایی،دانشگاه شاهد، تهران، ایران
3 کارشناس ارشد آمار،مرکز تحقیقات مولفه های اجتماعی سلامت، دانشگاه علوم پزشکی جهرم، جهرم،ایران
10.52547/jmj.18.3.1
چکیده
مقدمه: انتقال بیماران بدحال بستری در بخش‌های مراقبت ویژه که به طور عمده با هدف انجام فرایندهای تشخیصی و درمانی انجام می‌شود می‌تواند با بروز حوادث ناخواسته همراه باشد. این پژوهش با هدف تعیین بروز حوادث ناخواسته و عوامل خطر مرتبط با آن در هنگام انتقال بیماران بخش‌های مراقبت ویژه انجام شد.
روش کار: در این مطالعه توصیفی- مقطعی داده‌های انتقال بیماران در طی یک دوره شش ماهه توسط چک‌لیست حوادث ناخواسته جمع‌آوری شد. تجزیه‌ و تحلیل داده‌ها با آمار توصیفی و استنباطی (فراوانی، درصد، میانگین و انحراف معیار، آزمون مربع کای، آزمون دقیق فیشر و آزمون من ویتنی) با استفاده از نرم‌افزار SPSS نسخه 22 انجام شد.
یافته‌ها: 536 بیمار (91.2 درصد) دچار حادثه ناخواسته شدند. میزان بروز حوادث ناخواسته مرتبط با بیمار، مرتبط با کارکنان و مرتبط با تجهیزات به ترتیب 65.5 درصد، 73.3 درصد و 7.8 درصد بود. میزان بروز حادثه ناخواسته در مردان بالاتر از زنان بود (0.035=P ). میزان بروز حادثه ناخواسته در انتقال با برانکارد به‌طور معناداری بالاتر از روش‌های دیگر (0.001>P ) بود. میزان بروز حادثه ناخواسته در ICU به‌طور معناداری بالاتر از CCU بود (0.001=P ). بین بروز حادثه ناخواسته و وجود تجهیزاتی مانند کپسول اکسیژن (0.001 >P )، مانیتور قلبی (0.047=P )، ونتیلاتور پرتابل (0.004=P )، پالس اکسی متر (0.001>P ) و نرده محافظ تخت (0.001 >P ) ارتباط معنادار آماری وجود داشت.
نتیجه‌گیری: نتایج نشان داد که میزان بروز حوادث ناخواسته بالا است. سازمان‌ها باید خطرات حین انتقال را شناسایی و با آن‌ها فعالانه برخورد کنند. استفاده از چک‌لیست و ابزارهای ارتباطی مرتبط با انتقال اطلاعات می‌توانند کیفیت و ایمنی انتقال را بهبود بخشند.
 
کلیدواژه‌ها
حوادث ناخواسته
انتقال بیمار
عوامل خطر
بخش مراقبت ویژه

عنوان مقاله English

Incidence of ar and related risk factors in the transfer of patients from intensive care units

نویسندگان English

Mahdi Asadiyan 1
Mohammad Reza Heidari 2
Hamid Reza Dolatkhah 3
1 Dept. of Nursing, School of Nursing and Midwifery, Shahed University, Tehran, Iran
2 Dept. of Nursing, School of Nursing and Midwifery, Shahed University, Tehran, Iran
3 MSC of Statistics, Social Determinants of Health Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
چکیده English

Introduction: Transfer of critically ill patients admitted to intensive care units mainly for the purpose of performing
diagnostic and therapeutic procedures can be associated with adverse events. The purpose of this study was to determine the relationship between the incidence of adverse events and its associated risk factors during the transfer of ICU Patients.
Materials & Methods: In this descriptive cross-sectional study, patient data were collected through a checklist of adverse
events over a 6-month period. The data were analyzed by descriptive and analytical statistics using SPSS software (version 22).
Results: 536 patients (91.2%) had adverse events. The incidence of patient-related, staff-related, and equipment- related adverse events was 65.5%, 73.3%, and 7.8%, respectively. The incidence of adverse events was higher in men than women (P= 0.035). The incidence of adverse events in stroke transfer (51.9%) was significantly higher than other methods (P<0.001). Incidence of adverse events in ICU was significantly higher than CCU (P= 0.001). There was a statistically significant correlation between the occurrence of adverse events and the presence of equipment such as oxygen cylinder (P<0.001), cardiac monitor (P=0.047), portable ventilator (P=0.004), pulse oximeter (P<0.001) and bedside railing (P<0.001).
Conclusion: The results showed that the incidence of adverse events was high. Organizations must identify and actively address risks during the transition. The use of checklists and communication tools related to data transfer can improve the quality and safety of transfer.

کلیدواژه‌ها English

Adverse Events
Patient Transfer
Risk Factors
Intensive Care Unit
1. Garkaz O, Taghdir M, Sepandi M. The Analytical study of the Main Causes of Mortality of Patients in the ICU Section of the Selected Military Hospital between 2012 -2017. hrjbaq. 2019;4(3):129-36. 2. Mahomed S, Mahomed O. Cost of intensive care services at a central hospital in South Africa. South African Medical Journal. 2019;109(1):35-9. 3. Salt O, Akpinar M, Sayhan MB, Ors FB, Durukan P, Baykan N, et al. Intrahospital critical patient transport from the emergency department. Archives of medical science : AMS. 2020;16(2):337-44. 4. Philip JL, Saucke MC, Schumacher JR, Fernandes-Taylor S, Havlena J, Greenberg CC, et al. Characteristics and Timing of Interhospital Transfers of Emergency General Surgery Patients. The Journal of surgical research. 2019;233:8-19. 5. Knight PH, Maheshwari N, Hussain J, Scholl M, Hughes M, Papadimos TJ, et al. Complications during intrahospital transport of critically ill patients: Focus on risk identification and prevention. International journal of critical illness and injury science. 2015;5(4):256-64. 6. Veiga VC, Postalli NF, Alvarisa TK, Travassos PP, Vale R, Oliveira CZ, et al. Adverse events during intrahospital transport of critically ill patients in a large hospital. Revista Brasileira de terapia intensiva. 2019;31(1):15-20. 7. Martin M, Cook F, Lobo D, Vermersch C, Attias A, Ait-Mamar B, et al. Secondary Insults and Adverse Events During Intrahospital Transport of Severe Traumatic Brain-Injured Patients. Neurocritical care. 2017;26(1):87-95. 8. Kwack WG, Yun M, Lee DS, Min H, Choi YY, Lim SY, et al. Effectiveness of intrahospital transportation of mechanically ventilated patients in medical intensive care unit by the rapid response team: A cohort study. Medicine (Baltimore). 2018;97(48):e13490. 9. Ringdal M, Chaboyer W, Warren Stomberg M. Intrahospital transports of critically ill patients: critical care nurses' perceptions. Nursing in critical care. 2016;21(3):178-84. 10. Blakeman TC, Branson RD. Inter-and Intra-hospital Transport of the Critically IllDiscussion. Respiratory care. 2013;58(6):1008-23. 11. Pedreira L, Santos I, Farias M, Sampaio E, Barros C. Coelho ACC. Knowledge of the nurse intrahospital transport of critical patients. UERJ Nursing Journal. 2014:22-533. 12. Parmentier-Decrucq E, Poissy J, Favory R, Nseir S, Onimus T, Guerry M-J, et al. Adverse events during intrahospital transport of critically ill patients: incidence and risk factors. Ann Intensive Care. 2013;3(1):10. 13. Fanara B, Manzon C, Barbot O, Desmettre T, Capellier G. Recommendations for the intra-hospital transport of critically ill patients. Critical care (London, England). 2010;14(3):87. 14. Fanara B, Manzon C, Barbot O, Desmettre T, Capellier G. Recommendations for the intra-hospital transport of critically ill patients. Critical Care. 2010;14(3):R87. 15. Jones HM, Zychowicz ME, Champagne M, Thornlow DK. Intrahospital Transport of the Critically Ill Adult: A Standardized Evaluation Plan. Dimensions of critical care nursing : DCCN. 2016;35(3):133-46. 16. Kue R, Brown P, Ness C, Scheulen J. Adverse clinical events during intrahospital transport by a specialized team: a preliminary report. American Journal of Critical Care. 2011;20(2):153-62. 17. Oh TK, Kim S, Lee DS, Min H, Choi YY, Lee EY, et al. A rapid response system reduces the incidence of in-hospital postoperative cardiopulmonary arrest: a retrospective study. 2018;65(12):1303-13. 18. Min HJ, Kim HJ, Lee DS, Choi YY, Yoon M, Lee D, et al. Intra-hospital transport of critically ill patients with rapid response team and risk factors for cardiopulmonary arrest: A retrospective cohort study. 2019;14(3):e0213146. 19. Knight PH, Maheshwari N, Hussain J, Scholl M, Hughes M, Papadimos TJ, et al. Complications during intrahospital transport of critically ill patients: Focus on risk identification and prevention. Int J Crit Illn Inj Sci. 2015;5(4):256. 20. Gimenez FMP, Camargo WHBd, Gomes ACB, Nihei TS, Andrade MWM, Valverde MLdA, et al. Analysis of adverse events during intrahospital transportation of critically ill patients. Crit Care Res Pract. 2017;2017. 21. O'Leary RA, Marsh B, O'Connor P. Transfer of critically ill adults-assessing the need for training. Irish journal of medical science. 2018;187(3):585-91. 22. Jia L, Wang H, Gao Y, Liu H, Yu K. High incidence of adverse events during intra-hospital transport of critically ill patients and new related risk factors: a prospective, multicenter study in China. Critical care (London, England). 2016;20:12. 23. Hajjej Z, Gharsallah H, Boussaidi I, Daiki M, Labbene I, Ferjani M. Risk of mishaps during intrahospital transport of critically ill patients. Tunis Med. 2015;93(11):708-13. 24. Daud-Gallotti R, Novaes HMD, Lorenzi MC, Eluf-Neto J, Okamura MN, Velasco IT. Adverse events and death in stroke patients admitted to the emergency department of a tertiary university hospital. European Journal of Emergency Medicine. 2005;12(2):63-71. 25. ALMEIDA ACGd, Neves ALD, SOUZA CLBd, Garcia JH, LOPES JdL, BARROS ALBLd. Intra-hospital transport of critically ill adult patients: complications related to staff, equipment and physiological factors. Acta Paulista de Enfermagem. 2012. 26. Sethi D, Subramanian S. When place and time matter: How to conduct safe inter-hospital transfer of patients. Saudi J Anaesth. 2014;8(1):104. 27. Joosse P, Saltzherr T-P, van Lieshout WA, van Exter P, Ponsen K-J, Vandertop WP, et al. Impact of secondary transfer on patients with severe traumatic brain injury. J Trauma Acute Care Surg. 2012;72(2):487-90. 28. Min HJ, Kim H-J, Lee DS, Choi YY, Yoon M, Lee D, et al. Intra-hospital transport of critically ill patients with rapid response team and risk factors for cardiopulmonary arrest: A retrospective cohort study. PloS one. 2019;14(3). 29. Brunsveld-Reinders AH, Arbous MS, Kuiper SG, de Jonge E. A comprehensive method to develop a checklist to increase safety of intra-hospital transport of critically ill patients. Critical Care. 2015;19(1):214. 30. Blakeman TC, Branson RD. Inter- and intra-hospital transport of the critically ill. Respiratory care. 2013;58(6):1008-23. 31. Jia L, Wang H, Gao Y, Liu H, Yu K. High incidence of adverse events during intra-hospital transport of critically ill patients and new related risk factors: a prospective, multicenter study in China. Critical Care. 2016;20(1):12. 32. Alabdali A, Trivedy C, Aljerian N, Kimani PK, Lilford R. Incidence and predictors of adverse events and outcomes for adult critically ill patients transferred by paramedics to a tertiary care medical facility. J Health Spec. 2017;5(4):206. 33. Swickard S, Winkelman C, Hustey FM, Kerr M, Reimer AP. Patient Safety Events during Critical Care Transport. Air medical journal. 2018;37(4):253-8. 34. Lahner D, Nikolic A, Marhofer P, Koinig H, Germann P, Weinstabl C, et al. Incidence of complications in intrahospital transport of critically ill patients–experience in an Austrian university hospital. Wien Klin Wochenschr. 2007;119(13-14):412-6. 35. Kue R, Brown P, Ness C, Scheulen J. Adverse clinical events during intrahospital transport by a specialized team: a preliminary report. Am J Crit Care. 2011;20(2):153-62. 36. Bergman L, Pettersson M, Chaboyer W, Carlström E, Ringdal M. Improving quality and safety during intrahospital transport of critically ill patients: A critical incident study. Aust Crit Care. 2019. 37. Borimnejad L, Ansari K, Tatarpour P, Haghani H. Studying High risk newborn intra-hospital transport in Neonatal Intensive Care Unit (NICU). Iran J Crit C are Nurs. 2013;6(3):199-206.