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KEY POINTS
The intensive care unit (ICU) is particularly prone to medical errors as patients are very ill and require continuous monitoring.
A patient safety program that drives improvement for critical care patients can be categorized into 4 general domains: (1) ensuring compliance with patient safety regulations; (2) responding to adverse events by performing root cause analyses and implementing targeted corrective actions; (3) applying evidence-based risk reduction strategies that are not required by regulations, but are considered best practices; and (4) implementing strategies to meet and exceed patient safety metrics that are publicly reported or tied to pay-for-performance programs.
To prevent wrong patient errors, the Joint Commission requires the use of at least 2 patient identifiers when administering medications and blood products, when collecting laboratory specimens and taking imaging tests, and when providing any type of treatment.
The majority of adverse events are never reported and therefore cannot be addressed.
When a serious adverse event happens to a critical care patient, a systematic investigation of the event, called a root cause analysis, should be completed by an interdisciplinary team that has expertise in the areas involved in the event.
According to the Just Culture concept, the major focus of an adverse event investigation should be on potential system failures that led to the error as opposed to simply attributing blame to the providers involved in the error.
Team training is a well-established approach for preventing errors in high-risk industries such as the military and the airline industry, and is now being applied to the medical industry.
Simulation is a promising new strategy for improving patient safety. Similar to flight simulators used by the airline industry, health care simulators allow providers to learn a procedure or protocol using high-tech mannequins instead of live patients.
Pay-for-performance is a new approach for driving improvement in medical care by using financial incentives to reward hospitals that perform well on preestablished safety and quality measures.
Those who want to lead in patient safety should innovate new approaches for preventing errors, and study these approaches using rigorous research methodology.
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PATIENT SAFETY IN THE INTENSIVE CARE UNIT
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The modern patient safety movement began with the release of the 1999 Institute of Medicine (IOM) report “To Err Is Human,” which estimated that up to 98,000 patients die each year from medical errors. This high number of deaths exceeded the number attributed to the eighth leading cause of death at the time, and helped refocus the health care community on the importance of patient safety. The ICU is particularly prone to medical errors as patients are very ill and require continuous monitoring. The care of ICU patients can be complex, involving multiple consultants and many medications, where life-and-death decisions often need to be made quickly. A 2006 international study of 205 ICUs found an average of 38.8 events that compromised patient safety per every 100 patient critical care days, highlighting the need for ...