Selected Medical Errors in the ICU: Results of the IATROREF Study (Parts I and II).

RATIONALE: Although ICUs were created for patients with life-threatening illnesses, the ICU environment generates a high risk of iatrogenic events. Identifying medical errors (MEs) that serve as indicators for iatrogenic risk is crucial for purposes of reporting and prevention
OBJECTIVES: We describe the selection of indicator MEs, the incidence of such MEs, and their relationship with mortality.

METHODS: We selected indicator MEs using Delphi techniques. An observational prospective multicenter cohort study of these MEs was conducted from March 27 to April 3, 2006, in 70 ICUs; 16 (23%) centers were audited. Harm from MEs was collected using specific scales.

MEASUREMENT AND MAIN RESULTS. Fourteen types of MEs were selected as indicators; 1192 MEs were reported in 1369 patients, and 367 (26.8%) patients experienced at least one ME (2.1/1000 patient-days). The most common MEs were insulin administration errors (185.9/1000 days of insulin treatment). Of the 1192 medical errors, 183 (15.4%) in 128 (9.3%) patients were adverse events that were followed by one or more clinical consequences (n=163) or required one or more procedures or treatments (n=58). By multivariable analysis, having two or more adverse events was an independent risk factor for ICU mortality (odds ratio, 3.09; 95% confidence interval, 1.30-7.36, P=0.039).

CONCLUSIONS. The impact of medical errors on mortality indicates an urgent need for developing prevention programs. We have planned a study to assess a program based on our results.