Evaluation of the nature of untoward clinical events in adult high dependency care

Objective

Critically ill patients are exposed to a high degree of clinical risk and adverse events due to a number of factors including complex clinical interventions, polypharmacy, acuity and severity of illness, and a high level of physical dependency. The incidence of adverse events has been investigated as an indicator of quality of care and clinical risk. The purpose of this evaluation was to explore the nature of untoward clinical events (UCE) experienced by adult patients admitted to a high dependency unit in order to introduce an appropriate education and training programme.

Method

Twenty discrete assessments were carried out involving adult patients admitted to a high dependency unit. A systematic, in-depth assessment of each patient was undertaken by a critical care nurse consultant in order to identify UCE. Quantitative clinical data and descriptive data of diagnosis, clinical interventions, treatment and nursing care were collected. Quantitative data were analysed using SPSS version 11.5 for windows and descriptive data describing the nature and type of untoward clinical events were content analysed and coded into categories.

Results

Twenty-eight UCE were detected involving ten patients. Four categories of UCE were identified as deviation from treatment plans, hospital standards and guidelines; inaccurate information recorded/communicated influencing a patient’s treatment/care; service/resource shortfalls; and inadequate treatment plans.

Conclusions

All the events were seemingly preventable and mainly attributable to nursing practice although there were possibly a number of reasons why they occurred. Further research is needed to investigate the correlation of adverse events with organisational factors, nurse staffing and patient dependency.