Factors Associated with Triggers and Adverse Events in Pediatrics

Authors

DOI:

https://doi.org/10.15649/cuidarte.3060

Keywords:

Adverse Events, Risk Management, Tracking, Patient Safety, Pediatric Nursing

Abstract

Highlights:

  • This study evaluated triggers and adverse events in pediatric patients.

  • More than 50% of patients had at least one trigger.

  • The most common triggers included drops in hemoglobin and oxygen saturation.

  • Risk management is crucial to the safety of pediatric patients.

Introduction: The frequent occurrence of adverse events during hospital admission demands proactive means of risk management, including checking trackers/triggers. Objective: to verify the factors associated with triggers and adverse events in pediatric hospitalization. Material and Methods: Cross-sectional research based on the Institute for Healthcare Improvement (IHI) methodology, through the application of the Pediatric Trigger Tool (PTT) to a sample (n= 194) from medical records of pediatric patients from a hospital in the Center-West of Brazil. Descriptive, inferential statistical analysis and Poisson regression were performed. Results: More than half (n=107; 55.15%) of patients had at least one trigger upon admission. 204 triggers were identified, with the highest occurrence of a drop in hemoglobin/hematocrit (9.80%), a drop in oxygen saturation (9.80%) and an increase in kidney function markers (9.20%). Of the total triggers, 64 (31.37%) adverse events were confirmed, which were mostly classified as temporary damage requiring patient support (65.62%). The length of stay (p-value=0.004) and the nature of the hospitalization (p-value<0.001) were variables associated with the occurrence of triggers. Character of hospitalization and admissions from other institutions were predictors of the occurrence of triggers and adverse events.   Discussion: The study found 31.37% of triggers resulting in harm to the patient, early detection is essential in pediatric patient safety, prolonged hospitalizations are linked to infections and adverse events, patient transfers require rigorous and effective safety measures.   Conclusions:  Prolonged hospitalizations and children admitted via transfer deserve attention to triggers and/or adverse events.

How to cite this article: Moraes, Rúbia Marcela Rodrigues; Jucá, Sileyde Cristiane Bernardino Matos Povoas; de Quadros, Deise Vacario; de Magalhães, Ana María Müller; Júnior, Gilmar Jorge de Oliveira; Barbosa, Welistânia Vieira Bispo; de Oliveira, João Lucas Campos.  Fatores Associados aos Triggers e Eventos Adversos em Pediatria. Revista Cuidarte. 2023;14(3):e3060. http://dx.doi.org/10.15649/cuidarte.3060

Author Biographies

Rúbia Marcela Rodrigues Moraes, Hospital Universitário Júlio Müller, Cuiabá, MT, Brasil

Hospital Universitário Júlio Müller, Cuiabá, MT, Brasil

Sileyde Cristiane Bernardino Matos Povoas Jucá, Hospital Universitário Júlio Müller, Cuiabá, MT, Brasil

Hospital Universitário Júlio Müller, Cuiabá, MT, Brasil

Deise Vacario de Quadros, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil

Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil

Ana Maria Müller de Magalhães, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil

Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil

Gilmar Jorge de Oliveira Júnior, Universidade Federal do Mato Grosso, Cuiabá, MT, Brasil

Universidade Federal do Mato Grosso, Cuiabá, MT, Brasil

Welistânia Vieira Bispo Barbosa, Universidade Federal do Mato Grosso, Cuiabá, MT, Brasil

Universidade Federal do Mato Grosso, Cuiabá, MT, Brasil

João Lucas Campos de Oliveira, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil

Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil

References

Silva EMB, Garcia CRF, Silva DM, Duarte JC. A segurança dos cuidados da criança hospitalizada: percepção dos enfermeiros. Rev Psicol. Criança Adolesc. 9(1):67-82. https://doi.org/10.34628/sary-e786

Plint, AC, Stang, A., Newton, AS, Dalgleish, D., Aglipay, M., Barrowman, N., et al Adverse events in the paediatric emergency department: a prospective cohort study. BMJ Qual Saf. 2021;0:1–12. http://dx.doi.org/10.1136/bmjqs-2019-010055

Cunha EMD, Gomes LGA. Eventos adversos relacionados com a assistência à saúde no Ceará. Cadernos ESP/CE. 2019;13(2):131–147. https://cadernos.esp.ce.gov.br/index.php/cadernos/article/view/204/181

Lima EC, Matos GC, Vieira GML, Goncalves ICCR, Cabral LM, Turner M. Suspected adverse drug reactions reported for Brazilian children: cross-sectional study. Jornal de Pediatria. 2019;95(6):682-688. https://doi.org/10.1016/j.jped.2018.05.019

Morales-Ríos O, Cicero-Oneto C, García-Ruiz C, Villanueva-García D, Hernández-Hernández M, Olivar-Lopez V et al. Descriptive study of adverse drug reactions in a tertiary care pediatric hospital in México from 2014 to 2017. PLOS ONE. 15(3):e0230576. https://doi.org/10.1371/journal.pone.0230576

David C. Stockwell, Christopher P. Landrigan, Sara L. Toomey, Samuel S. Loren, Jisun Jang, Jessica A. Quinn et al. Adverse Events in Hospitalized Pediatric Patients. Pediatrics.2018;142(2):e20173360. https://doi.org/10.1542/peds.2017-3360

Zanetti ACB, Gabriel CS, Dias BM, Bernardes A, Moura AA, Gabriel AB et al. Assessment of the incidence and preventability of adverse events in hospitals: an integrative review. Rev Gaúcha Enferm. 2020;41:e20190364. https://doi.org/10.1590/1983-1447.2020.20190364

Institute for Innovation and improvemet, NHS. The Paediatric Trigger Tool User guide. 2014. United Kingdom UK. https://bmjopen.bmj.com/content/suppl/2014/07/03/bmjopen-2014 005066.DC1/bmjopen-2014-005066supp2.pdf

Alves MFT, Carvalho DS, Albuquerque GSC. Barriers to patient safety incident reporting by Brazilian health professionals: an integrative review. Ciência & Saúde Coletiva. 2019; 24(8):2895-2908. https://doi.org/10.1590/1413-81232018248.23912017

Arango HG. Bioestatística: teoria e computacional, Rio de Janeiro: Guanabara Koogan, 2005.

Griffin FA, Resar RK. IHI Global Trigger Tool for Measuring Adverse Events (Second Edition). IHI Innovation Series white paper. Cambridge, MA, Institute for Healthcare Improvement. [Online] 2009 [cited 2022 abril 12]. http://www.ihi.org/resources/Pages/IHIWhitePapers/IHIGlobalTriggerToolWhitePaper.aspx

NCC MERP. National Coordinating Council for Medication Error Reporting and Prevention. NCC MERP Taxonomy of Medication Errors. [Online] 2001 [cited 2022 abril 12]. https://www.nccmerp.org/sites/default/files/taxonomy2001-07-31.pdf

Moraes RMR, Juca SCMP, Quadros DV, Magalhães AMM de, Junior GJO, Barbosa WVB, et al. Fatores Associados aos Gatilhos e Eventos Adversos em Pediatria. Zenodo. 2023. https://doi.org/10.5281/zenodo.8342754

Salimath GS, Ganachari MS, Gudhoor M. Paediatric Focused Triggering Tool (PFTT) To Assess the Harm and its Utilization to Minimize the Levels of Harm among Children at a Tertiary Care Hospital. Indian J of Pharmaceutical Education and Research. 2020;54(3):819-25. https://doi.org/10.5530/ijper.54.3.134

Galdino SV, Reis EMB dos, Santos CB, Soares FP, Lima FS, Caldas JG, Piedade MACR, Oliveira A de S. Ferramentas de qualidade na gestão dos serviços de saúde: revisão integrativa de literatura. Rev. Gestao&Saúde. 2016;7(1):1023-1057. https://periodicos.unb.br/index.php/rgs/article/view/3569

Fajreldines A, Schnitzler E, Torres S, Panattieri N, Pellizzari M. Measurement of the incidence of care-associated adverse events at the Department of Pediatrics of a teaching hospital. Arch Argent Pediatr 2019;117(2):e106-e109. http://dx.doi.org/10.5546/aap.2019.eng.e106

Tavares PGB, Pacheco AVTMJ, Batista ACC, Miranda LR, Santos MEA, Oliveira ACPE, et al. Anemia Adquirida em Internação Hospitalar e sua Prevenção: Revisão de Literatura. Hematology, Transfusion and Cell Therapy. 2020; 42(2):20. http://dx.doi.org/10.1016/j.htct.2020.10.032

Mello PA de, Rocha BG, Oliveira WN, Mendonça TS, Domingueti CP. Nefrotoxicidade e alterações de exames laboratoriais por fármacos: revisão da literatura. Revista de Medicina. 2021;100(2):152–61. http://dx.doi.org/10.11606/issn.1679-9836.v100i2p152-161

Barrientos-Sánchez J., Hernández-Zavala M., Zárate-Grajales RA. Factores relacionados con la seguridad y la calidad en la atención del paciente pediátrico hospitalizado. Enferm. univ. 2019 ; 16(1): 52-62. https://doi.org/10.22201/eneo.23958421e.2019.1.592

Felix AS, Santos BPS, Rodrigues GM, Souza DA, Pimentel LC, Ferreira KD, Peronico JL. Doenãs crônicas na infância. Rev. Liberum Accessum 2023 [cited 2023 jul 12]jul;15(1):24-31. http://revista.liberumaccesum.com.br/index.php/RLA/article/view/210

Aloh HE, Obinna EO, Obianuju GA, Nweke CJ. Is bed turnover rate a good metric for hospital scale efficiency? A measure of resource utilization rate for hospitals in Southeast Nigeria. Cost Eff Resour Alloc.2020; [cited 2022 abril 12] 18: (21). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329453/

Lima Júnior AJ, Zanetti ACB, Dias BM, Bernandes A, Gastaldi FM, Gabriel CS. Occurrence and preventability of adverse events in hospitals: a retrospective study. Rev Bras Enferm. 2023;76(3):e20220025. https://doi.org/10.1590/0034-7167-2022-0025pt

Olino L, Gonçalves AC, Strada JKR, Vieira LB, Machado MLP, Molina KL et al. Comunicación efectiva para la seguridad del paciente: nota de transferencia y Modified Early Warning Score. Rev Gaúcha Enferm. 2019; e20180341. https://doi.org/10.1590/1983-1447.2019.20180341

Pritt A, Johnson A, Kahle J, Preston DL, Flesher S. Better Outcomes for Hospitalized Children through Safe Transitions: A Quality Improvement Project. Pediatr Qual Saf. 2021; 6: e378. https://doi.org/10.1097/pq9.0000000000000378

Batista J, Cruz EDA, Lopez ECMS, Sarquis LMM, Seiffert LS, Wolff LDG. Effect of the administrative transition of hospital management on the safety culture in surgical units. Texto Contexto Enferm. 2020; 29:e20190012. https://doi.org/10.1590/1980-265X-TCE-2019-0012

Maziero ECS, Cruz EDA, Batista J, Alpendre FT, Brandão MB, Krainski ET. Asociación entre calificación profesional y eventos adversos en unidades de tratamiento intensivo neonatal y pediátrico. Rev. Gaúcha Enferm. 2021; (42). https://doi.org/10.1590/1983-1447.2021.20210025

Brandi S, Troster EJ, Cunha MLR. Tempo de permanência em unidade de terapia intensiva pediátrica: modelo de predição. einstein (São Paulo). 2020;(18). https://doi.org/10.31744/einstein_journal/2020AO5476

Peters L, Olson L, Khu DT, Linros S, Le NK, Hanberger H, et al. Multiple antibiotic resistance as a risk factor for mortality and prolonged hospital stay: A cohort study among neonatal intensive care patients with hospital-acquired infections caused by gram-negative bacteria in Vietnam. PLOS ONE 14(5). https://doi.org/10.1371/journal.pone.0215666

Published

2023-12-01

How to Cite

1.
Rodrigues Moraes RM, Bernardino Matos Povoas Jucá SC, Vacario de Quadros D, Müller de Magalhães AM, de Oliveira Júnior GJ, Bispo Barbosa WV, et al. Factors Associated with Triggers and Adverse Events in Pediatrics. Revista Cuidarte [Internet]. 2023 Dec. 1 [cited 2024 Dec. 19];14(3). Available from: https://revistas.udes.edu.co/cuidarte/article/view/3060

Altmetrics

Downloads

Download data is not yet available.

Most read articles by the same author(s)