Medication & Ventilation Errors during Respiratory Therapy in Intensive care

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Patient safety is a core goal of health care. ICU patients are more prone to medical errors than other patients due to their critical condition, the use of high-tech devices like mechanical ventilation, and the fast-paced decision-making environment (Valentin 2007). Medical errors have been studied by a variety of specialties’ point of views including anesthesiologists, pharmacists and nurses, however medical errors in the area of Respiratory Therapists’ practice have not been investigated. To my knowledge, this is the first research to study ICU medical errors from the respiratory therapy perspective. The aims of this study are: 1. To observe and investigate the prevalence of medical errors in the ICU setting from the respiratory therapy viewpoint. 2. To gain the perception of ICU staff and respiratory therapists of safety culture, medical errors, causes, and solutions through a qualitative study. The research was conducted in two phases: in phase I, a cross-sectional a safety attitude study was used. Followed by a prospective, observational study conducted in two ICUs with total capacity of 50 beds, and 22 semi-structured interviews with respiratory staff from the observed ICUs. In phase II, a qualitative (In-depth interview & job satisfaction) study of ICU staffs’ perceptions of medical errors, causes, and solutions was conducted. To establish a baseline for safety culture in the studied ICUs, a Safety Attitude Questionnaire (SAQ) was used. The overall participants SAQ score was 52.8%, which is considered negative. In addition, the findings showed that 79.2% of the respondents had not reported any incidents in the last 12 months. The result of the study showed unsatisfactory levels of safety culture among healthcare staff in these two ICUs. The importance of this study is to establish a baseline for safety climate in these hospitals and specifically in ICUs. In addition, by exposing system weaknesses it helps the administration strengthen and improve patient care. To identify the types and prevalence of common incidents that occur during respiratory therapy in ICU and its relation to patients’ characteristics, an observational study was conducted in two adult ICUs in two main hospitals in the Eastern Region of Saudi Arabia. The two main hospitals have a total capacity of 759 beds and a total of 50 adult ICU beds. Most ICU admissions were for medical and surgical reasons. Data were collected over a period of 65 days between April and June 2019. Out of a total of 341 ICU admission, n=58 (17%) patients were exposed to respiratory-related medical incidents. The total rate of incidents per 1000 patient-days was 118.9 incidents. The total number of incidents during the observation period was 289 incidents. Among these incidents, 42.9% were related to infection control and documentation errors (Miscellaneous errors), and 38.4% were airway related. The most common incidents that occurred during respiratory therapy were documentation errors 27.3%, followed by infection control 11.8%, then 11.4 % of incidents were due to inappropriate pressure of endotracheal tube (ETT) cuff. The findings of this study will help the respiratory therapy management understand the types of medical errors that occur during respiratory therapy in ICU and therefore develop a targeted approach for preventing further errors with the same nature from happening in the future. 22 Semi-structured interviews were conducted to explore further the most common errors that occur during respiratory therapy in ICU, participants' understanding of these medical incidents, the contributing factors, and patient safety. Interviews were conducted on-site during a convenient time for each of the participants. Interviews were conducted between May and June 2019 and lasted between 15 to 25 minutes. The findings of this study showed an existing level of job di