Umfang og eðli óvæntra atvika og tengsl þeirra við hjúkrunarþyngd: lýsandi rannsókn

Abstract

Bakgrunnur: Þrátt fyrir að öryggi sjúklinga og starfsmanna sé forgangsmál á sjúkrahúsum verður nokkur fjöldi þeirra fyrir óvæntum atvikum á ári hverju. Meðal þátta sem taldir eru hafa áhrif á óvænt atvik sjúklinga og starfsmanna er vinnuálag og mönnun. Erlendar rannsóknir sýna fram á tengsl mönnunar, vinnuálags hjúkrunarfræðinga eða hjúkrunarþyngdar annars vegar og óvæntra atvika sjúklinga hins vegar.Tilgangur: Tilgangur þessarar rannsóknar var að varpa ljósi á umfang og eðli óvæntra atvika sjúklinga og starfsmanna á legudeildum, lýsa breytileika í vinnuálagi og hjúkrunarþyngd og leitast við að greina vísbendingar um tengsl óvæntra atvika við hjúkrunarþyngd.Aðferð: Rannsóknin er lýsandi og var gerð á 16 legudeildum á Landspítala með gögnum frá 2015 – 2017.Niðurstöður: Á þessum deildum voru samtals 3620 óvænt atvik sjúklinga árin 2015 – 2017. Talsverður breytileiki var í fjölda atvika og flokkun þeirra milli deilda, mánaða og ára. Flest voru atvikin í flokknum atvik tengd umhverfi / aðstæðum en þar eru byltur stærsti hlutinn. Fjöldi óvæntra atvika starfsmanna voru samtals 499 árin 2015 – 2017. Flest atvik starfsmanna tengdust átökum eða ofbeldi og óhöppum eða slysum. Hvað varðar hjúkrunarþyngd sást talsverður breytileiki í hjúkrunarstigum á hvern starfsmann hjúkrunar milli daga, mánaða, ára og deilda. Fram kom marktæk jákvæð sterk fylgni milli hjúkrunarstiga á starfsmann hjúkrunar og óvæntra atvika sjúklinga á tveimur deildum og jákvæð miðlungs tengsl á átta deildum á þessum árum. Ekki kom fram marktæk sterk fylgni milli fjölda daga í mánuði yfir æskilegu hjúkrunarstigi og óvæntra atvika sjúklinga en jákvæð miðlungs tengsl komu fram á níu deildum 2015 – 2017. Ekki var hægt að reikna fylgni með því að nota óvænt atvik starfsmanna þar sem þau voru svo fá.Ályktanir: Niðurstöður varpa ljósi á eðli og umfang óvæntra atvika sjúklinga og starfsmanna á Landspítala, vinnuálag og möguleg tengsl milli þessara breyta. Þær gefa vísbendingar um að einhverskonar tengsl geti verið milli vinnuálags í hjúkrun og óvæntra atvika á sjúkrahúsum en þau tengsl gætu verið undir áhrifum fleiri þátta sem ekki voru skoðaðir hér.Lykilorð: hjúkrunarþyngd, mönnun, óvænt atvik, öryggi sjúklinga, öryggi starfsmanna.

Background: Many patients and nursing staff experience adverse events every year despite the effort and the priority of patient safety and nursing staff safety in the hospital setting. The workload of nursing staff and staffing in nursing are believed to be important influencing factors in the prevalence of adverse events in hospitals. Research results have shown the relationship between staffing in nursing, nursing workload or nursing intensity and the prevalence of adverse events.Objective: The purpose of this study was to shed a light on the frequency and nature of patient and nursing staff adverse events in hospital units, demonstrate the variability of the workload of nursing staff and nursing intensity and attempt to identify the relationship between adverse events and nursing intensity.Method: This was a descriptive study using data from sixteen units at Landspítali University Hospital from the years 2015 – 2017. Results: On these units there were a total of 3620 adverse patient events in 2015 - 2017. There was a considerable variability in the frequency and nature of adverse events between units, and between months and years. The largest proportion of adverse events was in the category adverse events associated with the environment or situations, most of them were patient falls. The total number of staff adverse events was 499 during 2015 - 2017. The largest proportion of staff adverse events was equal in two categories, associated with conflict and violence and associated with accidents. The exploration of nursing intensity revealed a substantial variability in nursing intensity points per nurse staff over days, months, years and between hospital units. A statistically significant strong positive relationship was identified between patient adverse events and nursing intensity points per nurse staff on two units and a medium positive relationship on eight units in these three years. No significant strong positive relationship was revealed between patient adverse events and the number of days above optimal level of nursing intensity, but calculations showed a positive medium relationship on nine units in 2015 – 2017. It was not possible to determine any relationship between staff adverse events because they were so few.Conclusion: These findings shed a light on the frequency and nature of patient and staff adverse events and nursing workload in units at Landspítali University Hospital and the potential link between these variables. These results indicate some kind of relationship between workload in nursing and adverse events in hospitals, but this relationship could possibly be influenced by confounding factors not explored in this study.Keywords: adverse events, nursing intensity, nursing staff safety, patient safety, staffing.