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Notifications of adverse events: characterization of the events that occurred in a hospital complex

Abstract

OBJECTIVE

Analyze incident notifications related to the patient's safety.

METHOD

Cross-sectional study with quantitative approach, based on data from the risk Management of a hospital complex, located in northwest São Paulo, from August 2015 to July 2016.

RESULTS

4,691 notifications were analyzed. Nurses were the professionals who notified the most (71%), followed by physicians (8%). The most frequent period in which the notifications occurred was the daytime. There was significant difference in the proportion of notifications between the days of the week. The notifications were classified by reason and the most prevalent were those related to medication (17%), followed by skin lesions (15%), and phlebitis (14%). The highest frequency of notifications occurred in the hospitalization units. In relation to severity, 344 events caused damage to the patient, most of which were of mild intensity (65%).

CONCLUSION

Spontaneous notifications are an important source of information, and highlight the magnitude of the problem related to health incidents.

Keywords:
Notification; Patient safety; Quality of health care.

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