Feasibility and reliability of PRISMA-Medical for specialty-based incident analysis
Feasibility and reliability of PRISMA-Medical for specialty-based incident analysis
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DOI：
10.1136/qshc.2008.028068
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发表时间：
2009-12-01
影响因子：
--
通讯作者：
Molendijk, A.
中科院分区：
文献类型：
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作者：
Snijders, C.;van der Schaaf, T. W.;Molendijk, A.
目的和目标：在这项研究中，可行性和可靠性的预防恢复信息系统的监测和分析（PRISMA）-医学方法的系统，专业为基础的分析和分类的事件在新生儿重症监护病房（NICU）进行了测定。在八个三级护理新生儿重症监护室和一个儿科外科重症监护室引入新生儿医疗事件分析和反馈系统后，PRISMA-Medical已开始被多学科单位患者安全委员会用于确定自愿报告事件的根本原因，委员会成员接受过PRISMA培训，熟悉该部门及其流程。在这项研究中，PRISMA分析的结果，在第一年报告的事件进行了说明。在引入后t = 3个月和t = 12个月，使用PRISMA-Medical进行测试用例，以测量三个根本原因分类水平的一致性。评估员间的可靠性，确定通过计算广义kappa值为每个级别的classification.Results：在研究期间，981 1786合格的事件（55%）进行了分析的根本原因。总共确定并分类了2313个根本原因，平均每个事件有2.4个根本原因。虽然实质性协议在测试用例的根本原因分类的主要水平上达到（kappa 0.70-0.81）（区分技术、组织和人为故障）和第二级委员会之间的协议（区分基于技能、基于规则和基于知识的错误）是可以接受的（kappa 0.53-0.59），基于规则的错误之间的区分（第三级分类）较难评估（kappa 0.40-0.47）.结论：有一些限制，PRISMA-Medical被证明是可行的和可接受的可靠性，以确定和分类在新生儿重症监护室的医疗事件的多种原因。
Aims and objectives: In this study, the feasibility and reliability of the Prevention Recovery Information System for Monitoring and Analysis (PRISMA)-Medical method for systematic, specialty-based analysis and classification of incidents in the neonatal intensive care unit (NICU) were determined.Methods: After the introduction of a Neonatology System for Analysis and Feedback on Medical Events (NEOSAFE) in eight tertiary care NICUs and one paediatric surgical ICU, PRISMA-Medical was started to be used to identify root causes of voluntary reported incidents by multidisciplinary unit patient safety committees.Committee members were PRISMA-trained and familiar with the department and its processes. In this study, the results of PRISMA-analysis of incidents reported during the first year are described. At t = 3 months and t = 12 months after introduction, test cases were performed to measure agreement at three levels of root cause classification using PRISMA-Medical. Inter-rater reliability was determined by calculating generalised kappa values for each level of classification.Results: During the study period, 981 out of 1786 eligible incidents (55%) were analysed for underlying root causes. In total, 2313 root causes were identified and classified, giving an average of 2.4 root causes for every incident. Although substantial agreement (kappa 0.70-0.81) was reached at the main level of root cause classification of the test cases (discrimination between technical, organisational and human failure) and agreement among the committees at the second level (discrimination between skill-based, rule-based and knowledge-based errors) was acceptable (kappa 0.53-0.59), discrimination between rule-based errors (the third level of classification) was more difficult to assess (kappa 0.40-0.47).Conclusion: With some restraints, PRISMA-Medical proves to be both feasible and acceptably reliable to identify and classify multiple causes of medical events in the NICU.