Moderate and severe adverse events in pediatrics: characteristics of incidents reported during the COVID-19 pandemic

Lima, Gabrielli de Oliveira; Borges, Ananda Rosa; Sakamoto, Victoria Tiyoko Moraes; Florentino, Julia Rambo; Jardim, Anelise Leal Pereira; Silveira, Marina Scherer; Wegner, Wiliam

doi:10.1590/1983-1447.2024.20230020.en

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Revista Gaúcha de Enfermagem

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Original Article • Rev. Gaúcha Enferm. 45 • 2024 • https://doi.org/10.1590/1983-1447.2024.20230020.en copy

Moderate and severe adverse events in pediatrics: characteristics of incidents reported during the COVID-19 pandemic

Eventos adversos moderados y graves en pediatría: características de los incidentes reportados durante la pandemia del COVID-19

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To verify the characteristics of safety incident reports resulting in moderate and severe harm to pediatric patients in two hospitals during the COVID-19 pandemic.

Method:

Cross-sectional study conducted in two hospitals in southern Brazil. The sample consisted of 137 notifications from March 2020 to August 2021. The data were collected through the electronic records of the institutions’ notification systems and analyzed using descriptive and inferential statistics.

Results:

The most prevalent incidents were related to clinical processes or procedures (41.6%), affecting slightly more females (49.6%) and infants (39.4%). The majority of incidents (48.2%) occurred in inpatient units. The event sector (p=0.001) and the shift (p=0.011) showed statistically significant associations in both hospitals.

Conclusion:

The characteristics of the notifications are similar between the institutions surveyed, with a low number of moderate and severe incidents.

Descriptors:
Patient safety; Hospitalized child; Risk management; Pediatric nursing

Variable	hospital A	hospital B	total
Variable	n (105) %	n (32) %	n (137) %
Clinical process/ Procedures	41 (39.0%)	16 (50.0%)	57 (41.6%)
Medication/IV Fluids	33 (31.4%)	13 (40.6%)	46 (33.6%)
Clinical administration	12 (11.4%)	0	12 (8.8%)
Devices/ medical equipment	8 (7.6%)	2 (6.3%)	10 (7.3%)
Patient accidents	5 (4.8%)	1 (3.1%)	6 (4.4%)
Nutrition	2 (1.9%)	0	2 (1.5%)
Documentation	1 (1.0%)	0	1 (0.7%)
Blood/blood products	1 (1.0%)	0	1 (0.7%)
Behavior	1 (1.0%)	0	1 (0.7%)
Resource management/ Organizational	1 (1.0%)	0	1 (0.7%)
Infrastructure/building/facilities	0	0	0

Variable	hospital A	hospital B	p^*	total
Variable	n=105 (%)	n=32 (%)	p^*	n=137 (%)
Severity of harm			0.505^**
Moderate	75 (71.4%)	25 (78.1%)		100 (73%)
Severe	30 (28.6%)	7 (21.9%)		37 (27%)
Involves assistance			0.414^**
Yes	104 (99.0%)	31 (96.9%)		135 (98.5%)
No	1 (1.0%)	1 (3.1%)		2 (1.5%)
Preventable event			0.213^**
Yes	100 (95.2%)	28 (87.5%)		128 (93.4%)
No	5 (4.8%)	4 (12.5%)		9 (6.6%)
Contributing factors/risk reduction action	94 (89.5%)	28 (87.5%)	0.867^**	122 (89.1%)
Personnel factors
Work/environment factors	4 (3.8%)	3 (9.4%)		7 (5.1%)
Patient factors	5 (4.8%)	1 (3.1%)		6 (4.4%)
External factors	2 (1.9%)	0		2 (1.5%)
Immediate action was taken
Yes	32 (30.5%)	26 (81.3%)		58 (42.3%)
No	-	6 (18.8%)		6 (4.4%)
Missing	73 (69.5%)	0		73 (53.3%)
Improvement action			0.363^**
Diseased	76 (72.4%)	26 (81.3%)		102 (74.5%)
Organization	29 (27.6%)	6 (18.8%)		35 (25.5%)

Variable	hospital A	hospital B	p^*	total
Variable	n=105 (%)	n=32 (%)	p^*	n (137) %
Gender			0,226^**
Female	55 (52.4%)	13 (40.6%)		68 (49.6%)
Male	45 (42.9%)	19 (59.4%)		64 (46.7%)
Missing	5 (4.8%)	0		5 (3.6%)
Age group
Infant	35 (33.3%)	19 (59.4%)		54 (39.4%)
Newborn	29 (27.6%)	0		29 (21.2%)
Adolescent	23 (21.9%)	6 (18.8%)		29 (21.2%)
School-age	12 (11.4%)	3 (9.4%)		15 (10.9%)
Preschool	6 (5.7%)	3 (9.4%)		9 (6.6%)
Missing	0	1 (3.1%)		1 (0.7%)
Event date			0,547^**
2020	55 (52.4%)	19 (59.4%)		74 (54%)
2021	50 (47.6%)	13 (40.6%)		63 (46%)
Sector			0,001^*
Inpatient unit	44 (41.9%)	22 (68.8%)		66 (48.2%)
ICU	36 (34.3%)	2 (6.3%)		38 (27.7%)
Surgical environment	5 (4.8%)	6 (18.8%)		11 (8.0%)
Emergency	9 (8.6%)	1 (3.1%)		10 (7.3%)
Examination sector	6 (5.7%)	0		6 (4.4%)
Outpatient clinic	3 (2.9%)	1 (3.1%)		4 (2.9%)
Missing	2 (1.9%)	0		2 (1.5%)
Shift			0,011^**
Morning	7 (6.7%)	17 (53.1%)		24 (17.5%)
Afternoon	14 (13.3%)	13 (40.6%)		27 (19.7%)
Night	10 (9.5%)	2 (6.3%)		12 (8.8%)
Missing	74 (70.5%)	0		74 (54%)
Involved¹
Patient/Companion	105 (100%)	32 (100%)		137 (100%)
Professional	0	0		0
Notifier²
Professional	105 (100%)	32 (100%)		137 (100%)
Companion/ Others	0	0		0

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[1] Corresponding author:
Gabrielli de Oliveira Lima E-mail: gabrielli.limaa1@gmail.com