Abstract
Measurement of patient safety serves to identify opportunities to improve safety within
a neonatal intensive care unit (NICU), compare the safety of care provided by different
NICUs, determine changes in response to safety interventions or programs, follow safety
trends over time, and potentially deny payment for specific events. The ideal patient
safety measures are rates of events derived from surveillance with valid and reliable
detection of numerators (errors or adverse events) and denominators (the opportunities
for errors or adverse events to occur). Methods used to identify these numerators
and denominators include reporting, direct observation, videotaping, chart review,
trigger tools, and automated methods. However, there are significant methodological
and practical (feasibility) challenges to the accurate and reliable determination
of rates of errors and adverse events. These include failure to detect and document
such events, surveillance bias, lack of consistent definitions, frequent requirement
for judgment in identifying and classifying challenges (which introduces interrater
inconsistency), and need for significant additional resources.
Keywords
quality - safety - measurement - benchmarking - surveillance - error - adverse event
- near-miss
