Ventilator-Related Adverse Events: A Taxonomy and Findings From 3 Incident Reporting Systems

Respiratory Care
Julius Cuong PhamWilliam M Marella

Abstract

In 2009, researchers from Johns Hopkins University's Armstrong Institute for Patient Safety and Quality; public agencies, including the FDA; and private partners, including the Emergency Care Research Institute and the University HealthSystem Consortium (UHC) Safety Intelligence Patient Safety Organization, sought to form a public-private partnership for the promotion of patient safety (P5S) to advance patient safety through voluntary partnerships. The study objective was to test the concept of the P5S to advance our understanding of safety issues related to ventilator events, to develop a common classification system for categorizing adverse events related to mechanical ventilators, and to perform a comparison of adverse events across different adverse event reporting systems. We performed a cross-sectional analysis of ventilator-related adverse events reported in 2012 from the following incident reporting systems: the Pennsylvania Patient Safety Authority's Patient Safety Reporting System, UHC's Safety Intelligence Patient Safety Organization database, and the FDA's Manufacturer and User Facility Device Experience database. Once each organization had its dataset of ventilator-related adverse events, reviewers read the narrati...Continue Reading

Citations

Oct 29, 2017·Archives of Disease in Childhood. Fetal and Neonatal Edition·Gusztav Belteki, Colin J Morley
Feb 2, 2018·Applied Clinical Informatics·Katharine T AdamsRaj M Ratwani
Sep 28, 2020·Joint Commission Journal on Quality and Patient Safety·Anjana E SharmaUrmimala Sarkar
Aug 31, 2021·Applied Ergonomics·Beatrice ColdeweyMyriam Lipprandt
Oct 14, 2017·British Journal of Anaesthesia·J SpaethS Schumann

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