The possibility of malicious harm to patients was recently demonstrated by the Allitt case. Allitt was a nurse in a pediatric ward who murdered or injured several children in her care over a 3-month period. The principal recommendation of the formal inquiry ( C!oibiei...§.D.d...M.a.cD.9nald 19.9.4.) was that the 'disaster should serve to heighten awareness in all those caring for children of the possibility of malevolent intervention as a cause of unexplained clinical events'. This recommendation could equally apply to those caring for critically ill patients since, like children, they are completely vulnerable.
The inquiry also recommended that 'reports of serious untoward incidents to District and Regional Health Authorities should be in writing and through a single channel which is known to all'. ICUs need a mechanism whereby critical incidents can be analyzed and statistically atypical patterns detected. Good shift-by-shift record keeping is essential. Records should be 'constructed and completed in such a manner as to facilitate monitoring of standards, audit, quality assurance and the investigation of complaints' (UKCC 1993).
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