Effects of Learning Climate and Registered Nurse Staffing on Medication Errors

University of North Carolina at Chapel Hill School of Nursing, USA.
Nursing research (Impact Factor: 1.36). 01/2011; 60(1):32-9. DOI: 10.1097/NNR.0b013e3181ff73cc
Source: PubMed


Despite increasing recognition of the significance of learning from errors, little is known about how learning climate contributes to error reduction.
The purpose of this study was to investigate whether learning climate moderates the relationship between error-producing conditions and medication errors.
A cross-sectional descriptive study was done using data from 279 nursing units in 146 randomly selected hospitals in the United States. Error-producing conditions included work environment factors (work dynamics and nurse mix), team factors (communication with physicians and nurses' expertise), personal factors (nurses' education and experience), patient factors (age, health status, and previous hospitalization), and medication-related support services. Poisson models with random effects were used with the nursing unit as the unit of analysis.
A significant negative relationship was found between learning climate and medication errors. It also moderated the relationship between nurse mix and medication errors: When learning climate was negative, having more registered nurses was associated with fewer medication errors. However, no relationship was found between nurse mix and medication errors at either positive or average levels of learning climate. Learning climate did not moderate the relationship between work dynamics and medication errors.
The way nurse mix affects medication errors depends on the level of learning climate. Nursing units with fewer registered nurses and frequent medication errors should examine their learning climate. Future research should be focused on the role of learning climate as related to the relationships between nurse mix and medication errors.

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    • "We suggest that the application of integrated learning mechanisms, namely those operated by the nurses who administer the medication, can limit error rate. Nurses are frequently in the best position to identify operational problems in the medication administration process, as they often have direct access to data on the causes or consequences of errors, and it is their work routines that are disrupted by problems (Brady et al., 2009; Chang and Mark, 2011). Integrated learning mechanisms also enjoy wide acceptance and minor resistance by team members because they themselves participate in the decision making (Edmondson, 2004). "
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    ABSTRACT: Attention in the ward should shift from preventing medication administration errors to managing them. Nevertheless, little is known in regard with the practices nursing wards apply to learn from medication administration errors as a means of limiting them. To test the effectiveness of four types of learning practices, namely, non-integrated, integrated, supervisory and patchy learning practices in limiting medication administration errors. Data were collected from a convenient sample of 4 hospitals in Israel by multiple methods (observations and self-report questionnaires) at two time points. The sample included 76 wards (360 nurses). Medication administration error was defined as any deviation from prescribed medication processes and measured by a validated structured observation sheet. Wards' use of medication administration technologies, location of the medication station, and workload were observed; learning practices and demographics were measured by validated questionnaires. Results of the mixed linear model analysis indicated that the use of technology and quiet location of the medication cabinet were significantly associated with reduced medication administration errors (estimate=.03, p<.05 and estimate=-.17, p<.01 correspondently), while workload was significantly linked to inflated medication administration errors (estimate=.04, p<.05). Of the learning practices, supervisory learning was the only practice significantly linked to reduced medication administration errors (estimate=-.04, p<.05). Integrated and patchy learning were significantly linked to higher levels of medication administration errors (estimate=-.03, p<.05 and estimate=-.04, p<.01 correspondently). Non-integrated learning was not associated with it (p>.05). How wards manage errors might have implications for medication administration errors beyond the effects of typical individual, organizational and technology risk factors. Head nurse can facilitate learning from errors by "management by walking around" and monitoring nurses' medication administration behaviors.
    International journal of nursing studies 07/2013; 51(3). DOI:10.1016/j.ijnurstu.2013.06.010 · 2.90 Impact Factor
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    • "To ensure success in training safe clinicians, students should be empowered to employ critical thinking skills in practice and develop the confidence necessary for safe professional practice (Papastrat and Wallace, 2003). A learning climate recognising the value of learning from errors and feedback details of medication errors and near misses to both students and lecturers was seen as important (Chang and Mark, 2011). "
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    ABSTRACT: Background: Medication errors complicate up to half of inpatient stays and some have very serious consequences. To our knowledge, this is the first qualitative study of Iranian nursing students' perspectives of medication errors. Objectives: To describe nursing students' perspectives of the causes of medication errors. Design: Four focus groups were heldwith 24 nursing students from4 different academic semesters in the nursing school in Tehran, between November 2011 and November 2012. Using a qualitative descriptive design, themes and subthemes were identified by content analysis. Results: Two main themes emerged from the data: “under-developed caring skills in medication management” and “unfinished learning of safe medication management”, which was subdivided into “drifting between being worried and being careful”, and “contextualising pharmacology education”. All respondents felt that their education programmes were leaving them vulnerable to “drug errors” and cited incidents where patient safety had been jeopardised. Conclusion: Nursing curricula need to increase investment in medicines management. If nursing students are to become competent, skilful and safe practitioners, their learning will require extensive support from their academic institutions and clinical mentors.
    Nurse Education Today 05/2013; 34(3). DOI:10.1016/j.nedt.2013.04.015 · 1.36 Impact Factor
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    • "Lowering drug errors is deemed as a significant goal, but whole omission of such errors seems to be impossible. For instance, a teaching hospital with 600 beds and an estimated confidence level of 99.9% in accurate prescription order and dispensing reports 400 drug errors every year (8). With a stay rate of 2.2 million patients due to drug side effects (9), it can be argued that the hospital pharmacy department plays a significant role in reporting the drugs side effects (10). "
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    ABSTRACT: As a natural phenomenon in the patient's medication therapy, medication clinical complications potentially or concretely interrupt medical care consequential productivity for the patients. Medication related clinical complications include drug errors, drug side effects, drug interactions and drug usage-related challenges. The present research intends to explore the role that the Pharmacy Information System (PIS) may play in the management of medication complications with reference to the pharmaceutical societies of America and Australia in selected teaching, private and social services hospitals of the city of Isfahan. As an applied, descriptive-analytical study, this study has been conducted in teaching, private and social services hospitals situated in the city of Isfahan in 2011. The research population consisted of the PISs used in the hospitals under study. Research sample was the same as the population. The data collection instrument used was a self-designed checklist developed based on the guidelines of the American Society of Health System Pharmacists and Pharmaceutical Society of Australia validity of which was assessed by expert professors' views. The data, collected by observation and interview methods, were put into SPSS 18 software to be analyzed. The findings of the study revealed that among the 19 hospitals in question, the highest and lowest ranks in observing the societies of the pharmacists' established standards related to medication therapy, i.e. registration of drug use status and drug interactions belonged to social services hospitals (mean score of %10.1) and private hospitals (mean score of %6.24), respectively. Based on the findings, it can be claimed that the hospitals in question did not pay due attention to standards established by the societies of pharmacists regarding the medication therapy including register of drug usage status, drug interactions and drug side effects in their PISs. Hence, more thought must be given to the capabilities of the PIS in supporting the medication-related decisions and drug errors management so as to promote the treatment quality and satisfy medication therapy goals.
    Acta Informatica Medica 03/2013; 21(1):26-9. DOI:10.5455/AIM.2012.21.26-29
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