Effects of Learning Climate and Registered Nurse Staffing on Medication Errors
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.
Available from: Nick Sevdalis
- "A 'richer' skill mix, with higher proportions of care provided by registered nurses, is associated with improved outcomes for medical patients; observational studies show lower failure to rescue rates , in-patient mortality  and 30-day mortality  , and improved patient satisfaction . Improving skill mix may be the least expensive of the options available to improve nurse staffing , although a good learning climate on the ward may also mitigate the impact of a poor skill mix . Although a detailed discussion of nurse training lies outside the scope of this review, it is important to note that nurse education may also impact on patient outcomes. "
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ABSTRACT: Despite its place at the heart of inpatient medicine, the evidence base underpinning the effective delivery of medical ward care is highly fragmented. Clinicians familiar with the selection of evidence-supported treatments for specific diseases may be less aware of the evolving literature surrounding the organisation of care on the medical ward. This review is the first synthesis of that disparate literature. An iterative search identified relevant publications, using terms pertaining to medical ward environments, and objective and subjective patient outcomes. Articles (including reviews) were selected on the basis of their focus on medical wards, and their relevance to the quality and safety of ward-based care. Responses to medical ward failings are grouped into five common themes: staffing levels and team composition; interdisciplinary communication and collaboration; standardisation of care; early recognition and treatment of the deteriorating patient; and local safety climate. Interventions in these categories are likely to improve the quality and safety of care in medical wards, although the evidence supporting them is constrained by methodological limitations and inadequate investment in multicentre trials. Nonetheless, with infrequent opportunities to redefine their services, institutions are increasingly adopting multifaceted strategies that encompass groups of these themes. As the literature on the quality of inpatient care moves beyond its initial focus on the intensive care unit and operating theatre, physicians should be mindful of opportunities to incorporate evidence-based practice at a ward level.
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Patient safety culture is an important factor in the effort to reduce adverse events in the hospital and improve patient safety. A few studies have shown the relationship between patient safety culture and adverse events, yet no such research has been reported in China.
This study aimed to describe nurses perception of patient safety culture and frequencies of adverse events, and examine the relationship between them.
This study was a descriptive, correlated study.
Setting and Participants: We selected 28 inpatient units and emergency departments in 7 level-3 general hospitals from 5 districts in Guangzhou, China, and we surveyed 463 nurses.
The Hospital Survey on Patient Safety Culture was used to measure nurses perception of patient safety culture, and the frequencies of adverse events which happened frequently in hospital were estimated by nurses. We used multiple logistic regression models to examine the relationship between patient safety culture scores and estimated frequencies of each type of adverse event.
The positive response rates of 12 dimensions of the Hospital Survey on Patient Safety Culture varied from 23.6% to 89.7%. There were 47.8%-75.6% nurses who estimated that these adverse events had happened in the past year. After controlling for all nurse related factors, a higher mean score of “Organizational Learning-Continuous Improvement” was significantly related to lower the occurrence of pressure ulcers (OR = 0.249), prolonged physical restraint (OR = 0.406), and complaints (OR = 0.369); a higher mean score of “Frequency of Event Reporting” was significantly related to lower the occurrence of medicine errors (OR = 0.699) and pressure ulcers (OR = 0.639).
The results confirmed the hypothesis that an improvement in patient safety culture was related to a decrease in the occurrence of adverse events.
Available from: Ahmad Raeisi
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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.
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