Abstract
Aim
Nurses constitute an important group in identifying and preventing errors and risks in health care, but research on their perception of errors is scarce. This paper presents results of a representative study on health care errors, focusing on factors causing and influencing the occurrence of errors as perceived by nurses.
Subject and methods
The cross-sectional research design comprised descriptive and correlational parts. The sample consisted of 1,100 nurses employed at 30 hospitals and 46 nursing homes in Germany. Data were collected in 2008/2009 using a questionnaire listing 21 factors that can potentially cause or influence errors. Participants could choose up to three factors they deem the most important. Differences between the two settings and variables which might have an influence on the perception of error-causing factors were analyzed using cluster-adjusted methods.
Results
High workload, staff shortage and excessive labour topped the list. Hospital nurses more often chose “workload” and “interruptions” while nursing home nurses more often ranked “lack of knowledge” and “lack of motivation” as the most important. There are some significant variables such as years of professional experience and migration background that could affect nurses’ perception.
Conclusion
The findings support other studies, pointing to workload issues and below-optimum work processes producing errors. Inter-sectoral differences suggest the necessity of sector-specific support in education and on-going training as well as risk and quality management.
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References
Advisory Council for the Concerted Action in Health Care (2003) Report 2003: health care finance. User Orientation and Quality, Bonn, Germany
Armitage G, Knapman H (2003) Adverse events in drug administration: a literature review. J Nurs Manag 11:130–140
Arndt M (1994) Nurses' medication errors. J Adv Nurs 19:519–526
Balas MC, Scott LD, Rogers AE (2004) The prevalence and nature of errors and near errors reported by hospital staff nurses. Appl Nurs Res 17:224–230
Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL (2002) Medication errors observed in 36 health care facilities. Arch Intern Med 162:1897–1903
Becker A, Beck U (2010) Personalausstattung und Ergebnisqualität. Schwest Pfleg 49:74–79
Benner P, Malloch K, Sheets V, Bitz K, Emrich L, Thomas MB, Bowen K, Scott K, Patterson L, Schwed K, Farrell M (2006) TERCAP: creating a national database on nursing errors. Harv Health Policy Rev 7:48–63
Blegen MA (2006) Patient safety in hospital acute care units. Annu Rev Nurs Res 24:103–125
Carlton G, Blegen MA (2006) Medication-related errors: a literature review of incidence and antecedents. Annu Rev Nurs Res 24:19–38
Department of Health (2005) A safer place for patients: learning to improve patient safety. Department of Health, London
Federal Statistical Office (2005) Pflegestatistik 2003: Pflege im Rahmen der Pflegeversicherung—Deutschlandergebnisse. Federal Statistical Office, Wiesbaden, Germany
Federal Statistical Office (2010) Demografischer Wandel in Deutschland, Heft 2: Auswirkungen auf Krankenhausbehandlungen und Pflegebedürftige. Federal Statistical Office, Wiesbaden, Germany
Federal Statistical Office (2011a) Hospital statistics: basic data. Federal Statistical Office, Wiesbaden, Germany
Federal Statistical Office (2011b) Pflegestatistik 2009: Pflege im Rahmen der Pflegeversicherung—Deutschlandergebnisse. Federal Statistical Office, Wiesbaden, Germany
German Coalition for Patient Safety (2008) Patient safety agenda 2008. German Coalition for Patient Safety, Witten, Germany
Gladstone J (1995) Drug administration errors: a study into the factors underlying the occurrence and reporting of drug errors in a district general hospital. J Adv Nurs 22:628–637
Görres S, Bomball J, Schwanke A, Stöver M, Schmitt S (2010) “Imagekampagne für Pflegeberufe auf der Grundlage empirisch gesicherter Daten”: Einstellungen von Schüler/innen zur möglichen Ergreifung eines Pflegeberufes—Ergebnisbericht. University of Bremen, Bremen
Habermann M, Foraita R, Cramer H (2012) Categories of errors and error frequencies as identified by nurses: results of a cross-sectional study in German nursing homes and hospitals. J Public Health. doi:10.1007/s10389-012-0531-x
Handler SM, Perera S, Olshansky EF, Studenski SA, Nace DA, Fridsma DB, Hanlon JT (2007) Identifying modifiable barriers to medication error reporting in the nursing home setting. J Am Med Dir Assoc 8:568–574
Henneman EA, Blank FSJ, Gawlinski A, Henneman PL (2006) Strategies used by nurses to recover medical errors in an academic emergency department setting. Appl Nurs Res 19:70–77
Hoff T, Jameson L, Hannan E, Flink E (2004) A review of the literature examining linkages between organizational factors, medical errors, and patient safety. Med Care Res Rev 61:3–37
Hyrkas K, Parker S (2006) Safety in health care today: more than just freedom from errors and accidents? J Adv Nurs 56:220–222
Inoue K, Koizumi A (2004) Application of human reliability analysis to nursing errors in hospitals. Risk Anal 24:1459–1473
Institute of Medicine (2000) To err is human: building a safer health system. National Academy Press, Washington, DC
Isfort M, Weidner F, Neuhaus A, Kraus S, Köster VH, Gehlen D (2010) Pflegethermometer 2009. Eine bundesweite Befragung von Pflegekräften zur Situation der Pflege und Patientenversorgung im Krankenhaus. Deutsches Institut für angewandte Pflegeforschung, Köln, Germany
Ito H, Yamazumi S (2003) Common types of medication errors on long-term psychiatric care units. Int J Qual Health Care 1:207–212
Jeffe DB, Dunagan WC, Garbutt J, Burroughs TE, Gallagher TH, Hill PR, Harris CB, Bommarito K, Fraser VJ (2004) Using focus groups to understand physicians' and nurses' perspectives on error reporting in hospitals. Jt Comm J Qual Saf 30:471–479
Krahenbuhl-Melcher A, Schlienger R, Lampert M, Haschke M, Drewe J, Krahenbuhl S (2007) Drug-related problems in hospitals: a review of the recent literature. Drug Saf 30:379–407
Lang TA, Hodge M, Olson V, Romano PS, Kravitz RL (2004) Nurse-patient ratios: a systematic review on the effects of nurse staffing on patient, nurse employee, and hospital outcomes. J Nurs Adm 34:326–337
Meurier CE, Vincent CA, Parmar DG (1997) Learning from errors in nursing practice. J Adv Nurs 26:111–119
Mitchell P (2002) Nursing is essential to improving patient safety. J Adv Nurs 38:109–110
Montgomery VL (2007) Effect of fatigue, workload, and environment on patient safety in the pediatric intensive care unit. Pediatr Crit Care Med 2(Suppl):S11–S16
Reason J (1995) Understanding adverse events: human factors. Qual Health Care 4:80–89
Rogers AE, Hwang WT, Scott LD, Aiken LH, Dinges DF (2004) The working hours of hospital staff nurses and patient safety. Health Aff 23:202–212
Sanghera IS, Franklin BD, Dhillon S (2007) The attitudes and beliefs of healthcare professionals on the causes and reporting of medication errors in a UK Intensive care unit. Anaesthia 62:53–61
SAS Institute Inc. (2008) SAS (Version 9.2). SAS, Cary, NC
Scott-Cawiezell J, Vogelsmeier A (2006) Nursing home safety: a review of the literature. Annu Rev Nurs Res 24:179–215
Wakefield DS, Wakefield BJ, Uden-Holman T, Borders T, Blegen M, Vaughn T (1999) Understanding why medication administration errors may not be reported. Am J Med Qual 14:81–88
Weir C, Hoffman J, Nebeker JR, Hurdle JF (2005) Nurse's role in tracking adverse drug events: the impact of provider order entry. Nurs Adm Q 29:39–44
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The authors declare that they have no conflict of interest.
Funding
This research was funded by the German Federal Ministry of Education and Research, Grant Number 01GT0607.
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Cramer, H., Pohlabeln, H. & Habermann, M. Factors causing or influencing nursing errors as perceived by nurses: findings of a cross-sectional study in German nursing homes and hospitals. J Public Health 21, 145–153 (2013). https://doi.org/10.1007/s10389-012-0527-6
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DOI: https://doi.org/10.1007/s10389-012-0527-6