Safety climate reduces medication and dislodgement errors in routine intensive care practice
- 1.4k Downloads
To assess the frequency and contributing factors of medication and dislodgement errors attributable to common routine processes in a cohort of intensive care units, with a special focus on the potential impact of safety climate.
A prospective, observational, 48 h cross sectional study in 57 intensive care units (ICUs) in Austria, Germany, and Switzerland, with self-reporting of medical errors by ICU staff and concurrent assessment of safety climate, workload and level of care.
For 795 observed patients, a total of 641 errors affecting 269 patients were reported. This corresponds to a rate of 49.8 errors per 100 patient days related to the administration of medication, loss of artificial airways, and unplanned dislodgement of lines, catheters and drains. In a multilevel model predicting error occurrence at the patient level, odds ratios (OR) per unit increase for the occurrence of at least one medical error were raised for a higher Nine Equivalents of Nursing Manpower Use Score (NEMS) (OR 1.04, 95 % CI 1.02–1.05, p < 0.01) and a higher number of tubes/lines/catheters/drains (OR 1.02, 95 % CI 1.01–1.03, p < 0.01) at the patient level and lowered by a better safety climate at the ICU level (OR per standard deviation 0.67, 95 % CI 0.51–0.89, p < 0.01).
Safety climate apparently contributes to a reduction of medical errors that represent a particularly error-prone aspect of frontline staff performance during typical routine processes in intensive care.
KeywordsPatient safety Medical error Safety climate Intensive care unit Quality of health care
We thank the ICU teams and ICU study coordinators (see supplemental digital content) who participated in this study and contributed in an open-minded and dedicated fashion. This study was conducted as a joint research project and financed by the Vienna Mayor’s Medical-Scientific Fund and the Austrian Center for Documentation and Quality Assurance in Intensive Care (ASDI). The study was supported by the German Interdisciplinary Federation of Intensive Care Medicine and Emergency Medicine (DIVI) and the Suisse Society of Intensive Care Medicine (SGI). Last but not least, our thanks go to the editor and reviewers for their critical yet constructive remarks on previous versions of this manuscript.
- 1.Pronovost PJ, Goeschel CA, Colantuoni E, Watson S, Lubomski LH, Berenholtz SM, Thompson DA, Sinopoli DJ, Cosgrove S, Sexton JB, Marsteller JA, Hyzy RC, Welsh R, Posa P, Schumacher K, Needham D (2010) Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. BMJ 340:c309PubMedCrossRefGoogle Scholar
- 4.Garrouste-Orgeas M, Timsit JF, Vesin A, Schwebel C, Arnodo P, Lefrant JY, Souweine B, Tabah A, Charpentier J, Gontier O, Fieux F, Mourvillier B, Troche G, Reignier J, Dumay MF, Azoulay E, Reignier B, Carlet J, Soufir L (2010) Selected medical errors in the intensive care unit: results of the IATROREF study: parts I and II. Am J Respir Crit Care Med 181:134–142PubMedCrossRefGoogle Scholar
- 5.Rothschild JM, Landrigan CP, Cronin JW, Kaushal R, Lockley SW, Burdick E, Stone PH, Lilly CM, Katz JT, Czeisler CA, Bates DW (2005) The Critical Care Safety Study: the incidence and nature of adverse events and serious medical errors in intensive care. Crit Care Med 33:1694–1700PubMedCrossRefGoogle Scholar
- 9.Naveh E, Katz-Navon T, Stern Z (2011) The effect of safety management systems on continuous improvement of patient safety: the moderating role of safety climate and autonomy. Qual Manage J 18:54–67Google Scholar
- 14.Flin R (2006) Erosion of managerial resilience: from Vasa to NASA. In: Hollnagel E, Woods DD, Leveson N (eds) Resilience Engineering: concepts and precepts. Ashgate, Farnham, pp 223–233Google Scholar
- 15.Flin R, O’Connor P, Crichton M (2008) Safety at the sharp end. A guide to non-technical skills. Ashgate, FarnhamGoogle Scholar
- 16.Woods DD (2006) Essential characteristics of resilience. In: Hollnagel E, Woods DD, Leveson N (eds) Resilience Engineering: concepts and precepts. Ashgate, Farnham, pp 21–34Google Scholar
- 18.(EUNetPaS) ENfPS, (2010) EUNetPas publication of safety culture instruments used in EU-member states; http://www.eunetpas.eu/
- 26.Browne MW, Cudeck R (1993) Alternative ways of assessing equation model fit. In: Bollen K, Long JS (eds) Testing Structural Equation Models. Sage, Newbury Park, pp 136–162Google Scholar
- 27.Lütticke J, Pfaff H (2002) Wissenschaftliche Grundlagen für ein erweitertes Risiko-Management im Krankenhaus (GERM-Studie). Sozialmedizin und Sozialhygiene der Universität zu Köln, Köln, Abteilung Medizinische Soziologie des Institutes für ArbeitsmedizinGoogle Scholar
- 28.Rasbash J, Charlton C, Browne WJ, Healy M, Cameron B, (2005) MLwiN Version 2.02. Centre for Multilevel Modelling, University of Bristol, BristolGoogle Scholar
- 33.Reason JT (1997) Managing the risk of organisational accidents. Ashgate, LondonGoogle Scholar
- 35.Loukopoulos LD, Dismukes RK, Barshi I (2009) The multitasking myth: handling complexity in real-world operations. Ashgate, FarnhamGoogle Scholar
- 38.Byrnes MC, Schuerer DJ, Schallom ME, Sona CS, Mazuski JE, Taylor BE, McKenzie W, Thomas JM, Emerson JS, Nemeth JL, Bailey RA, Boyle WA, Buchman TG, Coopersmith CM (2009) Implementation of a mandatory checklist of protocols and objectives improves compliance with a wide range of evidence-based intensive care unit practices. Crit Care Med 37:2775–2781PubMedCrossRefGoogle Scholar
- 39.Poon EG, Keohane CA, Yoon CS, Ditmore M, Bane A, Levtzion-Korach O, Moniz T, Rothschild JM, Kachalia AB, Hayes J, Churchill WW, Lipsitz S, Whittemore AD, Bates DW, Gandhi TK (2010) Effect of bar-code technology on the safety of medication administration. N Engl J Med 362:1698–1707PubMedCrossRefGoogle Scholar