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Safety climate reduces medication and dislodgement errors in routine intensive care practice

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Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

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Acknowledgments

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.

Author information

Authors and Affiliations

  1. General and Medical ICU, Rudolfstiftung Hospital, Juchgasse 25, 1030, Vienna, Austria

    Andreas Valentin

  2. Research Institute for Health Care Management and Health Care Economics, Vienna University of Economics and Business, Vienna, Austria

    Michael Schiffinger, Johannes Steyrer & Clemens Huber

  3. Complexity-Research, Vienna, Austria

    Guido Strunk

  4. Department of Business Administration and Economic Education, University of Technology, Dortmund, Germany

    Guido Strunk

Authors
  1. Andreas Valentin
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  2. Michael Schiffinger
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  3. Johannes Steyrer
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  4. Clemens Huber
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  5. Guido Strunk
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Corresponding author

Correspondence to Andreas Valentin.

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134_2012_2764_MOESM1_ESM.doc

Supplementary material 1. Safety climate reduces medication and dislodgement errors in routine intensive care practice (DOC 47 kb)

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Valentin, A., Schiffinger, M., Steyrer, J. et al. Safety climate reduces medication and dislodgement errors in routine intensive care practice. Intensive Care Med 39, 391–398 (2013). https://doi.org/10.1007/s00134-012-2764-0

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