Volume 28, Issue 4 (Fall 2020)                   Avicenna J Nurs Midwifery Care 2020, 28(4): 20-31 | Back to browse issues page


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Kakemam E, Sheikhy-Chaman M. The Relationship between Patient Safety Culture and Adverse Events among Nurses in Tehran Teaching Hospitals in 2019. Avicenna J Nurs Midwifery Care 2020; 28 (4) :20-31
URL: http://nmj.umsha.ac.ir/article-1-2118-en.html
1- PhD Student in Health Services Management, Department of Services Management, School of Health Management and Information Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
2- PhD Student in Health Economics, Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran , urmialord@gmail.com
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✅ The results of the present study confirmed the hypothesis that improving the patient safety culture leads to decrease in the incidence of adverse events among nurses, therefore promoting the safety culture in hospitals of country should be considered as one of the main priorities of management programs.


Extended Abstract:   (696 Views)
Introduction

Patient safety culture has been identified as one of the important factors in reducing hospital adverse events and improving patient safety. The present study was conducted to investigate the relationship between patient safety culture and adverse events among nurses of selected teaching hospitals in Tehran.


 

Materials and Methods


This cross-sectional study was performed in 2019 on 260 nurses in 7 hospitals affiliated to Tehran University of Medical Sciences. Data was collected using the patient safety culture questionnaire and the frequency of adverse events. Multiple logistic regression was used to investigate the relationship between patient safety culture and adverse events in SPSS 22 (SPSS Inc., Chicago, Ill., USA).

 

Results

Among the dimensions of patient safety culture, the highest mean score was related to the dimension of "organizational learning" and the lowest score was in the area of "information exchange and transmission". Between 35.4% and 51.9% of nurses estimated that they had experienced one of six adverse event in the past year. Logistic regression results indicated that dimensions of management support for patient safety, general understanding of patient safety culture, teamwork within organizational units, communication and feedback about errors, staffing issues and information exchange and transmission were significant predictors for adverse events (P<0/05).
 
Table 1. Demographic characteristics of nurses
Variable Class N %
Gender Female 44 16.9
Man 216 83.1
Marital status Single 82 31.5
Married 178 68.5
Age (year) 33-23 117 45.0
43-34 93 35.8
44≤ 50 19.2
Experience in clinical work
 
10≥ 143 55.0
11-20 75 28.8
20˃ 42 16.2
Level of Education
 
Bachelor 255 86.5
Masters degree and higher 35 13.5
Workplace section
 
Intensive care 80 30.8
Emergency 12 4.6
General wards (internal medicine, surgery, gynecology, pediatrics, cardiology) 168 64.6
The amount of working hours ≥44 h 150 57.7
< 44 h 110 42.3
 
Table 2. Mean scores of patient safety culture dimensions
Dimensions of patient safety culture M ± SD
Organizational Learning 74.0±45.3
Communication and providing feedback on errors 82.0±44.3
Teamwork within organizational units 88.0±42.3
Employee management support 74.0±15.3
Incident reporting frequency 82.0±14.3
Unpunished response to an error event 93.0±10.3
Employee issues 76.0±5.3
Teamwork between organizational units 91.0±3
General understanding of patient safety 56.0±99.2
Open communication channels 730±87.2
Patient safety management support 65.0±62.2
Exchanges and transfer of information 86.0±45.2
Total score of patient safety culture 40.0±6.3
 
Table 3. Adverse events estimated by nurses in the past year
Unwanted events
 
N (%) Incidents occurred Number (%)
Several times a year Once a month or less Several times a month Once a week Several times a week Everyday
Bedsore (48.1)12۵ (35.8)93 (7.7)20 (5.4)15 (1.2)3 (1.5)4 (0.4) 1
Falling out of bed sick (64.6)168 (22.3)58 (8.8)2۳ (7.2)7 (0.8)2 (0.4)1 (0.4) 1
Side effects of the drug (51.9)135 (36.5)95 (8.1)21 (2.7)7 (0.4)1 (0.4)1 (0.4) 1
Surgical wound infection (51.5)134 (31.9)83 (8.8)23 (5.8)15 (1.2)3 (0.4)1 (0.4) 1
Reaction to transfusion or blood transfusion (59.2)154 (28.1)73 (9.6)25 (1.5)4 (0.8)2 (0.4)1 (0.4) 1
Complaints of the patient or his family (48.1)125 (32.3)84 (5.8)15 (9.2)24 (1.2)3 (3.1)8 (0.4) 1
 
Table 4. Relationship between dimensions of patient safety culture and adverse events
P 95% CI Exp (B) Variable
Bedsore
0.001> (1.34- 3.87) 28.2 Patient safety management support
The patient falls out of bed
0.01 (1.17- 3.23) 1.94 Communication and providing feedback on errors
0.03 (0.36- 0.97) 0.59 Employee issues
0.01 (1.08- 2.53) 1.65 Exchanges and transfer of information
Side effects of the drug
0.001> (1.18- 2.83) 1.83 Teamwork within organizational units
Reaction to transfusion or blood transfusion
0.03 (1.03- 3.41) 1.88 General understanding of patient safety culture
Complaints of patients or their families
0.01 (1.16- 3.21) 1.94 Patient safety management support
 


 
Discussion


The overall score of patient safety culture in the present study was moderate. In line with the findings of this study, the study of Mostafaei et al. in Tehran hospitals showed that patient safety culture in the studied hospitals with an average of 60% compared to other countries is at an average level and among the various dimensions of safety culture, the highest score Positive was the dimension of teamwork within hospital units and the frequency of reporting adverse events (25).
In the present study, among the dimensions of patient safety culture, the highest means were related to the dimension of organizational learning, the dimension of communication and providing feedback on errors, and the dimension of teamwork between organizational units. In studies conducted in other countries, the dimension of teamwork within hospital units and organizational learning were identified as the strength of patient safety culture, which were consistent with the findings of the present study [26-32].
In addition to some of the mentioned strengths, in the present study, the dimensions of exchanges and information transfer, management support for patient safety and open communication channel in the hospital were the weak points of patient safety culture from the nurses' point of view. In a study conducted in Sweden, management support for patient safety was also identified as a weakness of patient safety culture (32).
Regarding the prevalence of adverse events, the results of the present study showed that the prevalence of these accidents was high among nurses. The majority (35.4% to 51.9%) of nurses estimated that an unintended accident happened to them once a year. The rate of reporting unintended accidents in a study in Iran was between 57.7% and 76.1%, which for blood infection, bed sores, falls and nosocomial infections, this rate was 76.1%, 66.2%, 59% and 57.7%, respectively (8).
In relation to the association between the dimensions of patient safety culture and adverse events and based on the findings of the present study, general understanding of patient safety culture, teamwork within organizational units, communication and feedback on errors, staff and exchange issues and information transfer were the significant predictors of unintended incidents.


 

Conclusion

The results of the present study confirmed the hypothesis that improving the patient safety culture leads to decrease in the incidence of adverse events among nurses, therefore promoting the safety culture in hospitals of country should be considered as one of the main priorities of management programs.

 

Acknowledgments

This article was the result of a research project approved by Tehran University of Medical Sciences and Health Services in 2017 with the approved project number 36848-61-01-97 and ethics code IR.TUMS.VCR.REC.1397.293. The authors would like to thank the Vice Chancellor for Research and Technology of Tehran University of Medical Sciences and Health Services for their financial support and all the officials of the university hospitals for their cooperation in conducting the research.

 

Conflicts of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

 

Type of Study: Original Research | Subject: Nursing
Received: 2020/04/25 | Accepted: 2020/07/15 | Published: 2020/10/1

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