Patient safety presents a serious global public health issue (WHO, 2014). Health care organizations have worked to reduce errors, identify, and analyze near misses, and foster a patient safety culture for more than 15 years all over the world. Yet, estimates indicate that in developing countries one in ten patients is harmed by a range of errors or adverse events while hospitalized (WHO, 2014). In addition, recent studies suggest that close to 210,000 patients die in the United States from preventable errors (James, 2013) and at least 3.6% of hospital deaths in England are attributed to preventable errors (Yu, Flott, Chainani, Fontana, Darzi, 2016). Patient safety and patient safety culture are key components of quality health care. Keeping patients safe is inherent in nursing care. As the largest component of the healthcare workforce, registered nurses are viewed as “inseparably linked to patient safety” (IOM, 2004, p. 23). The aim of this study was to explore registered nurses’ perceptions of patient safety culture and safety outcomes in their workplace using the AHRQ Survey on Patient Safety Culture.
Methods:
This study involved a descriptive correlational design using the AHRQ Survey on Patient Safety Culture. Is a 42-item survey that measures seven patient safety composites at the unit level, three patient safety composites at the organizational level, and four safety outcomes. The Surveys on Patient Safety Culture were mailed to a randomized sample of 500 registered nurses with active and clear licenses in a southeastern state in the United States using the Dillman Tailored Design Method (2000). The estimated sample size was calculated using G* Power 3. The results yielded a minimum of 67 nurses were needed for a medium effect size (r = 0.30), 0.05 level of significance, and the desired power of 0.80 (Fault, Erdfelder, Lang, & Buchner, 2007). Data collection took place from November 2014 to February 2015. Data analysis was completed using SPSS software for Windows, Version 23.
Results:
A total of 108 valid surveys were returned resulting in a response rate of 24%. The percent of positive results were calculated for each survey item and each composite. Negatively worded items were recoded. Among the unit-level aspects of patient safety culture, teamwork within units had the highest average positive response (76.5%) and nonpunitive response to errors had the lowest average response (25.5%). Among the organizational-level aspects of patient safety culture, management support for patient safety had the highest average positive response (52%) and handoffs & transitions had the lowest average positive response (33.75%). Twelve percent of the respondents gave their workplace an overall grade of excellent while 14.9% rated their workplace as poor or failing. The average percentage of positive responses to the safety outcomes of overall perceptions of patient safety and the frequency of events reported were 46% and 50.33% respectively. Pearson correlation coefficient was used to examine the relationships between patient safety culture composites and safety outcomes. A significant positive correlations were found between communication and openness and the frequency of events reported (p<0.001) and supervisor/manager expectation & actions promoting patient safety and patient safety grade (p<0.001). A significant negative correlation was found between staffing and the number of events reported (p<0.001).
Conclusion:
There are several limitations to this study. A major limitation of this study is the low response rate, however, the sample was representative of nurses across numerous work areas. Another limitation is the self-selection of participants. Many factors could have influenced their responses such as recent exposure to safety training or adverse event in the practice setting. Finally, the survey was conducted in one state in the southeastern region of the United States and may not be generalized to the larger population.
The findings of this study have implications for nursing practice, nursing leadership, and future research. These results provide evidence for the need to further education of frontline nurses on the importance of reporting errors and near misses. In addition, nurses must feel safe reporting errors and near misses and these findings these suggest that there is more work to be done to ensure a non-punitive environment. Understanding nurses’ perceptions will help the profession and nursing leadership to develop strategies that foster transparency in the workplace, support patient safety culture, increase safety outcomes, and improve error reporting systems.
Further research is needed to explore nurses’ perceptions of patient safety culture, safety outcomes, and error reporting regionally, nationally, and globally. In addition, further research related to each composite on the AHRQ Survey on Patient Safety Culture is recommended.
See more of: Research Sessions: Oral Paper & Posters