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Patient safety during medication administration:

The influence of organizational and individual variables on unsafe work practices and

medication errors

Ergonomics Vol. 49, Nos. 5–6, 15 April–15 May 2006, 444–456

報告者：林秀芸

Study objective

Using SEM to measure organizational climate

To test a model with hypothesized links between climate and unsafe medication administration behaviors

Mediating role: stress and morale

Introduction

20% hospital incidents were caused by errors of medications. (Malpass et al., 1999)

17% hospital incidents were involved in medication errors. (Australian Quality of Health Care Study, 1995)

Medications: iatrogenic injury and illness (Bates, 1999)

Introduction

Most errors occurred in (Leape et al., 1995) Doctor prescribing 39% Nurse administration 38% Transcription pharmacy dispensing

Errors were caused by poor mathematical skills, lack of drug knowledge, excess workload, inadequate staffing levels, inexperience, failure to follow procedures, distractions, and interruption and quality of prescriptions. (O”Shea, 1999)

Introduction

Queensland Public Agency Staff Survey (QPASS; Hart et al., 1996) Organizational climate Individual stress Morale Quality of working life

Organizational climate Workplace morale, supportive leadership,

participative decision-making, role clarity, professional interaction, appraisal and recognition, professional growth, and goal congruence

Workplace distress and excessive work demands

Introduction

Introduction

176 nurses 11 public sector hospitals 41-50 years old: 33.5% 92% females 10 years experience with Queensland Health:

59.1% Work for over 20 years: 21.6%

Methods

Conclusions

Errors and violations are different. Violations: not intended to do harm Stress was a significant mediator. Excessive workload and expectations of doctors

increased the frequency of medication violations. No evidence showed that nurses are less safety-

conscious than workers in other high-risk industries.

Regular monitoring of organizational, safety climate and levels of individual distress and morale is helpful for achieving better health outcomes for everyone.

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