L o g o 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

 176 nurses  11 public sector hospitals  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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