Reducing medication errors in nursing practice part 4

Organisational safety culture

A safety culture in healthcare systems comprises enlightened leadership, teamwork and a patient-centred approach to care (Sammer et al 2010). Organisations involved in highly complex, technological processes demand a failure-free operational standard from their staff. Frankel et al (2006) summarise the attributes necessary to achieve this as ‘mindfulness’. Such attributes include:

• An awareness of the possibility of failure.
• Respect for all colleagues.
• An ability to adjust and remodel plans in unforeseen circumstances.
• An ability to accommodate the bigger picture, while maintaining focus on an isolated task.

Role played by unit manager in culture of safety

• While a culture of safety is partially determined by organisational structure and leadership, the unit manager plays a significant role in the effective implementation of the safety culture in a nursing team (Mayo and Duncan 2004, Ulanimo et al 2007, Valentin et al 2009).
• Until recently, nurses have focused on their individual actions in efforts to promote safety and prevent harm to patients (Mayo and Duncan 2004, Ulanimo et al 2007, Valentin et al 2009). While this remains good practice, nurses should also evaluate the way they function in teams to ensure that the collective systems and processes of practice are safe and to support and educate inexperienced colleagues (Mayo and Duncan 2004, Ulanimo et al 2007, Valentin et al 2009).
• An emotionally unsafe environment (that is, one led by managers who believe in demonstrating power and control over employees, who do not recognise individual needs or who are intimidating), along with fear of discipline, can inhibit the reporting of errors by nurses (Mayo and Duncan 2004, Ulanimo et al 2007, Valentin et al 2009).
• In a study of 983 nurses, 76.9% thought that medication errors were unreported because of fear of a negative reaction from the unit manager (Mayo and Duncan 2004).
• Organisations that aim to understand fully the factors, systems and processes that lead to medication errors and to identify error minimisation strategies need staff to feel free to voice concerns in a safe environment, and admit to errors and the need for development (Frankel et al 2006).

Importance of communication and experience in maintaining a safety culture

• Effective communication is a key element of the safety culture in an organisation, particularly the communication between and within multidisciplinary teams in relation to medication processes (Savvato and Efstratios 2014).
• Nurses are directly involved in preventing errors at administration level and are often integral to prompting prescriptions, advising on dosages during the prescription writing phase, informing pharmacy about incorrectly dispensed medication, detecting errors and taking corrective action in medication preparation before administration (Popescu et al 2011).
• Inexperienced nurses are particularly vulnerable to errors associated with miscommunication, because of low levels of anticipation or awareness of the potential for error. They are therefore less likely than their experienced colleagues to seek clarification either through verbal communication with colleagues or from written information (Kazaoka et al 2007, Savvato and Efstratios 2014).
• Experience promotes anticipation and early detection of errors (Seki and Yamazaki 2006). Therefore, ensuring an adequate skill mix on shifts may help prevent medication errors (Tang et al 2007).
• Communicating with and educating patients about their medications during the administration process can result in individuals being better informed about and more involved with their medicines, thereby improving the quality and safety of medication administration (Popescu et al 2011). This may be particularly the case in community settings, such as in a patient’s home, where the most common reason for medication errors relates to administration. Therefore, helping patients to understand and manage medication administration safely can contribute to reducing errors (NPSA 2007).

Complete time out activity 3

List any strategies that foster a safe reporting environment in your workplace. How could you personally contribute towards implementing them?

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Learning points

1. The safety culture in healthcare systems comprises enlightened leadership, teamwork and a patient-centred approach to care. The necessary attributes to achieve a failure-free operational standard are awareness of the possibility of failure, respect for all colleagues, ability to adjust and remodel plans in unforeseen circumstances and ability to accommodate the bigger picture while still maintaining focus on an isolated task.
2. The unit manager plays a significant role in the effective implementation of the safety culture in a nursing team. An emotionally unsafe environment along with fear of discipline can inhibit the reporting of errors by nurses.
3. Organisations that aim to understand the factors, systems and processes that lead to medication errors and to identify error minimisation strategies need staff to feel free to voice concerns in a safe environment, and admit to errors and the need for development.
4. Effective communication is a key element of the safety culture in an organisation, particularly the communication between and within multidisciplinary teams in relation to medication processes.