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Utility of patient safety case finding methods and associations among organizational safety climate, nurse injuries, and errors.

Baltimore, MD: Johns Hopkins University, 2008 May; :1-178
Background. Medical errors claim 44,000-98,000 lives annually. Understanding the role of organizational safety climate and nurse staffing are integral to successful patient safety interventions and may also pertain to nurse injury. Methods. This study triangulated multiple data systems and case identification criteria to maximize patient safety event case-finding with the goal of conceptualizing a feasible and sustainable patient safety surveillance system. One hospital's inpatient discharge data and its error-reporting system were used. Unique identifiers were linked to find identical cases among data systems. Using multilevel logistic regressions, two additional study components assessed nursing unit characteristics, nurse perceptions of organizational safety climate as measured by the Safety Attitudes Questionnaire (SAQ, and associations with patient and nurse injury. Results. Data triangulation was necessary to detect patient safety events. The lack of overlap among the detection systems was significant. Increasing Stress Recognition was associated with a 3-fold increase in the odds of nurse injury, and a 1.5 to 3-fold increase in the odds of patient falls, medication errors, and decubitus ulcers. Nurse injury odds decreased with increasing positive attitudes regarding Safety Climate and Morale/Job Satisfaction. A negative association was observed between Safety Climate and the odds of decubitus ulcers. A two-fold increase in the odds of nurse injury with increasing turnover was observed. No associations between nurse turnover and patient outcomes were found. Nursing hours per patient day were negatively associated with patient falls and positively associated with medication errors. Conclusions. The case-finding study found little overlap among case identification criteria as applied to administrative data and an error-reporting system. Available data systems should be triangulated to maximize the detection of patient safety events. The study components linking organizational climate to injuries showed that: (1) nurse injury is associated with turnover while patient injury is not, (2) patient injuries are associated with nursing hours per patient day while nurse injuries are not, (3) increasingly positive perceptions of Safety Climate and Morale/Job Satisfaction are associated with decreased odds of nurse injury, while only Safety Climate is associated with decreased odds of decubitus ulcer, and (4) increased Stress Recognition is associated with increased odds of nurse and patient injury.
Medical-personnel; Nurses; Safety-measures; Stress; Injuries; Occupational-health; Health-care-personnel; Medical-services; Medical-treatment
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Utility of Patient Safety Case Finding Methods and Associations Among Organizational Safety Climate, Nurse Injuries, and Errors
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Johns Hopkins University