Medication Error Management Climate and Perception for System Use according to Construction of Medication Error Prevention System

Myoung Soo Kim

doi:10.4040/jkan.2012.42.4.568

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Kim: Medication Error Management Climate and Perception for System Use according to Construction of Medication Error Prevention System

Original Article

J Korean Acad Nurs 2012;42(4):568-578.

Published online: 12 August 2012

DOI: https://doi.org/10.4040/jkan.2012.42.4.568

Medication Error Management Climate and Perception for System Use according to Construction of Medication Error Prevention System

Myoung Soo Kim

Department of Nursing, Pukyong National University, Busan, Korea

Address reprint requests to : Kim, Myoung Soo Department of Nursing, Pukyong National University, 599-1 Daeyeon 3-dong, Nam-gu, Busan 608-737, Korea Tel: +82-51-629-5782 Fax: +82-51-629-7906 E-mail: kanosa@pknu.ac.kr

Received 18 October 2011 Revised 31 October 2011 Accepted 24 July 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this cross-sectional study was to examine current status of IT-based medication error prevention system construction and the relationships among system construction, medication error management climate and perception for system use.

Methods

The participants were 124 patient safety chief managers working for 124 hospitals with over 300 beds in Korea. The characteristics of the participants, construction status and perception of systems (electric pharmacopoeia, electric drug dosage calculation system, computer-based patient safety reporting and bar-code system) and medication error management climate were measured in this study. The data were collected between June and August 2011. Descriptive statistics, partial Pearson correlation and MANCOVA were used for data analysis.

Results

Electric pharmacopoeia were constructed in 67.7% of participating hospitals, computer-based patient safety reporting systems were constructed in 50.8%, electric drug dosage calculation systems were in use in 32.3%. Bar-code systems showed up the lowest construction rate at 16.1% of Korean hospitals. Higher rates of construction of IT-based medication error prevention systems resulted in greater safety and a more positive error management climate prevailed.

Conclusion

The supportive strategies for improving perception for use of IT-based systems would add to system construction, and positive error management climate would be more easily promoted.

Keywords: Medication errors, Safety management, Culture, Perception

References

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Table 1.

Demographic and Hospital related Characteristics of Participants (N=124)

Characteristics	Categories	n (%)	M±SD
Gender	Male	8 (6.5)
	Female	116 (93.5)
Age (yr)	22-29	5 (4.0)	41.28±7.43
	30-39	42 (33.9)
	40-49	60 (48.4)
	≥50	17 (13.7)
Marital status	Married	101 (81.5)
	Single	23 (18.5)
Educational status	Diploma	13 (10.5)
	BSN	54 (43.5)
	MSN	48 (38.7)
	Doctoral course or higher	9 (7.3)
Total clinical experience (yr)	< 5	23 (18.5)	13.12±7.71
	5 -< 10	21 (16.9)
	10 -< 15	27 (21.8)
	≥15	53 (42.7)
Clinical experience in current position (yr)	< 3	62 (50.0)	4.49±4.40
	3 -< 5	18 (14.5)
	5 -< 10	32 (25.8)
	10 -< 15	7 (5.6)
	≥15	5 (4.0)
Number of beds	< 300	18 (14.5)
	300 -< 500	47 (37.9)
	500 -< 700	26 (21.0)
	700 -< 1,000	27 (21.8)
	≥1,000	6 (4.8)
Hospital type	Secondary	97 (78.2)
	Third	27 (21.8)

BSN=Bachelor of science in nursing; MSN=Master of science in nursing.

Table 2.

Current Status on Construction of Medication Error Prevention System (N=124)

System	Characteristics	Categories	n (%)
Electric pharmacopoeia	Knowledge	Yes	105 (84.7)
		No	19 (15.3)
	Construct or use	Yes	84 (67.7)
		No	40 (32.3)
	Type (n=84)	KIMS	51 (41.1)
		Developed by own hospital	23 (18.5)
		Bit drug info	10 (8.0)
	Reason for inability	Deficiency in information	28 (33.3)
	to establish	Deficiency in personal needs	24 (28.6)
		Deficiency in orientation/training	20 (23.8)
		Deficiency in hospital support	12 (14.3)
Patient safety	Knowledge	Yes	113 (91.1)
reporting system		No	11 (8.9)
	Construct	Yes	98 (79.0)
		No	26 (21.0)
	Type (n=98)	Computer-based only*	42 (33.9)
		Computer-based+Paper-based^*†	13 (10.5)
		Computer-based +Verbal-based^*‡	3 (2.4)
		All of the above*	5 (4.0)
		Paper-based only^†	46 (37.1)
		Paper-based+Verbal-based only^†‡	6 (4.8)
		Verbal-based only^‡	9 (7.3)
	Anonymity	ⓐ Real-name use	56 (45.2)
		ⓑ Anonymity guaranteed	37 (29.8)
		ⓒ Anonymity guaranteed but revealed real name	11 (8.9)
		ⓐ+ⓒ	13 (10.5)
		ⓐ+ⓑ	4 (3.2)
		ⓑ+ⓒ	2 (1.6)
		ⓐ+ⓑ+ⓒ	1 (0.8)
	Reason for inability	Deficiency in information	6 (23.0)
	to establish (n=26)	Deficiency in institutional need	6 (23.0)
		Deficiency in orientation/training	6 (23.0)
		Staff shortage/Overload	5 (19.0)
		Institutional cultural trait	2 (8.0)
		Deficiency of personal needs	1 (4.0)
Electric drug dosage	Knowledge	Yes	65 (52.4)
calculation system		No	59 (47.6)
	Construct	Yes	40 (32.3)
		No	84 (67.7)
	Type (n=40)	Unit based developed program	8 (20.0)
		EMR based	32 (80.0)
	Reason for inability	Deficiency in institutional needs	26 (31.0)
	to establish (n=84)	Deficiency in economic support	22 (26.2)
		Deficiency in information	18 (21.4)
		Deficiency in orientation/training	5 (6.0)
		Delayed construction	5 (6.0)
		Deficiency in personal need	2 (2.4)
		Institutional cultural trait	3 (3.6)
		Staff shortage/Overload	1 (1.2)
		Communication problem	1 (1.2)
		Others	1 (1.2)
Barcode system	Knowledge	Yes	104 (83.9)
		No	20 (16.1)
	Construct	Yes	20 (16.1)
		No	104 (83.9)
	Type (n=20)	Unit based developed program	3 (15.0)
		Link to the EMR	17 (85.0)
	Reason for inability	Deficiency in economic support	59 (56.7)
	to establish (n=104)	Deficiency in institutional needs	25 (24.0)
		Institutional cultural trait	7 (6.7)
		Delayed constructing	6 (5.8)
		Deficiency in information	3 (2.9)
		Staff shortage/Overload	2 (1.9)
		Deficiency in orientation/training	2 (1.9)

KIMS=Korean index of medical specialties; EMR=Electronic medical record. *Computer-based reporting system=50.8 %;

^† Paper-based reporting system=54.9 %;

^‡ Verbal-based reporting system=14.5 %.

Table 3.

Error Management Climate, Perception on Medication Error Prevention System (MEPS) Use according to MEPS Construction (N=124)

Categories		n (%)	Error management climate				Perception on program use
			Learn from medication errors	Thinking about medication errors	Medication error competence	Medication error communication	Perception on program use
			M±SD	M±SD	M±SD	M±SD	M±SD
EP	Yes	84 (67.7)	4.32±.056	4.17±0.53	3.59±0.56	4.04±0.58	7.20±1.11
	No	40(32.3)	4.08±0.52	3.85±0.83	3.56±0.61	3.62±0.82	6.87±1.59
	t (p)		2.29 (.024)	2.25 (.028)	2.13 (.035)	2.89 (.005)	0.92 (.368)
PSRS	Yes	98 (79.0)	4.28±0.53	4.10±0.58	3.50±0.55	3.92±0.64	7.10±1.26
	No	26 (21.0)	4.12±0.64	3.97±0.89	3.57±0.71	3.84±0.85	7.56±0.50
	t (p)		1.33 (.185)	0.65 (.518)	−0.50 (.618)	0.52 (.601)	−2.15 (.047)
DDCS	Yes	40 (32.3)	4.39±0.49	4.18±0.58	3.59±0.53	4.08±0.57	7.25±1.11
	No	84 (67.7)	4.18±0.57	4.02±0.69	3.48±0.61	3.82±0.73	7.06±1.29
	t (p)		2.01 (.037)	1.23 (.222)	1.02 (.311)	1.96 (.053)	0.74 (.459)
BS	Yes	20 (16.1)	4.30±0.48	4.25±0.55	3.60±0.46	4.16±0.59	7.44±1.07
	No	104 (83.9)	4.23±0.57	4.04±0.67	3.50±0.61	3.85±0.70	7.06±1.25
	t (p)		0.49 (.624)	1.34 (.183)	0.70 (.487)	1.85 (.067)	1.26 (.211)

EP=Electric pharmacopoeia; PSRS=Patient safety reporting system; DDCS=Drug dosage calculation system; BS=Barcode system.

Table 4.

Partial Correlation among Research Variables (N=124)

Variables	MEPS construction	EMC 1	EMC 2	EMC 3	EMC 4	Total EMC
Variables	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)
MEPS construction	1.00
EMC 1-learn from medication errors	.28 (.005)	1.00
EMC 2-thinking about medication errors	.37 (< .001)	.46 (< .001)	1.00
EMC 3-medication error competence	.13 (.201)	.36 (< .001)	.71 (< .001)	1.00
EMC 4-medication error communication	.20 (.042)	.14 (.150)	.62 (< .001)	.52 (< .001)	1.00
Total EMC	.34 (.001)	.63 (< .001)	.93 (< .001)	.81 (< .001)	.74 (< .001)	1.00
Perception on MEPS use	.13 (.182)	.27 (.005)	.30 (.003)	.29 (.003)	.30 (.002)	.37 (< .001)

MEPS=Medication error prevention system; EMC=Error management climate.

Table 5.

Differences in Error Management Climate and Perception on Medication Error Prevention System Use according to MEPS Construction (N=106)

	Variables	Categories	Pillai trace (p)	F	df	sig.	eta²
Covariate	Gender	Learn from medication errors	.35 (.88)	1.48	1	.227	.02
		Thinking about medication errors		0.01	1	.999	.00
		Medication error competence		0.01	1	.937	.00
		Medication error communication		0.04	1	.837	.00
		Perception on MEPS use		0.02	1	.879	.00
	Age (yr)	Learn from medication errors	1.54(.19)	0.05	1	.822	.00
		Thinking about medication errors		3.15	1	.079	.03
		Medication error competence		0.20	1	.655	.00
		Medication error communication		0.01	1	.917	.00
		Perception on MEPS use		0.17	1	.680	.00
	Education	Learn from medication errors	1.34 (.26)	4.05	1	.047	.04
		Thinking about medication errors		2.52	1	.115	.03
		Medication error competence		0.57	1	.451	.00
		Medication error communication		2.64	1	.108	.03
		Perception on MEPS use		0.69	1	.407	.01
	Nursing experience	Learn from medication errors	1.44 (.22)	0.80	1	.374	.01
		Thinking about medication errors		0.01	1	.945	.00
		Medication error competence		0.15	1	.703	.00
		Medication error communication		2.11	1	.150	.02
		Perception on MEPS use		0.56	1	.458	.01
Independent variable	MEPS	Learn from medication errors	1.79 (.04)	2.99	3	.035	.08
	construction	Thinking about medication errors		6.21	3	.001	.16
		Medication error competence		0.74	3	.533	.02
		Medication error communication		1.77	3	.157	.05
		Perception on MEPS use		0.82	3	.486	.02

MEPS=Medication error prevention system.

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