Impact of Safety Climate Perception and Barriers to Adverse Drug Reaction Reporting on Clinical Nurses' Monitoring Practice for Adverse Drug Reactions

Hyun Jin Kim; Seon Young Hwang

doi:10.7475/kjan.2018.30.2.115

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Kim and Hwang: Impact of Safety Climate Perception and Barriers to Adverse Drug Reaction Reporting on Clinical Nurses' Monitoring Practice for Adverse Drug Reactions

Original Article

Korean J Adult Nurs 2018;30(2):115-125.

Published online: 21 April 2018

DOI: https://doi.org/10.7475/kjan.2018.30.2.115

Impact of Safety Climate Perception and Barriers to Adverse Drug Reaction Reporting on Clinical Nurses' Monitoring Practice for Adverse Drug Reactions

Hyun Jin Kim¹, Seon Young Hwang^2,

¹Hanyang University Seoul Hospital ․ Graduate School, Hanyang University, Seoul, Korea

²School of Nursing, Hanyang University, Seoul, Korea

Corresponding author: Hwang, Seon Young https://orcid.org/0000-0003-3613-3350 College of Nursing, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. Tel: +82-2-2220-0702, Fax: +82-2-2295-2074, E-mail: seon9772@hanyang.ac.kr

Received 24 October 201714 December 2017 Accepted 25 March 2018

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 aim of this study was to impact describe the perception of safety and barriers to adverse drug reactions (ADR) reporting on clinical nurses' monitoring practice for ADR.

Methods

A cross-sectional descriptive study was conducted for 270 nurses working at two major general hospitals by convenience sampling. Data were collected using self-report structured questionnaires from May to June, 2017 and analyzed using the SPSS/WIN 22.0 program.

Results

The nurses' mean score of perceived safety climate was identified towards the hospital organization level (34.41±7.12), towards the work unit level (66.32±9.42), towards the individual level (7.56±1.50) and towards the ADR monitoring practice (32.68±5.42). ADR monitoring practices are positively correlated with that of perceived safety climate at the work unit level and negatively correlated with the barriers to ADR reporting both at the individual and organizational (p<.001) levels. Multiple regression analysis showed that perceived safety climate at the work unit level (β=.37), at the hospital organization level (β=-.18) and the individual barriers to ADR reporting (β=-.42) were found to be predictors of ADR monitoring practice (Adj R²=.36, F=16.38, p<.001).

Conclusion

These findings suggest that an effective educational program needs to be developed to assist the clinical nurses’ ADR monitoring practice by improving the nurses’ perception of safety climate at the work unit level and reducing the barriers to ADR reporting.

Keywords: Nurses, Safety culture, Adverse drug reaction, Drug monitoring

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Table 1.

Degrees of Perceived Safety Climate, Barriers to Adverse Drug Reaction (ADR) Reporting and ADR Monitoring Practice (N=270)

Variables	Categories	M± SD (total score)	Actual range	Possible range	M± SD (by item)
Perceived safety climate	Hospital safety climate (12 items)	34.41±7.12	15~54	12~60	2.87±0.67
	Work-unit safety climate (21 items)	66.32±9.42	21~91	21~105	3.16±0.60
	Individual/Interpersonal safety climate (2 items)	7.56±1.50	3~10	2~10	3.78±0.74
Barriers to ADR reporting	Individual barriers to ADR reporting	17.18±3.96	5~30	5~30	3.45±1.09
	Lack of knowledge		1~6	1~6	3.40±0.97
	Lack of time to report		1~6	1~6	4.17±1.19
	Be unhelpful and meaningless to treat		1~6	1~6	3.32±1.15
	I'm not interested in reporting		1~6	1~6	3.05±1.07
	I don't know what medicines to report		1~6	1~6	3.28±1.08
	Organizational barriers to ADR reporting	14.21±4.30	5~25	5~30	2.84±1.15
	I'm afraid of doctors' reproaches		1~6	1~6	2.76±1.09
	I don't know how to report it.		1~6	1~6	2.51±1.27
	I'm afraid of get blamed by my co-worker		1~5	1~6	2.52±1.16
	Lack of positive feedback from the boss		1~6	1~6	3.27±1.10
	Because the reporting system is difficult		1~6	1~6	3.14±1.11
ADR monitoring practice		32.68±5.42	10~46	10~50	3.27±0.03

ADR=adverse drug reaction.

Table 2.

Differences in Perceived Safety Climate by Participants' Characteristics (N=270)

Variables	Categories	n (%)	Perceived safety climate
Variables	Categories	n (%)	Hospital		Work-unit		Individual/ Interpersonal
			M± SD	t or F (p)	M± SD	t or F (p)	M± SD	t or F (p)
Age (year)	22~29 ^a	164 (61.0)	34.54±7.52	2.41	66.42±9.83	2.08	7.45±1.61	1.28
	30~39 ^b	57 (20.8)	32.85±5.72	(.092)	64.55±9.04	(.127)	7.82±1.22	(.280)
	40~58 ^c	49 (18.2)	35.88±6.86		68.33±7.75		7.60±1.41
Education^†	College ^a	79 (29.3)	32.70±6.06	4.50	64.57±8.28	2.65	7.47±1.58	0.26
	Bachelor ^b	176 (65.2)	34.89±7.49	(.012)	66.80±9.99	(.073)	7.46±1.58	(.772)
	≥ Master ^c	15 (5.5)	34.86±5.16	a, c＜ b	70.00±5.87		7.73±1.28
Marital status	Unmarried	199 (73.7)	35.17±6.24	1.05	67.51±8.67	1.21	7.56±1.34	0.09
	Married	71 (26.3)	34.14±7.40	(.295)	65.91±9.65	(.227)	7.56±1.55	(.994)
Total clinical experience (year)^†	3 ^a	99 (36.7)	36.68±0.81	7.46	68.41±1.05	4.09	7.51±1.62	0.38
	3~4 ^b	46 (17.0)	31.69±0.89	(＜.001)	63.14±1.14	(.003)	7.41±1.54	(.823)
	5~9 ^c	61 (22.6)	31.85±0.68	a, e＞ b, c	64.03±1.16	a, e＞ b	7.70±1.38
	10~14 ^d	15 (5.6)	33.07±1.16		64.71±2.81		7.80±1.20
	≥15 ^e	49 (18.1)	35.92±0.97		68.25±1.12		7.52±1.44
Clinical experience in current hospital (year)^†	3 ^a	99 (36.7)	36.88±7.75	8.73	68.67±9.98	4.91	7.48±1.62	0.36
	3~4 ^b	47 (17.4)	31.31±6.46	(＜.001)	62.64±8.18	(＜.001)	7.49±1.53	(.833)
	5~9 ^c	62 (23.0)	31.68±5.39	a, e＞ b, c	63.82±8.92	a＞ b, c	7.69±1.39
	10~14 ^d	14 (5.2)	34.78±5.11		67.00±11.4		7.86±1.09
	≥15 ^e	48 (17.7)	35.66±6.66		67.96±7.62		7.51±1.45
Regional pharmacovigilance center	No	124 (45.9)	33.27±7.50	-2.42	64.56±9.02	-2.76	7.69±1.52	1.31
	Yes	146 (54.1)	35.38±6.64	(.016)	67.76±9.51	(.006)	7.44±1.47	(.190)

Frequency of ADR education	0	68 (25.1)	35.84±7.57	1.81	66.65±9.99	0.04	7.69±1.56	1.22
	1~3	199 (73.7)	33.91±7.03	(.165)	66.29±9.33	(.958)	7.57±1.46	(.296)
	4~6	3 (1.2)	34.00±3.00		65.67±1.15		6.33±2.08
Frequency of ADR reporting (for 1year)	0	128 (47.4)	34.70±7.59	0.64	65.73±9.69	0.80	7.61±1.49	0.27
	1~10	129 (47.7)	34.33±6.77	(.529)	67.06±9.28	(.450)	7.49±1.55	(.765)
	≥11	13 (4.9)	32.38±5.75		64.77±8.15		7.69±1.18

ADR=adverse drug reaction;

^† Scheffé test.

Table 3.

Differences in Barriers to Adverse Drug Reaction (ADR) Reporting and ADR Monitoring by Participants' Characteristics (N=270)

Variables	Categories	Barriers to ADR reporting				ADR monitoring practice
		Individual		Organizational		ADR monitoring practice
		M± SD	t or F (p)	M± SD	t or F (p)	M± SD	t or F (p)
Age (year)^†	22~29 ^a	17.37±3.92	0.77	14.99±4.10	8.48	32.26±5.04	3.48
	30~39 ^b	17.15±4.29	(.466)	13.45±4.29	(＜.001)	32.24±5.59	(.032)
	40~58 ^c	16.57±3.75		12.37±4.33	a＞ c	34.51±6.20
Education	College ^a	17.13±4.07	0.05	13.82±4.53	.62	32.41±5.70	1.33
	Bachelor ^b	17.17±3.99	(.956)	14.42±4.13	(.538)	32.61±5.30	(.267)
	≥ Master ^c	17.47±3.23		13.73±5.04		34.86±5.16
Marital status	Unmarried	17.36±3.89	-1.25	14.66±4.11	-2.94	33.98±5.61	2.34
Marital status	Married	16.67±4.14	(.214)	12.94±4.59	(.004)	32.22±5.29	(.020)
Total clinical experience (year)^†	3 ^a	16.66±4.22	1.30	15.65±3.98	6.25	32.89±4.99	2.81
	3~4 ^b	17.85±3.65	(.271)	14.07±4.16	(＜.001)	31.21±5.38	(.026)
	5~9 ^c	17.88±3.49		13.89±3.87	a＞ d	31.83±4.72	b＜ e
	10~14 ^d	16.86±5.48		13.07±4.96		33.00±6.55
	≥15 ^e	16.88±3.69		12.20±4.49		34.57±6.32
Clinical experience in current hospital (year)^†	3 ^a	16.58±4.19	1.71	15.58±4.07	5.77	32.92±4.98	2.90
	3~4 ^b	18.15±3.72	(.148)	14.21±3.98	(＜.001)	31.12±5.32	(.022)
	5~9 ^c	17.76±3.36		13.84±3.90	a＞ d	31.91±4.73
	10~14 ^d	16.92±5.72		12.79±5.15		32.84±6.53
	≥15 ^e	16.83±3.72		12.29±4.49		32.68±5.42
Regional pharmacovigilance center	No	16.85±4.10	-1.23	15.14±4.02	3.35	32.41±5.25	-7.36
Regional pharmacovigilance center	Yes	17.45±3.84	(.220)	13.42±4.38	(.001)	32.90±5.58	(.462)
Frequency of ADR education	0	16.47±3.83	1.43	14.62±4.08	0.44	31.77±5.48	1.54
	1~3	17.42±4.02	(.241)	14.05±4.40	(.644)	33.10±5.35	(.215)
	4~6	16.50±3.54		14.00±3.46		31.67±5.03
Frequency of ADR reporting (for 1 year)^†	0 ^a	17.31±3.97	0.20	15.83±3.88	23.57	31.84±5.45	4.88
	1~10 ^b	17.02±3.98	(.823)	13.05±4.05	(＜.001)	33.14±5.34	(.008)
	≥11 ^c	17.46±3.95		9.92±4.13	a＞ b＞ c	36.23±4.25	a＜ c

ADR=adverse drug reaction;

^† Scheffé test.

Table 4.

Correlations among Safety Climate, Barriers to Adverse Drug Reaction (ADR) Reporting, and ADR Monitoring Practice (N=270)

Variables	Categories	Perceived safety climate			Barriers to ADR reporting		ADR monitoring practice
		Hospital	Work-unit	Individual	Individual	Organizational	ADR monitoring practice
		r (p)	r (p)	r (p)	r (p)	r (p)	r (p)
Perceived safety climate	Hospital	1
	Work-unit	.70 (＜.001)	1
	Individual/	-.11 (.082)	.02 (.720)	1
	interpersonal
Barriers to ADR reporting	Individual	-.42 (＜.001)	-.54 (＜.001)	-.15 (.013)	1
Barriers to ADR reporting	Organizational	.17 (.006)	-.28 (＜.001)	-.24 (＜.001)	.51 (＜.001)	1
ADR monitoring practice		.27 (＜.001)	.47 (＜.001)	.06 (.318)	-.54 (＜.001)	-.31 (＜.001)	1

ADR=adverse drug reaction.

Table 5.

Predictors of Adverse Drug Reaction Monitoring Practice (N=270)

Variables	Categories	Model 1					Model 2
Variables	Categories	B	SE	β	t	p	B	SE	β	t	p
(Constant)		44.55	1.56		28.59	.001	32.11	3.40		9.45	.001
Individual factors	Age (year)
	40~58 (ref.)
	30~39	-1.23	1.95	-.09	-0.63	.528	-1.15	1.88	-.08	-0.61	.543
	22~29	1.27	1.03	.11	1.24	.217	1.07	0.99	.09	1.08	.280
	Marital status
	Married (ref.)
	Unmarried	0.66	0.95	.05	0.70	.482	0.69	0.91	.05	0.75	.452
	Total clinical experience
	≥15 (ref.)
	5~14	3.27	1.96	.23	1.67	.096	2.98	1.90	.21	1.57	.118
	＜5	-0.70	0.88	-.06	-0.78	.434	-0.54	0.88	-.05	-0.62	.538
	Perceived barriers to ADR reporting	-0.75	0.07	-.55	-10.08	.001	-0.58	0.10	-.42	-6.03	.001
Organizational factors	Safety climate at work-unit level						0.22	0.05	.37	4.81	.001
	Safety climate at hospital organization level						-0.14	0.06	-.18	-2.51	.013
	Organizational barriers to ADR reporting						0.01	0.78	.01	0.14	.886

R²=.32, Adjusted R²=.30, F=19.07, p＜.001 R²=.38, Adjusted R²=.36, F=16.38, p＜.001

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