Journal List > J Korean Acad Nurs > v.49(5) > 1136401

Park and Lee: Influencing Factors and Consequences of Near Miss Experience in Nurses’ Medication Error

Abstract

Purpose

This study aimed to predict the influencing factors and the consequences of near miss in nurses’ medication error based upon Salazar & Primomo's ecological system theory.

Methods

A convenience sample of 198 nurses was recruited for the cross-sectional survey design. Data were collected from July to September 2016. Using the collected data, the developed model was verified by structural equation modeling analysis using SPSS and AMOS program.

Results

For the fitness of the hypothetical model, the results showed that χ 2 (χ 2=258.50, p<.001) was not fit, but standardized χ 22/df=2.35) was a good fit for this model. Additionally, absolute fit index RMR=.06, RMSEA=.08, GFI=.86, AGFI=.81 reached the recommended level, but the Incremental fit index TLI=.82, CFI=.85 was not enough to reach to the recommended level. With the path diagram of the hypothetical model, caution (β=-.29 p<.001), patient safety culture (β=-.20, p=.041), and work load (β=.18, p=.037) had a significant effect on the near miss experiences in nurses’ medication error, while fatigue (β=-.06, p=.575) did not affect it. Moreover, the near miss experience had a significant effect on work productivity (β=-.25, p=.001).

Conclusion

These results have shown that to decrease the near miss experience by nurses and increase their work productivity in hospital environments would require both personal and organizational effort.

References

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Figure 1.
The conceptual framework of this study.
jkan-49-631f1.tif
Figure 2.
Path diagram for the final model.
jkan-49-631f2.tif
Table 1.
General Characteristics of the Subjects (N=198)
Characteristics Categorie s n % M±SD
 Total career (yr) 1~<3 77 28.8 5.64±5.22
3~<5 38 19.2
5~<10 57 38.9
≥10 26 13.1
 Present career (yr) 1~<3 103 52.0 3.79±3.16
3~<5 35 17.7
5~<10 45 22.7
≥10 15 7.6
 Working unit Medical 63 31.8
Surgical 68 34.3
ICU 31 15.7
ER 9 4.6
Others 27 13.6
 Hospital beds <500 29 14.7
500~<1000 0 87 43.9
≥1000 82 41.4
 Job position Staff nurse 177 89.4
Charge nur se 21 10.6
 Educational Diploma 40 20.2
Bachelor 145 73.2
≥Graduate 13 6.6
 Total 198 100.0

ER=Emergency room; ICU=Intensive care unit; M=Mean; SD=Standard deviation.

Table 2.
Descriptive Statistics of Research Variables (N=198)
Variables Categories Range Min Max M±SD Skewness Kurtosis C. R. AVE
 Caution Conscientiousness 1~5 2.33 5.00 3.61±0.52 -0.01 -0.13 .90 .70
Inattention 1~5 1.00 5.00 3.35±0.68 -0.49 0.12
Cautiousness 1~5 2.00 5.00 3.36±0.60 -0.30 -0.48
Risk sensitiveness 1~5 1.50 5.00 3.38±0.61 -0.41 -0.07
Total 1~5 2.00 4.38 3.43±0.45 -0.48 -0.21
 Fatigue Depletive 1~5 1.08 4.33 2.94±0.61 -0.20 -0.30 .87 .69
Nervous 1~5 1.00 5.00 3.43±0.82 -0.42 0.10
Chronic 1~5 1.00 5.00 2.94±0.76 0.23 -0.26
Total 1~5 1.03 4.58 3.10±0.61 -0.27 0.06
 Patient safety culture Event report 1~5 1.00 5.00 2.79±0.75 -0.15 -0.14 .87 .62
Safety management 1~5 1.00 5.00 3.33±0.60 -0.37 0.96
Supervisor 1~5 2.00 5.00 3.65±0.57 -0.71 0.88
Communication 1~5 1.67 5.00 3.50±0.48 -0.08 0.99
Total 1~5 2.22 5.00 3.62±0.41 -0.18 1.36
 Work load 1~21 4.60 21.00 15.69±2.82 -0.77 1.22
 Near miss in medication error 0~5 0.00 2.67 1.39±0.54 0.75 2.84
 Work productivity Cognitive demand -2~2 -0.50 2.00 1.16±0.54 -0.06 0.01 .92 .74
Handle workload -2~2 -1.80 2.00 0.61±0.59 -0.08 0.98
Support and communicati on -2~2 -1.00 2.00 0.76±0.58 -0.09 0.20
Safety and competency -2~2 -0.70 2.00 0.88±0.52 0.23 0.09
Total -2~2 -0.75 1.95 0.85±0.43 0.10 0.65

M=Mean; SD=Standard deviation; C.R.=Construct reliability; AVE=Average variance extracted.

Table 3.
Standardized Direct, Indirect, and Total Effects of the Final Model (N=198)
Endogenous variables Exogenous variables Standardized estimates C.R. p SMC Direct effect β (p) Indirect effect β (p) Total effect β (p)
 Near miss in medication error Caution -.29 -3.43 <.001 .18 -.29 (<.001) -.29 (<.001)
Fatigue -.06 -0.56 .575 -.06 (.575) -.06 (.575)
Patient safety culture -.20 -2.04 .041 -.20 (.041) -.20 (.041)
Work load .18 2.08 .037 .18 (.037) .18 (.037)
 Work Productivity Caution .07 (.003) .07 (.003)
Fatigue .02 (.528) .02 (.528)
Patient safety culture .05 (.021) .05 (.021)
Work load -.05 (.005) -.05 (.005)
Near miss in medication error -.25 -3.19 .001 .07 -.25 (.001) -.25 (.001)

C.R.=Critical Ratio; SMC=Squared Multiple Correlation.

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