Medication errors are a leading cause of unintended harm to patients both in Australia and internationally and there is now a concerted attempt to identify and correct individual and workplace factors that encourage medication errors. The current study used structural equation modelling to measure organisational climate and to test a model with hypothesised links between climate and unsafe medication administration behaviours. The study also examined the possible mediating role of stress and morale. Data were collected from 176 nurses working in rural areas in Australia. The model provided a reasonable fit to the data with organisational climate accounting for 39% of the variance in individual distress, which in turn explained 7% of the variance in selfreported violations. The only variable that made a direct contribution to errors was violations, which accounted for 24% of the variance in medication errors. These findings highlight the importance of monitoring the state of the whole health system. Deficiencies at the organisational level affect the psychological well-being of hospital employees, and distressed employees are more likely to engage in substandard work practices that ultimately endanger the patients under their care. Keywords: Medication errors, Patient safety, Systems approach.Patient safety during medication administration 2
IntroductionWithin the hospital environment, adverse events resulting from medication errors are recognised as a leading cause of unintended harm to patients. Here in Australia, Malpass et al. (1999) estimated that 20% of recorded hospital incidents involved an error in the use of medications. The Australian Quality of Health Care Study (Wilson et al. 1995) put the figure at 17%. These estimates are similar to those reported in the UK (Vincent et al. 2001) and the US (Leape et al. 1991(Leape et al. , 1995 and confirm that errors in the administration of medications are a significant contributor to iatrogenic injury and illness (Bates 1999). The well-documented prevalence and seriousness of this problem in health systems across different countries demands the attention of researchers from a range of disciplines employing different methodologies, each of which can shed light on particular aspects of the problem.The current study used structural equation modelling to assess the effects of organisational and individual level variables on medication administration behaviours reported by nurses working in hospital settings. These behaviours were divided into violations, which involve the deliberate deviation from rules that describe the safe or approved method of performing a particular task or job, and errors, which refer to unintended outcomes caused by slips, lapses and mistakes made by individuals (Reason 1990). We begin by defining the scope of the behaviours included in this study before reviewing the literature on the causes of medication errors and tracing the development of a model that describes the impact of organisational climate on individual stress and morale and the ...