Safety climate reduces medication and dislodgement errors in routine intensive care practice

Purpose: To assess the frequency and contributing factors of medication and dislodgement errors attributable to common routine processes in a cohort of intensive care units with a special focus on the potential impact of safety climate. <br/>Methods: A prospective, observational, 48 hour cross sectional study in 57 intensive care units (ICUs) in Austria, Germany, and Switzerland with self-reporting of medical errors by ICU staff and concurrent assessment of safety climate, workload and level of care. <br/>Results: For 795 observed patients a total of 641 errors affecting 269 patients were reported. This corresponds to a rate of 49.8 errors per 100 patient days related to the administration of medication, loss of artificial airways, and unplanned dislodgement of lines, catheters and drains. In a multilevel model predicting error occurrence at the patient level, odds ratios (OR) per unit increase for the occurrence of at least one medical error were raised for a higher Nine Equivalents of Nursing Manpower Use (NEMS) score (OR 1.04, 95% CI 1.02 - 1.05, p < .01) and a higher number of tubes/lines/catheters/drains (OR 1.02, 95% CI 1.01 - 1.03, p < .01) at the patient level and lowered by a better safety climate at the ICU level (OR per standard deviation 0.67, 95% CI 0.51 - 0.89, p < .01). <br/>Conclusions: Safety climate apparently contributes to a reduction of medical errors that represent a particularly error-prone aspect of frontline staff performance during typical routine processes in intensive care.