title: Barriers to emergency departments' adherence to four medication safety-related Joint Commission National Patient Safety Goals.
abstract: BACKGROUND
  Medication errors are a serious public health threat, causing patient injury and death and sharply increasing health care costs. Serious preventable errors are most likely to occur in areas of increased complexity and technology, such as the emergency department (ED). Although The Joint Commission in 2002 approved the first set of National Patient Safety Goals (NPSGs) to decrease the occurrence of health care errors, the literature suggests that the goals are not fully implemented. In 2006, the Emergency Nurses Association (ENA) conducted a national, multisite survey (1) to describe barriers to full implementation of the 2006 NPSGs related to medication safety (then known as Goals 1, 2, 3, and 8) as reported by ED registered nurses (ED nurses) and (2) to investigate factors related to those barriers.
  
  
  METHODS
  ED nurses (n = 2,220), managers (n = 129), and site coordinators (n = 126) representing 131 EDs completed surveys concerning NPSG implementation, policies, and barriers. Nonparametric statistical methods were used to analyze the data.
  
  
  RESULTS
  ED nurses frequently reported barriers to adherence to NPSGs. Patient safety education was not related to NPSG adherence. A complex work environment, such as that associated with residents in training, mixed-shift hours, and state designation as a trauma center, was associated with reduced NPSG adherence.
  
  
  CONCLUSIONS
  The low response rate (4.6%) to this study inherently limits the overall generalizability of the findings to the greater population of EDs. Yet, the findings suggest that substantial barriers remain to ED adherence to the NPSGs related to medication safety. Efforts to reduce the barriers should focus on system changes that facilitate adherence. Health care providers and their organizations must commit to and enforce a zero-tolerance policy for preventable medication errors.
authors.affiliation: Emergency Nurses Association, Des Plaines, Illinois, USA. ajuarez@ena.org
authors.forename: Altair
authors.initials: A
authors.lastname: Juarez
authors.forename: Jessica
authors.initials: J
authors.lastname: Gacki-Smith
authors.forename: Mary Rose
authors.initials: MR
authors.lastname: Bauer
authors.forename: Dennis
authors.initials: D
authors.lastname: Jepsen
authors.forename: Susan
authors.initials: S
authors.lastname: Paparella
authors.forename: Beverly
authors.initials: B
authors.lastname: VonGoerres
authors.forename: Susan
authors.initials: S
authors.lastname: MacLean
mesh_terms: D003144:Communication Barriers; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital / Q000592:standards*; D019538:Health Care Surveys; D006801:Humans; D007400:Interprofessional Relations; D007591:Joint Commission on Accreditation of Healthcare Organizations; D008508:Medication Errors / Q000517:prevention & control*; D009726:Nurses; D010355:Patient Identification Systems; D012308:Risk Management / Q000592:standards*; D017751:Safety Management; D014481:United States