title: Safety climate reduces medication and dislodgement errors in routine intensive care practice.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A prospective, observational, 48 h 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.
  
  
  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 Score (NEMS) (OR 1.04, 95 % CI 1.02-1.05, p < 0.01) and a higher number of tubes/lines/catheters/drains (OR 1.02, 95 % CI 1.01-1.03, p < 0.01) 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 < 0.01).
  
  
  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.
authors.affiliation: General and Medical ICU, Rudolfstiftung Hospital, Juchgasse 25, 1030 Vienna, Austria. andreas.valentin@meduniwien.ac.at
authors.forename: Andreas
authors.initials: A
authors.lastname: Valentin
authors.forename: Michael
authors.initials: M
authors.lastname: Schiffinger
authors.forename: Johannes
authors.initials: J
authors.lastname: Steyrer
authors.forename: Clemens
authors.initials: C
authors.lastname: Huber
authors.forename: Guido
authors.initials: G
authors.lastname: Strunk
mesh_terms: D000328:Adult; D003422:Critical Care / Q000592:standards*; D003430:Cross-Sectional Studies; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D008875:Middle Aged; D061214:Patient Safety / Q000592:standards*; D011446:Prospective Studies; D017751:Safety Management / Q000458:organization & administration*; D011795:Surveys and Questionnaires