The Relationship between Perceived Safety Culture, Nursing Leadership and Medication Errors Reporting (by nurses) in a Saudi Arabian Context: A Sequential Explanatory Mixed Method Design

Abstract

Abstract
Background: Medication errors have significant implications for patient safety and can cause serious harm and even death. Error discovery through an effective leadership and active reporting system uncovers medication errors and encourages safe practices. A positive safety culture and effective leadership likely plays an essential role in improving medication error reporting systems. A review of literature highlighted that no study had previously investigated the effect of safety culture and nursing leadership styles on medication error reporting.
Aim: The aim of this study was to explore the relationship between perceived safety culture, nursing leadership and medication errors reporting (by nurses) in adult medical-surgical wards in the Qassim region of Saudi Arabia.
Methods: The methodological design adopted for this study was an explanatory sequential mixed methods design; quantitative followed by qualitative in two phases. The first phase began with the collection and examination of quantitative data from four hospitals in the Qassim region using the Hospital Survey on Patient Safety Culture (HSOPSC) (n=218) and the Multifactor Leadership Questionnaire (MLQ 5X) (n=186), along with a prospective audit of type and rates of reported medication errors on these wards. The second, qualitative phase involved face-to-face semi-structured interviews with nurses (n=8) and nurse managers (n=8).
Results: The literature review highlighted a lack of studies exploring the relationship between perceived safety culture and nursing leadership styles and medication errors reporting. The findings from surveys showed that 50% of nurses in this study have not made an incident report in the last 12 months. Moreover, less than 10% of nurses report errors in two participant hospitals in the last two years. The qualitative findings revealed that fear was a key causal factor for underreporting of medication errors. Nurses feared punishment and legal action or losing their jobs. In addition, lack of feedback from quality or patient safety offices when nurses did make reports discouraged them from reporting future errors. Further barriers to reporting were personal characteristics, workload or shortage of staff, nursing leadership problems, blame, lack of knowledge or skills, unclear, or noncompliance with policy and safety culture.
Conclusion: This is the first study to explore the relationship between perceived safety cultures and nursing leadership styles on medication errors reporting in Saudi Arabia. The findings of the research presented in this thesis contribute new knowledge to the Yorkshire Contributory Factors Framework by evidencing the relationship between nursing leadership and safety culture through statistical methods. Also, the main methodological contribution of the research field has been the first mixed methods study to investigate these relationships. The results of this study offer guidance and present understanding of both the multicultural nurses’ and their managers’ opinions of improving the medication errors reporting system in Saudi Arabia. In addition, provide valuable local evidence that can be built into appropriate professional education and procedures for encouraging both Saudi and international nurses employed in Saudi Arabian hospitals to report errors. Finally the findings will assist policy makers and hospital managements to develop suitable medication safety education and procedures for encouraging nurses to report errors.