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

Intensive Care Med. 2013 Mar;39(3):391-8. doi: 10.1007/s00134-012-2764-0. Epub 2012 Dec 7.


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.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Critical Care / standards*
  • Cross-Sectional Studies
  • Equipment Failure
  • Female
  • Humans
  • Male
  • Medical Errors / prevention & control*
  • Medical Errors / statistics & numerical data
  • Medication Errors / prevention & control*
  • Medication Errors / statistics & numerical data
  • Middle Aged
  • Patient Safety / standards*
  • Prospective Studies
  • Safety Management / organization & administration*
  • Surveys and Questionnaires