Journal of American Science 2012;8(1) http://www.americanscience.

org

Patient Safety: Assessing Nurses' Compliance

1
Rabab M. Hassan and 2Soheir T. Ahmed
1
Nursing Administration Department, 2Medical-Surgical Nursing Department. Faculty of Nursing, Ain Shams
University, Cairo, Egypt.
Soheir2010@windowslive.com; drabab@yahoo.com

Abstract: Patient safety is a major challenge for quality improvement and enhancing provider’s performance. Protecting
patients and staff members from harm is fundamental responsibility of all hospitals, which must devote their attention to
manage the safety of patients .Sometimes unintentional harm comes to patient during a clinical procedure, this harm can
lead to death. Aim: The study aims to assess nurses' compliance to patient safety parameters at intensive care unit and
examine socioeconomic factors affecting it. Subjects and Methods: This study was conducted at ICU in the Ain-shams
University hospital using a descriptive design. 30 nurses were included in the study. Tools of the study included 1)
Interview questionnaire sheet to collect the study subjects characteristics data. 2) An observational checklists that
developed based upon review of International Patient Safety Goals accredited by Joint commission International
Standards for Hospitals (2008). Results: The mean score of nurses' compliance to parameter related to reducing the risk
of health care associated infection has the highest score, while safety of high alert medication has the lowest score. There
was statistically significant relation between nurses' compliance to most parameters of patient safety and their age,
qualification, years of experience and attending training courses. Conclusion: nurse's compliance highest score in
reducing the risk of healthcare associated infection, the second highest mean scores was improve effective
communication parameter and the parameter of correct patient identification was third high mean score. While, the
parameter of reducing the risk of patient harm from falls had low mean score, and the lowest score in improving the
safety of high alert medication. In addition, there are clear discrepancy in relation between total means scores of nurses'
compliance toward patients' safety parameters and their socio-demographic characteristics. Recommendation:
development programs for nurses working in ICU related to patient safety parameters improve and support a blame-free
and forgiveness environment enhance patient safety culture. Further studies are needed for testing the influence of safe
work environment on nurses' performance and productivity.
[Rabab M. Hassan and Soheir T. Ahmed Patient Safety: Assessing Nurses' Compliance. J Am Sci 2012;8(1):748-
755]. (ISSN: 1545-1003). http://www.jofamericanscience.org. 102

Keywords: Patient safety, Nurses' compliance.

1. Introduction which remains a fundamental principle of patient care

Patient safety, is a relatively new concept in and a critical component of quality management. WHO
health care organization, it is a global issue affecting is committed to make patient safety a high priority on
countries at all levels of development. Patient safety the policy agenda of countries (WHO, 2008).
has been defined as the freedom from accidental or Although estimate of the size of the problem are
preventable injuries produced by medical care (Agency scarce, particularly in developing and transitional
for Health care Research and Quality (AHRQ), countries, it is likely that millions of patients
2005). According to a World health organization worldwide suffer disabling injuries or death every year
(WHO) report, one out of every 10-hospital patients in due to unsafe medical care. Patient harm occurs
many developed countries experiences an adverse because of a constellation of factors and circumstances.
event that can lead to serious injury and death. The Understanding the magnitude of the problem and the
situation in developing countries is even worse. main contributed factors that lead to patients harm is
Care is often delivered in a pressurized and fast essential to design effective and efficient solutions for
moving environment, involving a vast array of different context in addition to establishing a safe
technology, and daily decisions and judgments by health system (Al-Ameri, 2000 and Milligan, 2007)
health care professional staff. Sometimes unintentional Bad events occur in hospitals everyday, it can
harm comes to patient during a clinical procedure, or occur in the most efficient and safety conscious areas,
because of clinical decision. Errors in the process of no area is immune. One challenge facing critical care
care can result in injury or harm that sometimes can units today is the need for safety standards because the
leads to death (Johnstone & Kanitsaki, 2006 and patient will be monitored closely for a critical medical
Markowitz, 2009). condition with safety. This is especially true because of
The increasing incidence of documented cases of the staffing pattern and the acuity of the patients
adverse events in health care has led to a growing admitted to the critical care units, which demand the
concern in a number of countries about patient safety, nurses be qualified and highly experienced in the care

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 Journal of American Science 2012;8(1) http://www.americanscience.org

of critically ill patients with highly compliance of Setting:

patients' safety (Attia, 2003, Marino, 2007 and The study was conducted in intensive care unit at Ain-
Lambert, 2010). Sham University hospital.
Nurses represent the largest component of the Subjects:
healthcare work force; they are in a key position to Subjects of the study included all nurses working
improve patient safety through exerting significant in intensive care units. Total number of nurses was 34
influence in the health care system. So, it is important working in three shifts. Out of the total number, 30
to understand nurses’ compliance to patient safety and nurses who were agreed to participate in this study.
to comprehend what factors influence their views The inclusion criterion was that nurses should be
(Affonso, et al., 2003 and page, 2004). working at least one year in the current unit.
Compliance has been defined as the extent to Tools of data collection:
which certain behavior is in accordance with the The following two tools were used;
physicians' instructions or health care advice. The •Interview questionnaire sheet was used to collect the
recent studies have linked global measures of a safety nurses’ characteristics data, such as; age, marital
culture to nurses and other health team compliance status, qualification, years of experience &
with safe work practices and to exposure to incidents, attending training courses.
regardless of the outcome, may be extremely •An observation checklists: to assess the nurse’s
burdensome to health team as well as to organizations compliance toward patient safety parameters. This
(Espin et al., 2006 and Sexton et al., 2011). tool was developed by the researcher based on
Significance of the study: review of the International Patient Safety Goals
Patient safety has received increased attention in accredited by the Joint Commission International
recent years, but mostly with a focus on the Standards for Hospital (2008). It consists of five
epidemiology of errors and adverse events, rather than parameters with 101 items. These parameters
on practices that reduce such events (The Institute of including: 1) parameter to ensure the accuracy of
Medicine, 2007). One of the United States National patient identification divided into 3sub items with
Academies - reported that, there are 44,000 to 98,000 21 items. 2) Parameter checks the effectiveness of
people who die in hospitals each year because of communication among healthcare workers through
preventable practice errors. Between 4% and 16% of two sub items with 19 items. 3)parameter to assess
hospitalized patients experienced to one or more the safety of high –alert medication with 10 items ,
adverse events, up to half of these adverse events are 4) parameter to observing staff nurse’s compliance
preventable. Searching about why these preventable to the policy and procedures related to infection
errors occur is the first step to develop strategies that control practices, classified into 3 sub items with 37
can minimize it. items and 5) parameter to recognize risk of patient
Nurse's compliance regarding to safety are rarely harm resulting from falls with 14 items . The
formally evaluated or considered during the design or parameter 4 to insure correct site, correct
updating of safety programs. Despite, a strongly nurse's procedures, and correct patient surgery with 5 items
compliance to patients' safety contributes to a positive was excluded from the observational checklist.
patients safety culture that necessary to maintain Because it is the responsibility of the physician to
patient safety and avoid needles patient death. In mark of surgical site, this procedure is performed as
addition, starting point for improving quality nursing a preoperative preparation to the patient either in
care is to assess nurse's compliance to patient's safety inpatient unit or inside the operating room directly
and examines factors affecting it (Thirumalai, 2010) before beginning the operation. Therefore, nurses
Aim of the study: have no responsibility to this parameter. Each item
The study aims at assessing nurses' compliance to the scored, as complied (1) while not complied (0) and
patient safety parameters at intensive care unit and total scores 101. Competent level is considered
examining socioeconomic factors affecting it. ≥80%, while incompetent level < 80%.
Research questions: Tools validity & reliability
What is the level of nurses’ compliance to patient To achieve the criteria of trustworthiness of the
safety parameters at intensive care unit? tool of data collection in this study, the tools were
What are the socioeconomic factors affect on of tested for validity and reliability.
nurses’ compliance to patient safety parameters at Five experts in the field administrative, and
intensive care unit? medical surgical nursing tested it for content validity.
Modification was carried out accordingly taking into
2. Subjects &Methods consideration hospitals policy and units facilities.
Research design The reliability has been examined and test-retest
A descriptive design was used in the conduction ranged from 0.81 to 0.89 for each of the patients’
of the study. safety parameters.

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 Journal of American Science 2012;8(1) http://www.americanscience.org

Procedures majority of them were complied during procedures of

An official permission from each hospital urinary catheter care and central & peripheral line care
administrative authority. was obtained. A study done with the parameter of reducing the risk of health care
and completed from November 2010 to August 2011. associated infection (90%& 86.7% respectively). The
The researchers themselves completed the same table showed that, less than two third of the study
observational checklists. They observed the nurses group was complied to reduce the risk of patient harm
performance two days per week each Saturday and resulting from falls (63.3%).
Wednesday throughout the morning and afternoon Table (4) represents the comparison between total
shifts for 3 months. Most of nurses in the study were mean scores of nurses' compliance toward patients'
cooperative with the researchers. safety parameters. The table shows that, the highest
A pilot study mean scores of nurses' compliance were with the
Was carried out on four nurses, to test the clarity parameters of reducing the risk of health care
and practicability of the tool in addition to the associated infection, improve effective
suitability of the setting. These Subjects not excluded communication, and correct patients' identification
from the study, as there were no radical modifications (83.0 + 6.3, 80.4 + 10.4, & 79.3+ 8.2 respectively).
on the study tool. Then, the purpose of the study was While the lowest mean score was regarding the
explained to nurses who accepted to participate in the parameter to improve the safety of high alert
study. medication (47.8 + 20.7).
Ethical Consideration and human rights: Table (5) illustrates the relation between total
Verbal approval from each participant was mean scores of nurses' compliance to patient's safety
obtained from subjects prior the study conduction and parameters and their socio-demographic
after explanation of the purpose of the study. They characteristics. There were statistically significant
were informed about their right to with draw at any differences between nurses' age and their compliance
time and that all data will be kept confidential. to all patients' safety parameters except correct patient
Statistical analysis: identification and reducing the risk of patient harm
Data entry and data analysis were done using resulting from falls parameters. No relation found
the Statistical Package for Social Sciences (SPSS) between nurses’ marital status and all patient safety
version 14.0 statistical software package. Data were parameters. However, there were statistical significant
presented using numbers, percentages, chi- and t- differences between years of experience and nurses’
tests. Statistical significance considered at p value compliance to all parameters. In addition, the table
<0.05. discovered that, there were statistical significant
differences between educational levels & attending
3. Result programs and total scores of nurses’ compliance to
As evident in table (1) 80% of the studied nurses, correct patient identification, improve the safety of
their age was 30 years and more with a total mean age high alert medication, and reducing the risk of health
(36.2±1.4 years), while more than half of them care associated infection parameters (p<0.05).
(56.7%) had experience less than 15 years. Results
also showed that less than three quarter of them was Table (1): Socio-demographic characteristics of the
married. As regards qualification level it was found study sample (n=30)
that, (70%) of the study group had a technical nursing
Items No (%)
diploma. Almost of study sample were attended Age( in Years)
training programs (90%). <30- 6 40
Concerning the nurses’ compliance toward two 30- 24 80
from patient’s safety parameters, the table (2) shows Mean ± SD= 36.2±1.4
that the highest percentage of nurses’ compliance Work Experience in Years
(96.7%) was when taking blood sample and other Less than 15 17 56.7
specimens, while the lowest percentage of their 15- 13 43.3
compliance (76.7%) was when giving medication, Marital status
which related to correct patient identification Married 22 73.3
parameter. As regarding improve effective Single 8 26.7
communication parameter, the same table revealed Qualification in nursing
Diploma 21 70
that, more than four fifths of the study group was
Technical institute 7 23.3
complied to shift reporting (83.3%). Bachelor 2 6.7
Table (3) illustrated the nurses’ compliance toward Attending Training programs
others patient’s safety parameters. Only (56.7%) of Yes 27 90
study group complied with the parameter related to No 3 10
improve the safety of high alert medication. The

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Table (2): Frequency distribution of nurses' compliance toward patients' safety parameters (n=30).
Nurses’ Compliance
Parameters Compliance not Compliance
No % No %
3-Improve the safety of high alert medication 17 56.7 13 43.3
4-Reducing the risk of health care associated infection
a) Patient with mechanical ventilation 21 70 9 30
b) In urinary catheterization 27 90 3 10
c) In central and peripheral line (Daily maintenance) 26 86.7 4 13.3
5-Reduce the risk of patient harm resulting from falls 19 63.3 11 36.7

Table (3): Frequency distribution of nurses' compliance toward patients' safety parameters (n=30).
Parameters Total mean scores
1-Correct patient identification 79.3+ 8.2
2-Improve effective communication 80.4 + 10.4
3-Improve the safety of high alert medication 47.8 + 20.7
4-Reducing the risk of health care associated infection 83.0 + 6.3
5-Reduce the risk of patient harm resulting from falls 66.2 + 12.5

Table (4): Total means scores of nurses' compliance toward patients' safety parameters
Nurses’ Compliance
Parameters Compliance not Compliance
No % No %
1-Correct patient identification
a) When giving medication 23 76.7 7 23.3
b) When giving blood or blood products 24 80 6 20
c) When taking blood sample and other specimens 29 96.7 1 3.3
2-Improve effective communication
a) In verbal orders 22 73.3 8 26.6
b) shift reporting 25 83.3 5 16.7

Table (1): The relation between total means scores of nurses' compliance toward patients' safety
parameters and their socio-demographic characteristics
Total scores of nurses’ compliance
Socio-demographic Correct Improve Improve the Reducing the Reduce the
characteristics patient effective safety of high risk of health risk of patient
identification communication alert care associated harm resulting
medication infection from falls
Age
• <30 82.7 + 5.6 79.8 + 13.3 37.4 + 4.0 68.2 + 8.1 66.2 + 13.4
• ≥30 84.1 + 9.2 80.6 + 9.9 65.3 + 4.0 79.9 + 9.2 66.1 + 8.7
t-test 0.474 0.159 3.8 2.04 0.026
P value >0.05 >0.05 <0.05* <0.05* >0.05
Work Experience in years
• <15 71.9 + 3.8 68.8 + 11.0 33.4 + 20.9 79.7 + 8.8 65.7 + 14.9
• ≥15 83.3 + 4.6 83.7 + 11.8 45.0 + 21.1 86.6 + 7.1 67.1 + 5.8
t-test 3.5 2.7 2.6 2.4 2.78
P value <0.05* <0.05* <0.05* <0.05* <0.05*
Marital status
•Married 83.9 + 5.7 80.6 + 10.0 48.6 + 22.6 80.3 + 8.7 67.2 + 14.4
•Single 80.4 + 7.6 79.9 + 12.1 45.6 + 15.2 76.7 + 6.3 63.4 + 3.7
t-test 1.409 0.157 0.347 1.066 0.735
P value >0.05 >0.05 >0.05 >0.05 >0.05

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Qualification in nursing
• Diploma 79.7 + 10.1 82.1 + 8.9 39.1 + 10.0 72.0 + 11.4 65.2 + 7.6
• Technical institute 91.5 + 10.6 83.8 + 5.3 58.6 + 26.8 89.5 + 10.6 66.4 + 14.5
• Bachelor 98.4 + 2.4 78.6 + 3.4 62.5 + 24.7 96.7+ 6.0 67.9 + 10.1
ANOVA test 3.1 0.710 4.303 5.64 0.045
P value <0.05* >0.05 <0.05* <0.05* >0.05
Attending Training Programs
• Yes 83.3 + 13.6 80.3 + 10.6 69.7 + 4.4 79.7 + 8.4 67.2 + 10.5
• No 61.2+ 10.4 82.9 + 9.3 37.4+ 4.1 56.3 + 7.9 51.8 + 32.8
t-test 2.6 0.340 3.9 4.4 0.662
P value <0.05* >0.05 <0.05* <0.05* >0.05
Insignificant at p>0.05 (*) Statistically Significant at p<0.05

4. Discussion communication among healthcare team. This results is

The present study was carried out to assess congruent with ( Cuthbertson et al.,2007 and Baker et
nurses’ compliance to the patient safety parameters at al., 2009) who concluded that effective team
Intensive Care Unit (ICU) at Ain-Shams university communication and coordination are recognized as
hospital to identify areas, which need improvement in being crucial for improving quality and safety in ICU.
the line of quality improvement. In agreement with this Additionally, the Joint commission of Accreditation
aim, Paul (2004) emphasized that improving patient (2009) emphasized the importance of effective
safety should be one of the highest priorities of communication among caregivers.
healthcare leaders. The Patient Safety Group (2008) On the same line, Shendell& Feinson (2007)
defined patient safety as the avoidance and prevention found that the transfer of essential information and the
of patient injuries or adverse events resulting from the responsibility for care of the patient from one health
processes of health care delivery. care provider to another is an integral component of
Despite, the present study discovered that; the communication in health care. This critical transfer
most of nurses in the present study had high point is known as a handoff. An effective handoff
percentage of compliance toward parameter of correct supports the transition of critical information and
identification of patients at different procedures continuity of care and treatment. Additionally, Peter
however; there was no enough when comparing with and Horn (2003) mentioned that an explicit approach
the importance of this parameter. By asking the nurses, to bedside rounds in ICU improves communication
they replied and interpreted that they are assigned for and satisfaction of health care providers.
small number of patients and they know the patient High Alert Medication (HAM) are drugs causing
very well due to his/her long stay in ICU. This finding significant patient harm when used in a wrong way;
is in agreement with Zidicky (2004), who stated that such as concentrated solution, chemotherapeutic drugs,
staff nurses sometimes mistakenly bypassed patient anesthetic drugs, hypoglycemic drugs, vasodilator
identification because they already know the patient. drugs, calcium channel blockers, adrenergic agonists,
The findings are also in agreement with Stephen and anti arrhythmic and anticoagulants (Institute for Safe
Peter (2000) who stated that the correct wristband Medication Practices, 2005).
identification was essential to prevent wrong blood Medication errors represent a major sector in
transfusion and preventing blood sampling errors. patient safety that needs special attention due to its
In addition, between November 2003 and July direct and high impact on patients; however, the
2005, the United Kingdom National Patient Safety present study highlighted on around half of present
Agency reported 236 incidents and near misses related sample were not complied with the parameter of
to missing wristbands or wristbands with incorrect improving the safety of high alert medication. This
information (WHO, 2007). As well; in recognition of result may be due to lack of nurses' knowledge &
this patient safety risk, the Australian Commission on experience about (HAM) that indicates importance of
Safety and Quality in Health Care (ACSQHC, 2008) educational program about high alert medication for
established a patient identification program to take a the nurses working in critical care units generally; and
national approach to reducing errors associated with ICU especially. This recommended agreement with
the misidentification of patients and their care and (Shady, 2008) who emphasized that medication errors
improving the patient identification process. are among the most common nursing errors, the nurse
The current study showed that nurses were spends time and energy in the administration process
highly comply to improve effective communication carrying the responsibility for accurately
parameter in verbal order and shift report .This result administration of the right drug. For that, the nurse
could be explained as nurses who working in intensive should encompass the knowledge about the reason for
care unit recognize the importance of effective

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giving a certain drug, its action, side effects, usual hospital policies. (JCI, 2008) emphasized that,
dose and recognize mistakes in prescriptions. Effective communication, which is timely, accurate,
Infection prevention and control are challenging complete, unambiguous, and understood by the
in most health care settings. Concerning nurses' recipient, reduces errors, and results in improved
compliance to reducing the risk of health care patient safety. The present finding consistent with
associated infection, the present study revealed that, similar study by, (Sexton, 2011).
the majority of nurses in the present study had high At the same table, the parameter of correct patient
percentage related to compliance at the procedures of identification was third high mean score. This may be
urinary catheter and central & peripheral care than the due to nurses sophisticated thought about their
procedure of mechanical ventilation care. This result remember quality about patient identification. (JCI,
indicates that, the nurses could reduce the risk for 2008) consistent with this meaning from emphasized
infection and colonization by their compliance of on the nurses should review existing policies,
infection control measures and applying stander procedures, and practices related to patient
precautions. The result agreement with (Collins, 2004) identification.
who mentioned that, when the nurses using evidence- On the other hand, the previous table discovered
based aseptic work practices that diminish the entry of that, the parameter of reducing the risk of patient harm
endogenous or exogenous organisms via invasive from falls had the lowest mean score. This result
medical devices. reflects the reality of nurses concern regarding this
The study finding revealed that, more than one parameter, which depending on lack of their
third of the study groups were not comply to reduce experiences. (Sexton , 2011)reported that, nurses are
the risk of patient harm resulting from falls parameter. responsible for identifying patients who are at risk for
This result may be due to adequate of nurses falls and developing a plan of care to minimize that
experiences to evaluate the factors caused it as ; the risk. In the same line, (Georgios, 2011) ensured that,
persons’ health status, response to medical the patient fall rates are perceived as the indicator that
interventions, external factors such as the type of floor could be most improved through nurse-led safety
or other factors. In the similar study, (Ari, 2011) stated strategies or interventions.
that, The evaluation could include fall history, Finally, the present study highlighted on the
medications and alcohol consumption review, gait and lowest mean score of nurses’ compliance was noticed
balance screening, and walking aids used by the in the parameter of improving the safety of HAM,
patient, and recommended that, the health despite, that medication-related errors were a
organizations establishes a fall-risk reduction program significant cause of morbidity and mortality. These
based on appropriate policies and/or procedures. findings could be due to the sophisticated patient care
As regarding, a comparison between total mean procedure performed by nurses in ICU and work
scores of nurses' compliance toward patients' safety overload that may lead to keep some of these
parameters, Table (4) answers the first research medications with patient medication in same drawer
question and discovered that, the mean score of nurses’ for save time as nurses perceived. In addition, this
compliance to reduce the risk of (HAI) parameter has error can occur when a staff member has not been
got the highest score. That could be attributed to the properly oriented to non-proprietary names and
effect of attending training courses especially related proprietary (brand or trademarked) names of
to infection control for all ICU nurses, continuous medication. Many drug names look or sound like other
supervision, as well as sufficient facilities inside ICU drug names. Contributing to this confusion are
that help all healthcare providers adhering to all illegible handwriting, incomplete knowledge of drug
practices that promote patient safety in work place. names, newly available products, similar packaging or
This finding is in agreement with Abdullatif (2008), labelling, similar clinical use, similar strengths, dosage
who stated that the poor state of infrastructure and forms, frequency of administration. (WHO, 2007).
equipment, unreliable supply and quality of drugs, The previous findings were agreed with
shortcomings in waste management and infection Timmons (2005), who stated that critical steps to
control, poor performance of personnel and severe meaningful improvements in patient safety are;
under financing of essential operating costs of health identification of all significant errors, analysis of each
services make the probability of adverse events much error , compilation of data about error frequencies and
higher than in industrialized nations. The majority of root causes, dissemination of derived information to
incidents occur as a result of such health system permit redesign of systems and processes. Then,
factors. finally periodic assessment of effectiveness of risk
As well, the second highest mean scores were reduction efforts should be done. In this respect, the
improving effective communication parameter. This AONE (2007) highlighted that when leaders begin to
may be due to the positive nurses' perception regarding change their responses to mistakes and failure, asking
safety patient culture and compliance of them for what happened instead of who made the error, the

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culture within their health care institutions will begin development of policies for storage and administration
to change. of HAM, adverse event reporting and recording,
A clear discrepancy in relation between total improving overall perception of patient safety, and
mean scores of nurses' compliance toward patients' leadership Walk rounds. There were statistically
safety parameters and their socio-demographic significant differences between nurse’s age,
characteristics was detected which answer the second qualification, years of experience, and attending
research question of the study. The table (5) shows training courses and their compliance with reducing
that, there were statistically significant differences the risk of health care associated infection and improve
between years of experiences, nurses’ qualification and the safety of high alert medication parameters.
attending training programs and most of the
parameters of patient safety; and the age was statistical Recommendations:
significant difference with improve the safety of high 1- Create a blame-free environment that encourages
alert medication and reducing the risk of health care nurses to report errors
associated infection. While, no statistical significant 2- Staff development programs for nurses working in
difference was noticed with marital status. This may ICU related to High Alert Medications.
attribute to that; higher education and training are 3- Improve nurses reporting skills of incidents related
concerning and affecting the employee performance to patient safety
and compliance. The findings are in agreement with 4- Develop a strategic plan for patient safety
Gaba et al. (2002) who stated that, there was 5- Further studies are needed for assessing patient
differences in the perception of safety between leaders safety culture and its effect on patient care,
and front line staff. assessing the effect of nurses’ compliance to
Leaders in general have more positive view of patient safety parameters on patient satisfaction,
safety within the organization. Sean (2003) stated that length of stay.
in hospitals with higher proportions of nurses who 6- Establish teamwork spirit among staff nurses and
highly educated, patients experienced lower mortality provide mutual communication.
and failure –to- rescue rates. Moreover, Hall(2004) 7- Collaborative efforts must begin to assess current
identified that a higher proportion of professional patient Safety culture and to identify nurses’
nurses were associated with low rate of medication perceptions and attitudes toward safety
errors and wound infections. environment.
The present study revealed a statistically 8- Search about factors influencing nurses’ compliance
significant difference in all parameters related to with safety in order to prevent patient harm.
patient safety and attending training programs. The
reason behind this could be simply explained as Implication of the study
training and ongoing education are usually directed to The study has implications for both clinical
critical care unit nurses which affect and improve their practices of nurses and managerial issue. The out come
clinical practice and increased their awareness to of this study would be useful in improving nurses
patient safety. In the study conducted by (Pollack and performance related to patient safety and quality
Patel, 2000) who found that; nurses working in ICU improvement in health care service. It could help nurse
with fellowship training programs are generally, managers to change their reactions to bad events and
associated with better risk-adjusted mortality rates than work effectively to minimize/ prevent accidental harm
those without training programs. Additionally, through identifying root causes of errors, analysis it,
(Ahmed, 2002) also reported that, most of the training and develop disciplinary action.
required by nurses was in the area of critical care unit.
Corresponding author
Conclusion Rabab M. Hassan
Nurse's compliance highest score in reducing the Nursing Administration Department,Faculty of
risk of healthcare associated infection, the second Nursing, Ain Shams University, Cairo., Egypt.
highest mean scores was improve effective drabab@yahoo.com
communication parameter and the parameter of correct
patient identification was third high mean score. 5. References:
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