Patient safety culture regarding intravenous therapy in Guangzhou, China: a cross-sectional survey

In this study, doctors and nurses from eight tertiary hospitals in Guangzhou were selected. All the doctors and registered nurses of this study were working in these hospitals. All the hospitals were tertiary hospitals in Guangzhou, China. The eight hospitals had an average bed capacity of 850. The questionnaires were distributed by a convenience sampling method in the eight hospitals. A total of 400 questionnaires were issued, and responses were received from 356 participants. There were 333 valid questionnaires, and the effective recovery rate was 83.3%.

The data management and analysis were conducted using SPSS Statistics 20.0. Data were expressed as mean (SD). P < 0.05 was considered as statistically significant. All the data were de-identified and organized by the questionnaire identification numbers. Descriptive statistical analyses, such as the frequencies and percentages of positive responses for each entry and dimension, were used to show age, work age, educational degree, position at the hospital, and score of intravenous therapy patient safety culture. Two-tailed independent t-test comparisons of the sample mean values were used to compare the scores of the patient safety culture regarding intravenous therapy between the medical staff and the patients.

The sample comprised 333 respondents from the eight tertiary hospitals in Guangzhou, China, including two provincial hospitals, five municipal hospitals and one military hospital. The mean age of the participants was 30.07 years (SD = 7.144). There were 333 medical staffs, including 98 (29.5%) doctors and 235 (70.5%) nurses, of which one was missing; there were 69 males (21.2%) and 256 females (78.8%), of which eight were missing; The educational structure of the study subjects was as follows: five (1.5%) subjects had technical secondary school education, 80 (24.0%) had college degree, 193 (58.0%) had bachelor degree, 44 (13.2%) had master’s degree, and 11 (3.3%) had doctor’s degree. In all, 256 (63.8%) participants were female. Among the medical staff, 5.7% did not know whether the hospital had established an intravenous therapy nursing team, 6% were not clear about whether the departments carried out transfusion tube placement, 3% were not clear about whether the departments carried out peripherally inserted central catheter (PICC), 4.8% did not know whether the hospital had an intravenous therapy nurse specialist, and 10.2% did not know whether the hospital had opened a catheter nursing outpatient unit. Subjects who were very familiar with and familiar with intravenous therapy accounted for 24.6% and 53.2%, respectively.

The total, the first level, and the second level scores of the culture score of safety of intravenous therapy are shown in Table 1. The evaluation table for patient safety culture regarding intravenous therapy used a 5-point Likert scale as follows: very poor (1 point), poor (2 points), moderate (3 points), good (4 points), and very good (5 points), and each item score ranged from 1 to 5. The summarized results show that the total and level one items’ scores are greater than 4.3 points (the full mark is 5 points). The lowest scoring of the five level one items is for the hospital’s security resources (4.53 ± 0.526), and the highest is for the hospital’s safety management commitment (4.65 ± 0.445). Among the 25 secondary entries, the four lowest-scoring entries are “doctors who can master the knowledge of drug efficacy and adverse reactions “(4.44 ± 0.622), “doctors who can master the knowledge of the choice of medicine”(4.45 ± 0.621), “a guarantee of sufficient human resources” (4.46 ± 0.647), and “doctors who can master the knowledge related to the observation and complications with the treatment of intravenous therapy operation” (4.435 ± 0.634).

This investigation included two provincial, five municipal, and one unit 3 armor hospital. The sample size of the survey is quite, and the results have certain representativeness. From Table 1, we can see that the total point, level one items, and the secondary entries’ scores of safety culture are greater than 4.3 points (the full mark is 5 points). We can know that the situation of 3 armor hospital’s intravenous treatment safety culture of Guangzhou is more optimistic. The objectives of patient safety culture assessment were to diagnose hospital’s patient safety, to determine the key factors to improve patient safety, to evaluate the effects of safety interventions through the comparison of the baseline and after intervention, and to provide targeted improvement opinions or suggestions.3 This assessment of intravenous treatment safety culture shows that the 3 armor hospitals in Guangzhou had played a good effect in promoting the intravenous treatment safety culture through constant efforts of relevant policies and system support.

Patient safety culture assessment, feedback, and targeted improvement are effective ways to improve patient safety culture,20 and fostering positive safety culture has become a necessary measure for the continual improvement of the patient safety. From Table 1, we can know that, the lowest secondary entries were a guarantee of sufficient human resources (4.446 ± 0.647). Some studies21, 22 had proved that plenty of human resources is a key factor to build a hospital safety culture, which can effectively improve patient safety. So we need to achieve rational allocation of clinical nurses and reasonable adjustment of working time. However, at present, China’s medical institutions, especially the 3 armor hospitals, have widespread shortage of nurses, and the resource is not sufficient. A large number of hospitalized patients, a rapid turnover, complex patients, and a large number of intravenous infusion result in a large workload for the nurses, which indirectly leads to a shortage of human resources. Therefore, if we want to enhance the patient safety culture of intravenous therapy, first, we need to focus on strengthening the investment in human resources, especially nurses, and in departments with a large workload, such as the department of gastrointestinal surgery, the department of hepatobiliary surgery, and the department of oncology, and the ratio of nursing beds needs to improve to increase human input.

The scores of two items, doctors who can master the knowledge of drug efficacy and adverse reactions and doctors who can master the knowledge of the choice of medicine, were low, and this is partly because of the great variety of clinical medicines and the complicated effect of medicines, and thus, it is difficult to grasp. There is not a good patient safety culture regarding intravenous therapy because the doctors do not pay attention to building a safety culture. So we need to enhance the doctors’ mastery about the knowledge related to intravenous drugs by training and assessments in order to strengthen safety, and we also must establish appropriate incentive policies and build a patient safety culture regarding intravenous therapy. In addition, we need to emphasize the active sharing of experiences about the safety problems and hidden dangers in the work process in order to absorb the experience and reduce the incidence of adverse events associated with intravenous treatment. We can build a safety culture to guide practice only through the improvement of many aspects to ensure the safety of patients.

Recently, many researchers18, 23 have investigated the status of professional development in intravenous therapy in various regions in order to understand the problems and to provide a reference for continuous improvement. In this study, there are eight hospitals, which are all tertiary hospitals, and all have an intravenous team, all have PICC, all have carried out transfusion port placements, all have specialized nurses in intravenous therapy, and all have catheter care clinics, and the results are consistent with the relevant research.18 Among the medical staff, 5.7% did not know whether the hospital had established an intravenous therapy nursing team, 6% were not clear about whether the departments carried out transfusion tube placement, 3% were not clear about whether the departments carried out PICC, 4.8% did not know whether the hospital had an intravenous therapy nurse specialist, and 10.2% did not know whether the hospital had opened a catheter nursing outpatient, and those who were very familiar with intravenous therapy and familiar with intravenous therapy accounted for 24.6% and 53.2%, respectively. Therefore, it is necessary to strengthen the awareness of the relevant information so that the hospital staff can fully grasp the relevant information, such as the development of the professional scale in intravenous therapy. It is useful to promote the construction of a patient safety culture regarding intravenous therapy.