Perspectives of healthcare professionals in Qatar on causes of medication errors: A mixed methods study of safety culture

BackgroundThere is a lack of robust, rigorous mixed methods studies of patient safety culture generally and notably those which incorporate behavioural theories of change. The study aimed to quantify and explain key aspects of patient safety culture which were of most concern to healthcare professionals in Qatar.MethodsA sequential explanatory mixed methods design of a cross-sectional survey followed by focus groups in Hamad Medical Corporation, Qatar. All doctors, nurses and pharmacists were invited to complete the Hospital Survey on Patient Safety Culture (HSOPS). Respondents expressing interest in focus group participation were sampled purposively, and discussions based on survey findings using the Theoretical Domains Framework (TDF) to explain behavioural determinants.ResultsOne thousand, six hundred and four questionnaires were received (67.9% nurses, 13.3% doctors, 12.9% pharmacists). HSOPS composites with the lowest levels of positive responses were non-punitive response to errors (24.0% positive) and staffing (36.2%). Specific TDF determinants potentially associated with these composites were social/professional role and identity, emotions, and environmental context and resources. Thematic analysis identified issues of doctors relying on pharmacists to correct their errors and being reluctant to alter the prescribing of fellow doctors. There was a lack of recognition of nurses’ roles and frequent policy non-adherence. Stress, workload and lack of staff at key times were perceived to be major contributors to errors.ConclusionsThis study has quantified areas of concern relating to patient safety culture in Qatar and suggested important behavioural determinants. Rather than focusing on changing behaviour at the individual practitioner level, action may be required at the organisational strategic level to review policies, structures (including resource allocation and distribution) and processes which aim to promote patient safety culture.

背景：当前普遍缺乏针对患者安全文化的严谨且稳健的混合方法研究，尤其是那些融入了行为改变理论的相关研究。本研究旨在量化并阐释卡塔尔医疗从业者最为关注的患者安全文化关键维度。
方法：本研究采用序贯解释性混合方法设计：先开展横断面调查，随后在卡塔尔哈马德医疗公司（Hamad Medical Corporation）举办焦点小组讨论。研究邀请所有医生、护士与药剂师参与患者安全文化医院调查问卷（Hospital Survey on Patient Safety Culture, HSOPS）。采用目的抽样法招募对焦点小组讨论感兴趣的受访者，并基于调查结果，借助理论域框架（Theoretical Domains Framework, TDF）阐释行为决定因素。
结果：本次研究共回收1604份问卷，其中护士占比67.9%，医生占比13.3%，药剂师占比12.9%。患者安全文化医院调查问卷的各合成维度中，正向回应率最低的两项为「对错误的非惩罚性应对」（24.0%正向回应）与「人员配置」（36.2%正向回应）。与这两项合成维度潜在相关的理论域框架关键决定因素包括：社会/专业角色与身份、情绪，以及环境背景与资源。主题分析结果显示，存在医生依赖药剂师纠正自身错误、不愿更改同行处方的问题；同时存在对护士角色认知不足、政策执行常不达标现象。受访者认为，压力、工作负荷以及关键时段人员短缺是引发错误的主要诱因。
结论：本研究量化了卡塔尔患者安全文化中存在的诸多问题，并提出了关键行为决定因素。相较于针对个体从业者的行为改变干预，或许应从组织战略层面采取行动，对旨在推动患者安全文化的相关政策、结构（含资源分配与配置）及流程进行审视与优化。