Available online on 15.03.2024 at http://jddtonline.info

Journal of Drug Delivery and Therapeutics

Open Access to Pharmaceutical and Medical Research

Copyright  © 2024 The   Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited

Open Access   Full Text Article                                                                                                                                                      Research Article

The Relationship between Patient Safety Culture and The Level of Knowledge of Health Personnel with Compliance in Patient Identification Implementation in Hospital

Agustina Ayu *, Puput Fiohana , Djazuly Chalidyanto , Nyoman Anita Damayanti 

Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia

INTRODUCTION

The basic principle of health care in health institutions that continue to require quality improvement is patient safety. ¹ Patient safety includes risk assessment, patient risk identification and management, incident reporting and analysis, the ability to learn from incidents and their follow-up, and the implementation of solutions to minimize risk generation and prevent injuries caused by mistakes due to carrying out an action or not taking action that should be taken.² Patient safety is currently a top priority and plays an important role in preventing and reducing risks, errors and injuries that can occur during the service process for hospitals.³ Patient safety is an important issue today considering the many cases of medical error that occur in various countries. Patient safety has become a priority for healthcare around the world.⁴ 

Patient identification is the first patient safety goal.⁵ Patient identification is a process of providing marks or differentiators that include medical record numbers and patient identities with the aim of distinguishing between patients from one another for the accuracy of providing services, treatments and actions or procedures to patients. Patient identification is one indicator of patient safety. Correctly identify a particular patient as a person to be given a particular service or treatment by matching services or treatments with that patient.⁶ 

Patient identification is important to identify patients who will get services or treatment so that unwanted mistakes do not occur. Errors due to misidentification of patients often occur in almost all aspects or stages of diagnosis and treatment. Errors caused by patient misidentification can be prevented when healthcare providers consistently use two unique patient identifiers such as the patient's name and identification number (the patient's room, or bed number is not used) for verification against the patient's identity.⁷ Research on the theme of misidentification conducted in India results show that many nurses, doctors and other health workers do not identify patients before performing actions on patients. More than 30% of staff do not carry out patient identification before drug administration.⁸

The research hospital is one of the type C private hospitals owned by a faith-based foundation and is located in the center of one of the cities in East Java. In the implementation of patient service activities, the Hospital also strives to contribute to public health maintenance that focuses on patient safety, but based on data and observations, there are problems related to patient safety and supported by reports on hospital quality indicators. In general, the results of patient identification compliance at RS X are quite fluctuating, but this still remains a problem because it has not reached the expected target of 100%. In addition, in the hospital there was a patient safety incident. From January to September 2022, there were 7 Near Injury Events (KNC), then 24 Uninjured Events (KTC), and 3 Unexpected Events (KTD) were found with an incident target of 0. 

Obedience is defined as a change in attitude and behavior to follow the requests and orders of others.⁹ Patient identification compliance is important, even related to patient safety. Patient identification is a very basic thing that must be done by a health worker.¹⁰ Proper identification of patients can avoid the occurrence of medical errors or unexpected events that can affect the patient. ¹¹ The importance of patient identification compliance is greatly supported by the knowledge of a health worker. If health workers apply or identify patients based on adequate knowledge, then the identification behavior towards patient safety will be long-lasting. Improper identification can result in patients undergoing procedures that they should not have. The implementation of patient identification that must be carried out by health workers should become a culture or habit so that incidents do not occur in the health service process.¹² 

Based on the description above, this study is to analyze the relationship between patient safety culture and the level of knowledge of health workers in hospitals with compliance with the implementation of patient identification.

RESEARCH METHOD 

This type of research is quantitative analytical research using an observational approach. The design of this study is Cross sectional. The location of the research site was carried out in a private hospital in East Java Indonesia, while the research time was carried out from February 2023 to July 2023. The population in this study was all health workers totaling 161 people. The sample in this study was health workers in a qualified sample of 70 people. Inclusion criteria are health workers who are currently active in health services who carry out the service process for patients. Exclusion criteria are health workers who are sick or work permits, health workers who are on leave, health workers who refuse to participate in research. The sampling techniques are: Propotion stratified random sampling by proportioning samples based on work units. Work units are IGD, Outpatient, Inpatient, ICU, Pharmacy, Laboratory, Radiology, Operating Room, Nutrition, Medical Staff Group (General Practitioner, General Dentist, Specialist, and Dental Specialist.

The independent variables consist of organizational factors, namely patient safety culture, and individual factors, namely the level of knowledge of health workers. The dependent variable in this study is the compliance of health workers with the implementation of patient identification. Data collection is carried out by observation activities and filling out questionnaires. Data analysis was carried out descriptive and correlation analysis. Correlation analysis in this study uses  the Chi-Square test where between independent and dependent variables there can be said to be a relationship if   the p value on the Chi-Square   test shows <0.05. 

RESULT AND DISCUSSION

The results found that the age of health workers varied. The highest number was at the age of 41 years at 24 people (34.3%). Most of them are female. Almost half of the respondents had a diploma 3 education and a tenure of more than 5 years. The largest number worked in inpatient (27.1%), outpatient (12.9%) and KSM (12.9%).

Table 1: Characteristics of Respondents

Teamwork shows that the teamwork culture in this hospital is mostly strong (91.4%). Strong teamwork strengthens collaboration to improve patient safety. Expectations from supervisors, managers, and actions that support patient safety are the majority strong (74.3%). Strong expectations are necessary to create a solid patient safety culture. The majority of organizational learning cultures related to patient safety are strong (90%). A strong learning culture allows for continuous improvement to prevent mistakes. Management support for patient safety is mostly strong (91.4%). Strong management support is a key factor in creating a good patient safety culture. Overall perception of patient safety: The overall perception of patient safety is mostly strong (92.9%). Strong perceptions reflect a high awareness and priority for patient safety. The hospital has a strong culture of providing feedback from communication regarding errors (87.1%). Constructive feedback aids learning and improvement. The majority of open communication in this hospital is moderate (71.4%). Good communication openness enables effective exchange of information and error prevention. The majority incident reporting culture is strong (78.6%). Regular incident reporting helps identify problems and take corrective actions. Teamwork between units is mostly strong (84.3%). Good cooperation between units facilitates collaboration in addressing patient safety challenges. The majority staffing arrangement was strong (84.3%). Good staffing arrangements include the allocation of adequate resources to improve patient safety. Handover and transfer of patients were predominantly strong (92.9%). A well-organized handover and transfer process is essential to ensure smooth patient care. The culture of non-punitive response to error is a moderate majority (91.4%). 

Table 2 : Analysis of 12 Dimensions of Patient Safety Culture

Health workers mostly have good knowledge of the concept of patient identification, the purpose of patient identification, the time of implementation of patient identification, patient identification strategies, evidence of implementation of identification, color of patient bracelets and factors affecting identification. However, there is an area where their knowledge is still sufficient or lacking, namely SPO patient identification methods. 

Table 3: Level of Knowledge of Health Workers related to Patient Identification

The results of identifying compliance of health workers show that in all indicators, most actions have been taken correctly. Table 4 shows observations of health worker compliance. 

Table 4: Health Workforce Compliance 

The results found a relationship between patient safety culture and compliance in the implementation of patient identification, with the significancy   value in the results showing (p = 0.000 < 0.05). In addition, there is a relationship between knowledge of patient identification and compliance in the implementation of patient identification, with the value of significancy in the results showing (p = 0.000 < 0.05). 

Table 5: The Relationship of Patient Safety Culture and Adherence to Patient Identification Implementation Adherence

The results showed a significant relationship between patient safety culture and adherence to patient identification. Culture is defined as a mixture of values, devices, beliefs, communication and explanations of behavior that provide guidance to a person. Organizational culture is a form of a group of principles and rules that are understood together and shape the behavior of members. Patient safety culture is a product of the values, attitudes, perceptions, competencies, and behavior patterns of individuals and groups that determine the commitment and style and proficiency of an organization's safety and health management. A patient safety culture is implemented with the aim of increasing awareness in preventing errors and reporting incidents.¹³  

Patient safety culture can be defined as part of the organizational culture, and to achieve patient safety there must be a culture that allows health workers working in hospitals to share information about patient safety issues and take corrective actions.¹⁴ Safety culture surveys are useful for measuring organizational conditions that can reduce unwanted events and patient accidents in hospitals.¹⁵ 

Compliance is the behavior of officers who are focused on instructions or instructions that have been given in any form of practice that has been determined.¹⁶ According to Niven (2002) in Suadnyani (2017), compliance of professional officers (health workers) is the extent to which a person's behavior is in accordance with the provisions that have been given by the leadership or the hospital.¹⁷

The results also found a significant relationship between patient safety culture and knowledge level and adherence to patient identification. This is in accordance with other research which found there was a significant relationship between the level of nurse knowledge and the implementation of patient identification¹⁸. It is recommended that hospital management make efforts to increase nurses' knowledge, especially in the field of patient safety.¹⁹ Research in Saudi Arabia found health care providers and non-health care providers reported high levels of knowledge about patient identification standards, including the need to use two patient identifiers. However, the audit results showed that health service providers used two identifiers, namely only checking the patient's name and not checking the medical record number. These results highlight the need for further attention to inappropriate patient identification, including understanding the causes and ways to improve the translation of patient identification standards into practice.²⁰ In individual health services, checking patient identity through identification bracelets is one of the most effective and safest methods, besides verbal identification and checking health documentation. The format/shape of the bracelet is usually standardized thanks to the protocols implemented by each healthcare organization to ensure patient safety goals are achieved; However it is recommended to have at least two of the following descriptions that should always be considered in the design of an identification bracelet: name and surname (mother's full name for newborns), date of birth and medical record number. The use of non-recommended identifiers such as bed number, age and hospitalization data will not guarantee safe assistance to users as they may represent misleading information.²¹ 

CONCLUSION

The patient safety culture and the level of knowledge of health workers is significantly related to compliance with the implementation of patient identification in hospital. Recommendations for increasing the compliance of health workers in the implementation of patient identification include: periodic re-socialization to all staff about the importance of patient identification in compliance and correctly according to applicable standards, optimization of the team and members of the patient safety program, so that patient safety program activities can run well, so as to reduce the number of insiedn, especially related to patient identification and optimization of the role of superiors, full support and creating a strong safety culture in each and between units

Acknowledgment

Thanks for Universitas Airlangga for supporting this research

Funding 

Self-funding

Conflict of Interest

The authors declare any conflict of interest.

Author contribution

Agustina Ayu: Conceptualization, Methodology, Data Curation, Investigation, Writing-Original draft preparation

Puput Fiohana : Conceptualization, Data Curation, Writing-Original draft preparation

Djazuly Chalidyanto: Writing-Reviewing, and Editing

Nyoman Anita Damayanti: Supervision, Validation

REFERENCES

1. Macgillivray T. Advancing the Culture of Patient Safety and Quality Improvement. Methodist Debakey Cardiovasc J [revista en Internet] 2020 [acceso 7 de noviembre de 2021]

16(3): 192-198. 2020;16(3). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7587327/pdf/i1947-6094-16-3-192.pdf

2. Kemenkes. Peraturan Menteri Kesehatan Republik Indonesia No 11 Tahun 2017 tentang Keselamatan Pasien. Indonesia. 2017;

3. WHO. Patient Safety. 2023; Available from: https://www.who.int/news-room/fact-sheets/detail/patient-safety 

4. Mulyatiningsih S, Sasyari U. Gaya Kepemimpinan Yang Efektif Dalam Meningkatkan Keselamatan Pasien. Healthc Nurs J. 2021;3(1):59-64. https://doi.org/10.35568/healthcare.v3i1.1093

5. Silalahi Y, Wahyuni Nasution S, Novalinda Ginting C. The Effect Of Implementation Of Patient Identification Based On The Pall Accreditation Standards On Improving The Patient Safety Program At Royal Prima General Hospital In 2022. Int J Heal Pharm. 2022;2(4):765-9. https://doi.org/10.51601/ijhp.v2i4.88

6. Mutiara Putri I, Diniyah K. Gambaran Tingkat Pengetahuan Tentang Identifikasi Pasien Pada Perawat Dan Bidan Di Rs Rajawali Citra Bantul Yogyakarta. Avicenna J Heal Res. 2022;5(1):118-25. https://doi.org/10.36419/avicenna.v5i1.598

7. Kim KJ, Yoo MS, Seo EJ. Exploring the Influence of Nursing Work Environment and Patient Safety Culture on Missed Nursing Care in Korea. Asian Nurs Res (Korean Soc Nurs Sci) [Internet]. 2018;12(2):121-6. https://doi.org/10.1016/j.anr.2018.04.003 PMid:29684580

8. Kaushik S, Chawla, R. Incidence of Patient Identification Errors observed before Medication and Procedure/Intervention. Int J Res Found Hosp Healthc Adm. 2016;4(2):100-6. https://doi.org/10.5005/jp-journals-10035-1066

9. Violato E, Witschen B, Violato E, King S. A behavioural study of obedience in health professional students. Adv Heal Sci Educ [Internet]. 2022;27(2):293-321. https://doi.org/10.1007/s10459-021-10085-4 PMid:34807358 PMCid:PMC9117351

10. Riplinger L, Piera-Jiménez J, Dooling JP. Patient Identification Techniques - Approaches, Implications, and Findings. Yearb Med Inform. 2020;29(1):81-6. https://doi.org/10.1055/s-0040-1701984 PMCid:PMC7442501

11. Gani M, Arso S, Dwiantoro L. Factors influencing health worker compliance in implementing patient safety goals in Indonesia: Systematic review. Indones J Multidiscip Sci. 2023 Nov 5;3:102-9. https://doi.org/10.55324/ijoms.v3i2.680

12. Darliana D. Hubungan Pengetahuan Perawat dengan Upaya Penerapan Patient Safety di Ruang Rawat Inap Rumah Sakit Umum Daerah Dr. Zainoel Abidin Banda Aceh. Idea Nurs J. 2016;VII(1):2016.

13. Rochmah TN, Santi MW, Endaryanto A, Prakoeswa CRS. Budaya Keselamatan Pasien Berdasarkan Indikator Agency for Healthcare Research and Quality di RSUD Dr. Soetomo. J Penelit Kesehat SUARA FORIKES. 2019;10(2):112-8.

14. Farokhzadian J, Dehghan Nayeri N, Borhani F. The long way ahead to achieve an effective patient safety culture: Challenges perceived by nurses. BMC Health Serv Res. 2018;18(1):1-13. https://doi.org/10.1186/s12913-018-3467-1 PMid:30134980 PMCid:PMC6106875

15. Fontes-Mota GCH, Ribeiro E. Patient safety culture from the perspective of employees in a university hospital. Brazilian J Pharm Sci. 2022;58:1-16.

16. Chirinos Muñoz MS, Orrego C, Montoya C, Suñol R. Predictors of patient safety culture in hospitals in Venezuela: A cross-sectional study. Med (United States). 2021;100(18):E25316. https://doi.org/10.1097/MD.0000000000025316 PMid:33950920 PMCid:PMC8104285

17. Suadnyani. Penerapan Theory of Planned Behavior terhadap Perilaku Kepatuhan Perawat dalam Pencegahan VAP di ICU RS Katolik Surabaya. Universitas Airlangga. 2017;

18. Silverglow A, Wijk H, Lidén E, Johansson L. Patient safety culture in home care settings in Sweden: a cross-sectional survey among home care professionals. BMC Health Serv Res [Internet]. 2023;23(1):998. https://doi.org/10.1186/s12913-023-10010-y PMid:37716938 PMCid:PMC10505324

19. Hilda Hilda, Arsyawina Arsyawina SS, Hesti Prawita Widiastuti AS, Pramono JS. Relationship between nurses knowledge level and workload about implementation of patient identification. Healthc Low-resource Settings. 2023;11:11756. https://doi.org/10.4081/hls.2023.11756

20. Abu Mostafa F, Saadallah A, Barazi H, Alghammas H. Assessing Knowledge and Compliance of Patient Identification Methods in a Specialized Hospital in Saudi Arabia. Glob J Qual Saf Healthc. 2019 Aug 1;2. https://doi.org/10.4103/JQSH.JQSH_27_18

21. Romano R, Marletta G, Sollami A, La Sala R, Sarli L, Artioli G, et al. The safety of care focused on patient identity: an observational study. Acta Biomed. 2021;92(3)