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Exploring Organizational Context and Structure as Predictors of Medication Errors and Patient Falls

Mark, Barbara A. PhD, RN, FAAN*; Hughes, Linda C. PhD, RN; Belyea, Michael PhD; Bacon, Cynthia T. MSN, RN*; Chang, YunKyung PhD, RN*; Jones, Cheryl A. PhD, RN, FAAN*

Journal of Patient Safety: June 2008 - Volume 4 - Issue 2 - p 66-77
doi: 10.1097/PTS.0b013e3181695671
Original Articles

Objectives: To examine relationships among organizational context (characteristics of the external, hospital, and nursing unit environments), organizational structure (unit capacity, work engagement, and work conditions), patient characteristics (age, sex, and health status), safety climate, and effectiveness (medication errors and falls) in acute care hospitals.

Methods: Data came from 278 medical-surgical units at 143 hospitals that participated in the Outcomes Research in Nursing Administration Project II, a longitudinal multisite study.

Results: Selected measures of the external, hospital, and nursing unit environment had significant influences on the organizational structure of nursing units, which in turn significantly predicted unit-level safety climate. However, structural measures had limited effects on medication errors and falls. Patient age and health status were associated with falls but not with medication errors. There was a significant structure-safety climate interaction, where units with higher levels of unit capacity but lower levels of safety climate reported fewer medication errors. In contrast, units with higher levels of unit capacity and higher levels of safety climate reported more falls.

Conclusions: There are important influences of contextual, structural, and safety climate factors on both medication errors and falls. The limited effect of structure on effectiveness and the differential moderating effect of safety climate suggest that future studies may benefit from the use of theoretical models that are targeted more specifically to the explanation of a particular type of adverse event.

From the *University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; †Virginia Commonwealth University, Richmond, Virginia; and ‡Arizona State University, Tempe, Arizona.

This research was supported with funding from the National Institute of Nursing Research, Grant Number R01NR003149.

Correspondence: Barbara A. Mark, PhD, RN, FAAN, The University of North Carolina at Chapel Hill, Carrington Hall CB7460, Chapel Hill, NC 27599-7460 (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.