RxCe - Culture of Safety in the Pharmacy Setting Materials

A CULTURE OF SAFETY IN THE PHARMACY SETTING

STEVEN MALEN, PharmD, MBA

Dr. Steven Malen graduated with a dual degree: Doctor of Pharmacy (PharmD) and Master of Business Administration (MBA) from the University of Rhode Island. Over his career, he has worked as a clinical pharmacist in the retail, specialty, and compounding sectors. He specialized and taught on topics from vaccines to veterinary compounding. Dr. Malen has also written a science fiction novel and taught and co- founded the concept of Patient Empowered Blockchain (P.E.B.). Currently, Dr. Malen continues to write, teach, and consult various companies in the healthcare sector.

Topic Overview

A culture of safety in any setting is important to make sure people feel comfortable being honest about making mistakes. If people feel they will be reprimanded even for the smallest, inconsequential mistake, they will sweep it under the rug instead of addressing it head-on with the rest of the team. In the pharmacy setting, this is even more important as there are many repetitive processes that can have serious consequences if any part is compromised. The general concept of culture of safety in pharmacy is to make sure no one working in the pharmacy is afraid to talk about the potential for mistakes, and even more importantly, when mistakes happen, to know how to address them.

Accreditation Statement:

RxCe.com LLC is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.

Universal Activity Number (UAN): The ACPE Universal Activity Number assigned to this activity is

Pharmacist 0669-0000-23-018-H05-P

Pharmacy Technician 0669-0000-23-019-H05-T

Credits: 1 hour of continuing education credit

Type of Activity: Knowledge

Media: Computer-Based Training/ Homestudy Fee Information: $4.99

Estimated time to complete activity: 1 hour, including Course Test and course evaluation

Release Date: March 5, 2023 Expiration Date: March 5, 2026

Target Audience: This educational activity is for pharmacists.

How to Earn Credit: From March 5, 2023, through March 5, 2026, participants must:

Read the “learning objectives” and “author and planning team disclosures;”

Study the section entitled “educational activity;” and

Complete the Course Test and Evaluation form. The Course Test will be graded automatically. Following successful completion of the Course Test with a score of 70% or higher, a statement of participation will be made available immediately. (No partial credit will be given.)

Credit for this course will be uploaded to CPE Monitor®.

Learning Objectives: Upon completion of this educational activity, participants should be able to:

Define culture of safety and its impact on healthcare

Describe what “just culture” is in the context of a culture of safety

Identify barriers to a culture of safety

Learn how to overcome barriers to a culture of safety

Disclosures

The following individuals were involved in the development of this activity: Steve Malen, PharmD, MBA, and Susan DePasquale, MSN, PMHNP-BC. There are no financial relationships relevant to this activity to report or disclose by any of the individuals involved in the development of this activity.

Introduction

Patient safety is a top priority in healthcare. Patient safety improves and better patient outcomes occur when healthcare institutions promote a culture of safety within the organization. This is often expressed through what is called a “just culture,” where there is open communication, and staff members feel comfortable discussing errors or near misses without fear of retaliation. Healthcare professionals should recognize what makes an organization safe, what the barriers to a culture of safety are, and how to remove the barriers.

Defining What is Meant by a Culture of Safety

Singer, et al. (2009) provides a useful definition for a culture of safety: “the safety culture of an organization is viewed as the values shared among organization members about what is important, their beliefs about how things operate in the organization, and the interaction of these with work unit and organizational structures and systems, which together produce behavioral norms in the organization that promote safety.”1 This definition focuses on how coworkers interact with each other as a work unit, and how the organization can contribute to the development of shared beliefs and assumptions of personnel that develop over time as they work within the organization.1 This definition can be broadly applied to any organization, not just healthcare institutions.1

When applying the concept of culture of safety to healthcare, it is often described in terms of the “patient safety climate.”1-3 While patient safety climate is an important part of a culture of safety, it does not capture the broader, fuller meaning when describing an organization’s culture generally.2 In a broader sense, culture shapes clinician and staff perceptions about behavior and what is praiseworthy and what is not in the eyes of coworkers or management. In this way, culture influences a person’s motivation to engage in safe behaviors in their daily practice.2

However, there is a logic to focus more on patient safety when speaking of a culture of safety in healthcare since patient safety is a top priority in healthcare organizations.3 Moreover, patient safety can be measured using data, whereas beliefs, assumptions, and culture within an organization are more amorphous and difficult to assess.1,2

The relationship between a culture of safety and patient safety was reviewed in a study conducted by Singer, et al. (2003).4 The authors assessed the safety culture in 15 California hospitals.4 They showed significant differences in safety culture, with some hospitals having a more robust safety culture than others. The authors concluded that a strong safety culture reduced errors and improved patient outcomes.4 In addition, a strong safety culture is tied to job satisfaction.6 On the other side, the absence of a strong safety culture can lead to an increase in adverse events, injuries, and accidents to patients.5,7 It can also lead to a healthcare worker’s injury in the workplace.7 It is important for healthcare organizations to prioritize safety and create the necessary environment required to mitigate these negative effects, and to create a positive workplace environment.

Application of a Culture of Safety

A culture of safety is necessary for all healthcare environments. It is required in emergency departments and long-term care homes.8,9 Safe care is not suspended because of a natural disaster, crisis, civil unrest, or pandemic.10 It is important to understand that safe, high-quality care remains the standard during such events.10 The COVID-19 pandemic is an example of this. The pandemic placed a heavy burden on healthcare providers and systems, dramatically impacting how healthcare services were delivered.16 The healthcare systems had to respond quickly to make changes that would protect the safety and quality of care.10

Characteristics of a Culture of Safety

Healthcare organizations with a strong culture of safety will share values, beliefs, and attitudes that prioritize safety within their organization.8,9

Several key factors characterize a culture of safety. They include a just culture, open communication, teamwork, leadership, and continuing education in the area of cultural safety.9,11-13

Culture of Safety and a “Just Culture”

Organizations that promote a “just culture” balance the need for personnel to be held accountable for their actions and the idea of blamelessness.9 These organizations emphasize the need to make system changes, rather than blame individuals when mistakes happen, i.e., more emphasis is placed on system design and behavioral choices than on errors and results.12 This approach is seen in the World Health Organization’s (WHO) definition of a “just culture as a concept that recognizes the complexity of situations and events and acknowledges that most patient safety failures occur due to weak systems.”12 This does not mean that people are not accountable for their actions.9 A “just culture” includes a “robust accountability model.”9 The policies and procedures of an organization for accountability are clear and published for all to know. Accountability in a “just culture” requires an understanding of the interaction between systems and human behavior. In some cases, because of system designs, accountability for mistakes should be shared.9

A just culture can lead to open communication. Staff members feel comfortable discussing errors and near-misses without fear of retaliation. Transparency and trust are highly valued within a just culture. Rawlings, et al. (2018) gave an example of open communication.3 They state that in an environment that prioritizes a climate of patient safety, a pharmacy technician who overhears another technician providing inaccurate information to a patient will not hesitate to report the incident, and will not be afraid of retaliation from management, or being shunned by coworkers.3 In this case, patient safety is primary, and the “culture” of the organization means that the person who gave the incorrect information to the patient will appreciate the correction, and the person reporting will not feel the personal negativity, or be judged by others, that often is associated with reporting a coworker. This

is the type of patient-centered care that provides safe, high-quality care tailored to individual patient needs.

Culture of Safety and Teamwork

In a culture of safety, all personnel work together as a team to identify and mitigate hazards. They are part of a team working towards a common goal of providing safe care.9 Team members are empowered to make decisions, speak up about safety concerns, and take ownership of their work.

Culture of Safety and Leadership

Strong leadership is an essential part of a culture of safety.9 Leadership must be visible, engaged, and committed to creating a safety culture. Leaders must also provide the necessary resources and support to promote safety and model safe behaviors.13

Culture of Safety and Continuing Education

Continuous improvement is essential to a culture of safety.14 Staff members are taught and encouraged to identify and report errors. The organization actively works to improve processes and systems to prevent future errors. Team members can learn from their mistakes and the mistakes of others. The organization continuously improves its safety practices.

Evaluating a Culture of Safety

There are several tools that can be used to evaluate the culture of safety within a healthcare organization. Surveys can be used to gather information from staff members about their perceptions of safety, their experiences with errors, and their views on communication, teamwork, and leadership. Surveys can also be used to identify strengths and weaknesses within the safety culture.

Safety Attitudes Questionnaire (SAQ): The SAQ consists of questions measuring different dimensions of safety culture. These dimensions might include perceptions of communication, teamwork, leadership, and error reporting.

Patient Safety Culture Survey (PSCS): The PSCS is a survey tool developed by the Agency for Healthcare Research and Quality (AHRQ) to measure perceptions of safety culture in healthcare organizations.

Focus groups and interviews: Focus groups and interviews can be used to gather qualitative data about a culture of safety. They allow staff members to discuss their experiences, perceptions, and views on safety more in-depth and interactively.

Root cause analysis: Root cause analysis is a systematic process to identify the underlying causes of errors or adverse events. It can be used to identify systemic issues or cultural factors that may be contributing to unsafe conditions and provide insights for improvement.

Safety Performance Indicator (SPI): A tool that helps identify the areas of strengths and weaknesses in the safety culture and can be used to track progress over time.

Several studies were conducted to evaluate the validity and reliability of the tools listed above.

In a study conducted by Aboneh, et al. (2020), researchers used a Hospital Survey on Patient Safety Culture (HSOPS) to assess staff members' perceptions of patient safety culture in their workplace.15 The HSOPS is a validated survey tool that measures 12 dimensions of patient safety culture, including communication, teamwork, leadership, and reporting of errors.15

The study found that the overall patient safety culture at community pharmacies was moderate. The highest scores were in the dimensions of Teamwork within Units and Supervisor/Manager Expectations & Actions

Promoting Patient Safety, while the lowest scores were in the dimensions of Non-punitive Response to Error and Feedback & Communication about Error.15

The authors suggest that the moderate overall patient safety culture in community pharmacies may be due to a lack of a clear safety policy and procedures, a lack of adequate training and education on patient safety, and a lack of a system for reporting and learning from errors.15 They recommend that community pharmacies should develop and implement a comprehensive patient safety program that includes regular training and education for staff, clear safety policies and procedures, and a system for reporting and learning from errors.15

Overall, the study demonstrates that using a validated tool such as the HSOPS can provide a useful way to evaluate patient safety culture in community pharmacies. The study also highlights the importance of ongoing efforts to improve patient safety culture in these settings.15

In a study performed by Sorra and Dyer (2010), researchers conducted a study to evaluate the multilevel psychometric properties of the Hospital Survey on Patient Safety Culture (HSOPS), meaning the reliability and validity of the survey across different levels of the organization, such as units, departments, and the whole hospital.16

The study found that the HSOPS has acceptable reliability and validity levels and that the survey has good construct validity, meaning it measures what it is supposed to measure and is sensitive to changes in patient safety culture over time. Furthermore, the HSOPS can be used as a basis for continuous improvement in patient safety culture.16

In another study, Nordén-Hägg, et al. (2010) performed psychometric validation of the Safety Attitudes Questionnaire (SAQ) in community pharmacies in Sweden.17 The results showed that the questionnaire had good internal consistency, test-retest reliability, and construct validity. The study also showed that the safety culture assessment could be adapted and used in other countries.17

Barriers to a Culture of Safety

Barriers can exist that impede the development and maintenance of a culture of safety in healthcare organizations. According to Amalberti, et al. (2005), there are five system barriers to achieving safe healthcare. These barriers include:13

Fragmentation of care: Healthcare organizations often have siloed systems that do not communicate effectively with one another, leading to a lack of coordination and continuity of care.

The complexity of care: Healthcare has become increasingly complex. Advances in technology and treatments make it difficult for staff members to keep up with the latest information and best practices.

Limited feedback: Feedback is not provided on performance, making it difficult for the staff to identify and correct errors.

Limited standardization: Lack of standardization leads to confusion and errors.

Limited participation: Staff members are not actively engaged in the design and implementation of safety initiatives.

Without active participation, it is difficult to achieve a culture of safety. The authors argued that healthcare organizations should work to overcome these barriers by adopting a systems approach to safety, which involves creating a culture of safety, standardizing care, providing regular feedback, and involving staff members in the design and implementation of safety initiatives.13 Again, this approach is consistent with a just culture. As the WHO said, a just culture “recognizes the complexity of situations and events and acknowledges that most patient safety failures occur due to weak systems.”12 By developing and using systems that promote safety, the individual who may have made an error is not the main focus.13 The article concluded by highlighting that overcoming these barriers will require a change in mindset and behavior, as well as strong leadership and an organizational commitment to safety.13

Barriers to safe care may also arise during times of natural disasters, crises, civil unrest, or pandemics.10 As was mentioned above, safe, high- quality care remains the standard during such events, e.g., the COVID-19 pandemic.10

Grissinger (2014) pointed out the importance of actions in creating a safety culture in healthcare organizations.18 The key takeaways found from the article by Grissinger include the following:

A culture of safety is not just about having the right policies and procedures in place but also about the actions of staff members in implementing these policies and procedures.

Staff members must be held accountable for their actions and rewarded for improving safety.

Leadership creates a safety culture by setting the tone, providing the necessary resources, and modeling safe behaviors.

Staff members must be actively engaged in identifying and mitigating hazards and be empowered to make decisions that affect patient safety.

Regularly monitoring and measuring safety performance, and providing feedback, is essential to identify areas for improvement and track progress over time.

The author concludes that creating a culture of safety is not a one- time event but a continuous journey that requires ongoing effort, commitment, and leadership. The staff actions and behaviors, not just the policies and procedures, are the key elements of a culture of safety.

In another interesting article by Warholak, et al. (2011), the authors argued that pharmacy students must be educated about patient safety to become safe practitioners. This education should be integrated throughout the curriculum.19

The key takeaways found in this article include the following:

Pharmacy students need to be educated about patient safety to become safe practitioners.

Patient safety education should be integrated throughout the pharmacy curriculum rather than being confined to a single course or rotation.

Pharmacy students should learn about the science of safety, including the causes of errors, the systems approach to safety, and strategies for preventing errors.

Pharmacy students should also learn about the importance of communication, teamwork, and leadership in creating a safety culture.

The authors suggest that patient safety education could be enhanced by incorporating simulation and other active-learning techniques and involving practicing pharmacists in the education of pharmacy students.

They suggest that interprofessional education (IPE) is also important for pharmacy students to understand how different health professionals work together and how this affects patient safety.

Roman, et al. (2022) discuss the need to overcome barriers in capturing, tracking, and analyzing medical errors.20 The authors encourage teams to:

Discuss openly and in a balanced manner about failures

Encourage a common goal

Focus on the solutions rather than the culprits

Create a culture of safety so that the system which allowed the mistake to happen is changed

Incorporate specific quality indicators

These indicators will help teams better understand and correct deviations that may lead to errors or negative outcomes for the quality and safety of the healthcare system.20

Overcoming Barriers to a Culture of Safety

There are several strategies that healthcare organizations can use to overcome barriers to a culture of safety. Some of these strategies are discussed here.

Encourage open communication: Create a culture where staff members feel comfortable discussing errors and near-misses without fear of retaliation. Encourage transparency and trust by creating channels for communication, such as anonymous reporting systems or suggestion boxes.

Promote teamwork: Foster a sense of teamwork by encouraging staff members to work together to identify and mitigate hazards. Provide opportunities for staff members to collaborate and share ideas, such as regular meetings or team-building activities.

Strong leadership: Provide strong, visible leadership that sets a clear direction and demonstrates a commitment to safety. Encourage leaders to model safe behaviors and provide the necessary resources and support to promote safety.

Standardize care: Implement standard protocols and procedures to reduce confusion and errors. Regularly review and update protocols to ensure they are based on the latest best practices.

Involve staff members: Involve staff members in the design and implementation of safety initiatives. Empower staff members to make decisions, speak up about safety concerns, and take ownership of their work.

Provide regular feedback: Regularly monitor and measure safety performance and provide feedback to staff members. Use this feedback to identify areas for improvement and track progress over time.

Education and training: Provide regular training and education for staff members on patient safety topics. This will help them understand the importance of safety and how to identify and mitigate hazards.

Interprofessional approach: Foster interprofessional communication and collaboration among staff members from different disciplines. This will promote a shared understanding of safety issues and a sense of teamwork.

Regularly review and improve: Continuously review and improve safety protocols, policies, and procedures. Continuous training to keep up with the latest best practices and tackle new and emerging risks.

Culture of Safety and a Look Forward

There is a degree of enthusiasm that the interventions described above and in the scientific literature can create effective, measurable results when it comes to a culture of safety.21 However, Singer and Vogus (2013) highlighted the fact that the evidence supporting many of the interventions is weak or inconsistent.21 They point out that “[i]mplementing organisational interventions is not a matter of taking a pill or flipping a switch, and they must not be treated as such. That is, organisational interventions are not inherently effective or ineffective. They require attention to behavioural and relational implications of the change and sustained, dedicated commitment of personnel and other resources.”21

The difficulties surrounding the development of a culture of safety persist.22 This is in large part due to its multidimensional character. This means that it is of utmost importance for organizations to identify specific aspects of institutional culture that are significantly associated with patient safety, implement organizational interventions to promote safety, and then incorporate feedback to determine that the goals are being met.22

Summary

A culture of safety in an organization includes shared values that individuals within an organization find are important company-wide, as well as their beliefs on how things work, and their interaction within organizational structures and systems. This definition focuses on how coworkers interact with each other as a work unit, and how the organization can contribute to the development of shared beliefs and assumptions of personnel that develop over time as they work within the organization.

A culture of safety includes a “just culture” that balances the need for punishment in appropriate circumstances and the idea of blamelessness. In a just culture, more emphasis is placed on system design and behavioral choices than on errors and results.

Barriers can exist that impede the development and maintenance of a culture of safety in healthcare organizations. There are several strategies that healthcare organizations can use to overcome barriers to a culture of safety. It is of utmost importance to identify specific aspects of institutional culture that are significantly associated with patient safety, implement organizational interventions to promote safety, and then incorporate feedback to determine that the goals are being met.

Course Test

A culture of safety in an organization can be defined in part by the

ability of individuals within the organization to set their own culture.

shared values by individuals that are held company-wide.

organization must focus on the individual who makes a mistake rather than looking for systemic causes.

fact that most patient safety failures occur due to weak personnel, not weak systems.

What are some important factors in creating a culture of safety in healthcare organizations?

Strong and visible leadership

Open communication

Teamwork

All of the above

Organizations that promote a “just culture” are more likely to emphasize

the need to make system changes rather than blame individuals when mistakes happen.

an individual’s mistakes rather than look at system designs.

that most patient safety failures occur due to weak individuals.

that personal accountability has no place.

is a systematic process to identify the underlying causes of errors or adverse events.

Social media

Safety Attitudes Questionnaire (SAQ)

Root Cause Analysis

Patient Safety Culture Survey (PSCS)

Which of the following dimensions of safety culture is typically measured in a hospital survey on patient safety culture?

Staff turnover rate

Perceptions of communication

Budget allocation

Patient satisfaction scores

A culture of safety in healthcare

is suspended during natural disasters, crises, or pandemics.

becomes important only in emergency healthcare settings.

arises only in the context of cultural diversity.

is necessary for all healthcare environments.

True or False: A culture of safety does not impact patient outcomes.

True

False

In a “just culture” workplace, a healthcare professional who overhears a coworker giving a patient incorrect healthcare advice should

not report the incident because “telling on” a coworker is unjust.

correct the coworker in front of the patient so the patient knows not to ask that coworker for information again.

not hesitate to report the incident to the supervisor or management.

not report the incident but wait until the coworker leaves and then provide the patient with the correct information.

True or False: In an organization that promotes a culture of safety and a “just culture,” individuals are not held accountable for their actions or mistakes.

True

False

In order for an organization to have sustained change toward an improved culture of safety, it is important for an organization

to identify specific aspects of its culture that are significantly associated with patient safety.

implement organizational interventions to promote safety.

incorporate feedback to determine that the goals are being met.

All of the above

References

Singer S, Lin S, Falwell A, Gaba D, Baker L. Relationship of safety climate and safety performance in hospitals. Health Serv Res. 2009;44(2 Pt 1):399-421. doi:10.1111/j.1475-6773.2008.00918.x

Weaver SJ, Lubomksi LH, Wilson RF, Pfoh ER, Martinez KA, Dy SM. Promoting a culture of safety as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158(5 Pt 2):369-374. doi:10.7326/0003- 4819-158-5-201303051-00002

Rawlings JE, Herner SJ, Delate T, Palmer KE, Swartzendruber KA. Assessment of Pharmacy Department Patient Safety Culture with the Use of Validated Work Environment Survey Indices. Perm J. 2018;22:17-070. doi:10.7812/TPP/17-070

Singer SJ, Gaba DM, Geppert JJ, Sinaiko AD, Howard SK, Park KC. The culture of safety: results of an organization-wide survey in 15 California hospitals. Qual Saf Health Care. 2003 Apr;12(2):112-8. doi: 10.1136/qhc.12.2.112

Battles JB, Lilford RJ. Organizing patient safety research to identify risks and hazards. Qual Saf Health Care. 2003;12 Suppl 2(Suppl 2):ii2-ii7. doi:10.1136/qhc.12.suppl_2.ii2

Wang KY, Chou CC, Lai JC. A structural model of total quality management, work values, job satisfaction and patient-safety-culture attitude among nurses. J Nurs Manag. 2019;27(2):225-232. doi:10.1111/jonm.12669

Almost JM, VanDenKerkhof EG, Strahlendorf P, et al. A study of leading indicators for occupational health and safety management systems in healthcare. BMC Health Serv Res. 2018;18(1):296. Published 2018 Apr

23. doi:10.1186/s12913-018-3103-0

Świtalski J, Wnuk K, Tatara T, Miazga W, Wiśniewska E, Banaś T, Partyka O, Karakiewicz-Krawczyk K, Jurczak J, Kaczmarski M, Dykowska G, Czerw A, Cipora E. Interventions to Increase Patient Safety in Long- Term Care Facilities-Umbrella Review. Int J Environ Res Public Health. 2022 Nov 21;19(22):15354. doi: 10.3390/ijerph192215354. PMID:

36430073; PMCID: PMC9691014.

Rogers E, Griffin E, Carnie W, Melucci J, Weber RJ. A Just Culture Approach to Managing Medication Errors. Hosp Pharm. 2017;52(4):308-

315. doi:10.1310/hpj5204-308

Denning M, Goh ET, Scott A, et al. What Has Been the Impact of Covid- 19 on Safety Culture? A Case Study from a Large Metropolitan Healthcare Trust. Int J Environ Res Public Health. 2020;17(19):7034. Published 2020 Sep 25. doi:10.3390/ijerph17197034

Mrayyan MT. Predictors and outcomes of patient safety culture: a cross- sectional comparative study. BMJ Open Qual. 2022;11(3):e001889. doi:10.1136/bmjoq-2022-001889

Kim BB, Yu S. Effects of Just Culture and Empowerment on Patient Safety Activities of Hospital Nurses. Healthcare (Basel). 2021;9(10):1324. Published 2021 Oct 4.

doi:10.3390/healthcare9101324

Amalberti R, Auroy Y, Berwick D, Barach P. Five system barriers to achieving ultrasafe health care. Ann Intern Med. 2005;142(9):756-764. doi:10.7326/0003-4819-142-9-200505030-00012

Hays D, Kruse JA. Nursing Student and Faculty Perceptions of Just Culture. J Nurs Educ. 2022;61(5):257-260. doi:10.3928/01484834- 20220303-10

Aboneh EA, Stone JA, Lester CA, Chui MA. Evaluation of Patient Safety Culture in Community Pharmacies. J Patient Saf. 2020;16(1):e18-e24. doi:10.1097/PTS.0000000000000245

Sorra JS, Dyer N. Multilevel psychometric properties of the AHRQ hospital survey on patient safety culture. BMC Health Serv Res. 2010;10:199. Published 2010 Jul 8. doi:10.1186/1472-6963-10-199

Nordén-Hägg A, Sexton JB, Kälvemark-Sporrong S, Ring L, Kettis- Lindblad Å. Assessing safety culture in pharmacies: the psychometric validation of the Safety Attitudes Questionnaire (SAQ) in a national sample of community pharmacies in Sweden. BMC Clin Pharmacol. 2010;10:8. Published 2010 Apr 11. doi:10.1186/1472-6904-10-8

Grissinger M. That's the Way We Do Things Around Here!: Your Actions Speak Louder Than Words When It Comes To Patient Safety. P T. 2014;39(5):308-344.

Warholak TL, Holdford DA, West D, et al. Perspectives on educating pharmacy students about the science of safety. Am J Pharm Educ. 2011;75(7):142. doi:10.5688/ajpe757142

Roman MD, Fleacă SR, Boicean AG, et al. Failure in Medical Practice: Human Error, System Failure, or Case Severity?. Healthcare (Basel). 2022;10(12):2495. Published 2022 Dec 9.

doi:10.3390/healthcare10122495

Singer SJ, Vogus TJ. Safety climate research: taking stock and looking forward. BMJ Qual Saf. 2013;22:1–4. doi:10.1136/bmjqs-2012-001572

Lee SE, Dahinten VS. Using Dominance Analysis to Identify the Most Important Dimensions of Safety Culture for Predicting Patient Safety. Int J Environ Res Public Health. 2021;18(15):7746. Published 2021 Jul

21. doi:10.3390/ijerph18157746

DISCLAIMER

The information provided in this course is general in nature, and it is solely designed to provide participants with continuing education credit(s). This course and materials are not meant to substitute for the independent, professional judgment of any participant regarding that participant’s professional practice, including but not limited to patient assessment, diagnosis, treatment, and/or health management. Medical and pharmacy practices, rules, and laws vary

from state to state, and this course does not cover the laws of each state; therefore, participants must consult the laws of their state as they relate to their professional practice.

Healthcare professionals, including pharmacists and pharmacy technicians, must consult with their employer, healthcare facility, hospital, or other organization, for guidelines, protocols, and procedures they are to follow. The information provided in this course does not replace those guidelines, protocols, and procedures but is for academic purposes only, and this course’s limited purpose is for the completion of continuing education credits.

Participants are advised and acknowledge that information related to medications, their administration, dosing, contraindications, adverse reactions, interactions, warnings, precautions, or accepted uses are constantly changing, and any person taking this course understands that such person must make an independent review of medication information prior to any patient assessment, diagnosis, treatment and/or health management. Any discussion of off-label use of any medication, device, or procedure is informational only, and such uses are not endorsed hereby.

Nothing contained in this course represents the opinions, views, judgments, or conclusions of RxCe.com LLC. RxCe.com LLC is not liable or responsible to any person for any inaccuracy, error, or omission with respect to this course, or course material.

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