Evaluation of patient safety culture among Malaysian retail pharmacists: results of a self-reported survey

Assessment of patient safety culture among healthcare providers in tertiary hospitals in Malaysia-A cross-sectional study

Background and Aim

Patient safety culture is crucial for every health care institution, as a lack of it may harm patients seeking treatment. The current study aimed to identify the level of safety culture and assess the knowledge, attitude, and perception of patient safety culture among healthcare providers (HCPs') in tertiary hospital settings.

Methods

A cross-sectional study was conducted among HCPs from two private tertiary hospitals in Johor and Selangor. A structured validated questionnaire, including the Hospital Survey on Patient Safety Culture, was used to assess the level of patient safety culture in these hospitals.

Results

In this study, the calculated sample size was 320, and all 550 eligible participants from both hospitals were approached to participate. However, only 158 responded, resulting in a response rate of 49.38%. The majority of the HCPs (n = 110; 69%) rated their hospital as very good or excellent in maintaining an overall patient safety culture. The study revealed that communication about the errors (PRR = 80) and organizational learning and continuous improvement (PRR = 74) were good in their hospital settings. However, staffing and work pace (PRR = 28), response to errors (PRR = 40), reporting patient safety events (PRR = 48), and handoffs and information exchange (PRR = 39) were inadequate. These findings indicate the negative attitudes among HCPs and the need for further improvement to maintain a culture of patient safety.

Conclusion

HCPs in the study settings had optimal knowledge but negative attitudes towards the culture of patient safety in their organization. Inadequate staffing, work pace, and a lack of response to mistakes were commonly observed, which may increase the chances of errors and pose health threats to patients that need to be addressed immediately. Every healthcare organization is urged to address the issue of patient safety culture as a matter of urgency.

Status of Patient Safety Culture in Community Pharmacy Settings: A Systematic Review

OBJECTIVES

This systematic aimed to understand the global status using the results of survey studies based on the Community Pharmacy Survey on Patient Safety Culture and set the directions of development in terms of the patient safety culture of community pharmacies.

METHODS

Electronic searches were performed in EMBASE, MEDLINE, PubMed, and CINAHL databases by using the words "patient safety," "culture," and "community pharmacy" with synonyms or associated words in the original English language research articles published between January 1, 2012, and March 2, 2023. This systematic review was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Eleven surveys from 10 countries were selected. Five studies were conducted on pharmacists, whereas 6 studies were carried out on all pharmacy staff members such as pharmacists, technicians, clerks, and pharmacy students on apprenticeship. There was a considerable variation in the positive response rates across the dimensions of all the surveys. The highest positive response score was demonstrated for "teamwork" and "patient counseling," whereas the "staffing, work pressure, and pace" dimension was essential for improving patient safety culture in community pharmacy settings. For overall rating of the pharmacy on patient safety, 84.8% of pharmacy staff members gave good, very good, or excellent as their responses.

CONCLUSIONS

Despite the differences among studies, findings of this study are expected to be used as valuable evidence to develop patient safety improvement strategies after reflecting each country's health care setting or community pharmacy practice. Furthermore, the results would offer meaningful assistance to achieve the goals of global campaigns such as the World Health Organization Patient Safety Challenge.

Role of community pharmacists in cardiovascular diseases-related health promotion and dyslipidemia management in Malaysia: A nationwide cross-sectional study

BACKGROUND

Cardiovascular disease (CVD) is a leading cause of death and disability worldwide, imposing a significant burden on patients and healthcare systems. The role of pharmacists in reducing cardiovascular disease (CVD) is pivotal as they play an essential part in the healthcare team, particularly in medication management and patient education. Pharmacists are well-positioned to contribute to the prevention and control of CVD through various roles, including medication management and patient education. This study aims to investigate the current involvement of community pharmacists in Malaysia, specifically in cardiovascular diseases-related health promotion activities and dyslipidemia management, including their perceived barriers.

METHOD

This cross-sectional survey was conducted among community pharmacists in all 14 states of Malaysia between November 2021 and July 2022. The self-administered survey was shared to relevant groups through various social media platforms.

RESULTS

A total of 312 community pharmacists were involved in the survey. Majority of the respondents were females (66%), with a mean age (SD) of 32.9 (8.4) years. Most of the respondents showed satisfactory practice for patient counselling, but improvements are needed particularly in risk assessment and collaborative care aspect. Most of them expressed their interest for dyslipidemia management training (89.4%). Lack of access to medical records (71.2%) and lack of CVD-related educational materials (70.8%) were the two main perceived barriers identified.

CONCLUSION

Community pharmacists in Malaysia provide a satisfactory role in the provision of cardiovascular disease-related health promotion activities, especially in providing patient counselling. Strengthening collaborative care is essential for providing comprehensive and patient-centered intervention in dyslipidemia management. This requires ongoing efforts to address and overcome existing barriers for effective teamwork and coordination among healthcare professionals.

Patient safety culture among community pharmacists in Cairo

BACKGROUND

Measuring perception of patient safety culture among pharmacists working in community pharmacies is crucial to identify opportunities and areas that require improvement. The aim of this work is to measure patient safety culture among pharmacists working in community pharmacies in Cairo.

METHODS

A cross-sectional study was conducted among pharmacists working in community pharmacies in the center and south regions of Cairo. The Pharmacy Survey on Patient Safety Culture (PSOPSC), developed by the Agency for Healthcare Research and Quality (AHRQ) was used to collect data.

RESULTS

The study included 210 community pharmacies with a 95% response rate. The mean age of pharmacists was 28 ± 5.4 years. The overall positive response percentage (PRP) ranged between 35 and 69% with a mean of 57.4%. The highest PRP was identified in the domains of "teamwork" (68.97%), "organizational learning-continuous improvement" (64.93%) and "patient counseling" (61.83%). The PRP was less than 60% in 6 out of the 11 composites. The lowest PRP was found in the domain of "staffing, work pressure, and pace", which scored 34.98%.

CONCLUSION

The study identified areas of patient safety culture that require improvement in community pharmacies, especially in allocating staff, appropriate working hours, and training community pharmacists on the importance and principles of patient safety. The overall mean PRP of patient safety culture among community pharmacists highlights the need to include patient safety as the strategic priority at the level of community pharmacies.

Patient Safety Culture in the Southern Region of Saudi Arabia: A Survey among Community Pharmacies

Measuring patient safety culture in the community pharmacy can help with identifying areas for development. The current study is a descriptive, cross-sectional, electronic survey conducted among pharmacists working in community pharmacies located in the southern region of Saudi Arabia. The community pharmacy version of the "Pharmacy Survey on Patient Safety Culture" (PSOPSC) was used to collect data. The positive response rate (PRR) was calculated as per the guidance provided by the Agency for Healthcare Research and Quality (AHRQ). Based on the PRR, two least-achieved items (<25%) were taken for further analysis to identify the possible predictors. A sum of 195 pharmacists were included in this study and most of them were working in chain pharmacies. The highest PRRs were observed with teamwork (94.99), and patient counseling (94.13), followed by physical space and environment (93.07). The lowest PRRs were observed with staffing, work pressure, and pace (47.70), followed by communication openness (72.60). Specific characteristics, such as experience and the number of working hours, are significantly related to a poor PRR. The current study results indicate that the scope for improving patient safety exists in various areas of community pharmacies. However, it is necessary to prioritize the need based on a positive response rate.

The COVID-19 Pandemic and Patient Safety Culture: A Cross-Sectional Study among Community Pharmacies in Jordan

The COVID-19 pandemic has dramatically imposed stressful conditions that may impact the ability of healthcare staff to provide safe and effective care. Research on patient safety culture among community pharmacies during the pandemic is limited. This study aimed to assess the patient safety culture among community pharmacies in Jordan during the COVID-19 pandemic. Pharmacists and pharmacy assistants from 450 community pharmacies were approached through online means, with 378 answering the questionnaire written in Arabic that had been adapted from the Community Pharmacy Survey on Patient Safety Culture (PSOPSC). This study showed that various patient safety standards were addressed to a high degree during the COVID-19 pandemic, as represented by the high positive response rate (PRR) measures that were mainly observed in the dimensions "Teamwork" (90.1%), "Patient Counseling" (85.2%), and "Staff Training and Skills" (82.7%). Furthermore, significantly higher PRR scores for the "Teamwork", "Staffing, Work Pressure, and Pace", "Response to Mistakes", "Organizational Learning-Continuous Improvement", and "Overall Perceptions of Patient Safety" dimensions were observed among participants who worked in independent pharmacies than those who worked in chain pharmacies. Despite an overall positive patient safety culture in the current context of community pharmacies in Jordan during the COVID-19 pandemic, pitfalls were observed in the "Staffing, Work Pressure, and Pace" dimension.

A nationwide assessment of community pharmacists’ attitudes towards dispensing errors: A cross-sectional study

Objectives

Dispensing errors (DEs) are common causes of preventable harm to patients. Interestingly, very little is known about their prevalence and types in the community pharmacy setting in Lebanon due to the lack of an effective reporting system. Therefore, this study aims to explore the perceptions of community pharmacists about the types of these errors in Lebanon, the factors behind their occurrence, the reasons for underreporting, and the current practices for reducing them.

Methods

A cross-sectional survey was conducted through a self-administered questionnaire, using a scale of 0–4, distributed among a sample of community pharmacists in Lebanon.

Results

A total of 171 pharmacists responded to the survey, of whom 68% reported that DEs were common, and 52% believed that they were increasing. The main reported contributing factors to DEs were unreadable and incomplete prescriptions (≈3.0 ± 1.0 out of 5), workload, multitasking, interruptions, similarity in names of medications, and fatigue (≈2.5 ± 1.0). Moreover, the perceived strategies to limit the risks of DEs were collaboration with physicians, improving handwriting, double-checking, proper patient counselling, encouraging reporting, and issuance of guidelines (≈3.2 ± 1.0). Finally, the main reasons for underreporting DEs were the lack of obligation to report and the lack of reporting systems (59% and 56%, respectively).

Conclusions

DEs may be very prevalent in Lebanon because they are unmonitored by the authorities. Electronic prescription and fair reporting systems are highly recommended, along with follow-up studies.

Determination of pharmacy students' patient safety approach using the theory of planned behaviour: a mixed-method study

OBJECTIVES

To investigate pharmacy students' attitudes, subjective norms, perceived behavioural control, intentions and their behaviour towards patient safety using a theory of planned behaviour framework.

DESIGN

Mixed-methods research.

SETTING

Private university in Malaysia.

PARTICIPANTS

Pharmacy undergraduate students participated in the study. There were 18 students participated in the qualitative study and 272 students responded to the survey questionnaire.

METHODS

A convergent parallel-mixed method design, involving a quantitative survey and qualitative focus group discussions was used among pharmacy students in a private university in Malaysia. Qualitative data of transcribed verbatim texts were then subjected to a thematic content analysis framework. Multiple correlations were undertaken using the quantitative data to examine how the dependent variable (self-reported knowledge) related to the independent variables (attitudes, behavioural intentions, subjective norms, perceived behavioural control.

PRIMARY OUTCOME

Pharmacy students' attitudes, subjective norms, perceived behavioural control, behavioural intentions constructs led to their behaviour towards patient safety.

SECONDARY OUTCOME

The quantitative study revealed that there was a moderate positive correlation between students' self-reported knowledge and attitudes (r=0.48, p=0.03).

RESULTS

Pharmacy students' attitudes and perceived behavioural control constructs had positive correlations with pharmacy students' self-reported knowledge on patient safety. There was no correlation between students' self-reported knowledge and subjective norms (r=0.27, p=0.23). There was a weak positive correlation between students' self-reported knowledge and perceived behavioural control (r=0.39, p=0.04). There was no correlation between students' self-reported knowledge and behavioural intention (r=0.20, p=0.56).

CONCLUSIONS

Theory of planned behaviour constructs such as attitudes, subjective norms, perceived behavioural control and behavioural intentions of pharmacy students, defined their behaviour towards patient safety. Pharmacy students' attitudes and perceived behavioural control constructs were correlated with their self-reported knowledge on patient safety.

A cross-sectional study on prescribing and dispensing errors at a corporate hospital in South India

BACKGROUND

The substantial and increasing use of medications escalating the risk of harm globally. The serious medication errors in hospital and community settings resulting from patient injury and death. Hence, a cross-sectional study was aimed to analyse the prescribing and dispensing errors in the outpatient departments of a south Indian hospital.

MATERIALS AND METHODS

A prospective cross-sectional study was carried out to evaluate the prescribing, and dispensing errors in outpatients who seek patient counseling at the tertiary care multispecialty hospital. The data were collected from various sources such as patient's prescriptions and dispensing records from the pharmacy.

RESULTS

A total of 500 prescriptions were screened and identified 65.60% of prescriptions with at least any one type of medication errors. Out of 328 prescriptions, 96.04% were handwritten and 3.96% were computerised prescriptions. Among the 328 prescriptions with medication errors, 32.62% noticed prescribing errors, 37.80% with dispensing errors, and 29.58% with both prescribing and dispensing errors. Out of these 328 prescriptions, 74.09% prescriptions were found to have polypharmacy.

DISCUSSION

Medication errors are serious problems in healthcare and can be a source of significant morbidity and mortality in healthcare settings. The present study showed that dispensing errors were the most common among the types of medication errors, in these particularly wrong directions were the most common types of errors.

CONCLUSION

This study concludes that the overall prevalence of medication errors was around 80%, but there were no life-threatening events observed. A clinical pharmacist can play a major role in this situation appears to be a strong intervention and early detection and prevention of medication errors and thus can improve the quality of care to the patients.

Evaluation of patient safety culture in community pharmacies in Qatar

INTRODUCTION

Patient safety culture is a key contributor to medication safety globally. However, the perspective of pharmacists and other personnel in community pharmacy regarding patient safety culture may vary from one country to another.

OBJECTIVE

The aim of this study was to determine the perspectives of community pharmacy personnel in Qatar about patient safety culture in community pharmacy setting.

METHODS

A cross-sectional web-based survey utilising the Agency for Healthcare Research and Quality Community Pharmacy Survey on Patient Safety Culture was conducted. Participants included community pharmacy personnel practicing in Qatar. Both descriptive and inferential statistics were applied for data analyses, with statistical significance set at ≤ 0.05.

RESULTS

Two hundred and forty participants completed the survey. A large proportion of the respondents (52.5%) reported an "excellent" overall rating of patient safety in their respective community pharmacies. Patient counselling and teamwork composites of patient safety culture were associated with the highest positive responses (95% and 93.7%, respectively). The "staffing, work pressure and pace" composite demonstrated the lowest positive response (50.6%) among the 11 composites. Inferential analysis revealed that working in chain pharmacies was significantly associated with positive responses related to "teamwork" (P = .019). Furthermore, working for more than 40 hours per week had a significant positive influence on the overall perceptions of patient safety (P = .025).

CONCLUSION

There was an overall positive perception towards patient safety culture among the surveyed community pharmacy personnel in Qatar. Superiority was observed with patient counselling and teamwork, while staffing, work pressure and pace were judged poorly, warranting further investigations and potential targeting for interventions.

Road towards promoting patient safety practices among hospital pharmacists: Hospital-based baseline patient safety culture assessment cross-sectional survey

ABSTRACT

Patient safety is a fundamental aspect of a healthcare system. The aim of this study was to assess the perception and determinants of the patient safety culture of pharmacists in hospitals, in Riyadh, Saudi Arabia.A survey was conducted with pharmacists in the pharmacies of governmental, /military and private hospitals in Riyadh, Saudi Arabia. The pharmacy survey on patient safety culture questionnaire developed by Agency for Healthcare Research and Qualtity, a hard copy was distriuted to the pharmacists. The positive response rate (RR) was calculated and compared across hospitals using a chi-square test. The predictors of patient safety grades were identified using the generalized estimating equation. The data was analyzed using SAS.A total of 538 questionnaires were distributed, of which 411 responded (RR 76.4%). Of the participants, 229 (56%) were females. The majority 255 (62%) were in the 18 to 34 years age range, and 361 (88%) had a bachelor's degree. The majority of the sample 376 (92%) was a pharmacist. The Positive RR (PRR) ranged between (25.6%-74%). The highest PRR was observed in teamwork (74.4%), followed by 'staff, training and skills' (68%), and 'organizational learning continuous improvement' (66%). The lowest PRR was observed in 'staffing, work pressure, and pace' (25.5%). Comparing the PPR of the various healthcare sectors, the governmental hospitals scored the highest in all patient safety domains. Generalized Estimating Equation analysis showed that with increase in scores of all patient safety culture domains increased the likelihood of reporting a better patient safety grade, whereas respondents' demographic characteristics had no effect except the working experience years 6 years and above had odds of poor reporting of the patient safety grade (odds ratio = 2.54, 95% confience interval (1.543, 4.194), (P = .0003).The grades achieved in the various domains of patient safety culture by pharmacists in Riyadh are below the expected standard. The highest scores were achieved in teamwork, with the lowest scores in staffing, work pressure and pace. Overall, pharmacists in government hospital settings have a better perception of patient safety than their peers in other settings. These results provide the baseline evidence for developing future interventional studies aiming at improving patient safety culture in hospital pharmacy settings.

Exploring patient-safety culture in the community pharmacy setting: a national cross-sectional study

OBJECTIVE

The community pharmacy is one setting that plays a crucial role in patient safety. To develop tailored patient safety improvement programs in this setting, it is essential to know the perspectives of the pharmacies' staffs on patient safety. Thus, in this study, we assessed patient-safety culture in the community pharmacy setting in Saudi Arabia.

METHODS

Between January and August of 2019, we conducted a cross-sectional study among staff working in the community pharmacies in Saudi Arabia. Data on patient safety culture were collected using the Pharmacy Survey on Patient Safety Culture (PSOPSC). Analyses were performed with descriptive statistics (frequency/percentages), Fisher's Exact test, Chi-square analysis, and multivariable ordinal logistic regression with proportional odds model analysis.

RESULTS

PSOPSC data from 805 community pharmacies in Saudi Arabia were received (response rate: 78%). The overall average positive response rate for the 11 dimensions of the PSOPSC survey was 60.2%, with a range from 34.8% in the dimension of Staffing, Work Pressure, and Pace to 76.4% in the dimension of Teamwork. Most participants responded positively, as in total, 504 (62.6%) of the participants rated their pharmacy as 'excellent' or 'very good' on patient safety. Gender and work experience in a pharmacy were important predictors of the overall patient safety grade.

CONCLUSIONS

The study revealed that all dimensions are scope for further improvement, and critical consideration ought to be given to the areas of weakness, for the most part in the dimension of Staffing, Work Pressure, and Pace.

Arabic version of pharmacy survey on patient safety culture: Hospital pharmacy settings

Objective:

The objective was to assess the validity and reliability of a translated Arabic language version of the pharmacy survey on patient safety culture released by the United States Agency for Healthcare Research and Quality in 2012 and to utilize this to assess staff attitudes and perceptions of the patient safety culture in hospital pharmacies of Kuwait.

Methods:

This study used a cross-sectional timeframe. Data were gained from three of the largest public hospital pharmacies and three of the largest private hospital pharmacies in Kuwait. The primary and secondary outcome measures were descriptive statistics, internal consistency, construct validity, model fit, and calculation of the positive response rate for all composites and items.

Results:

The results demonstrated that 9 of the 11 composites had a Cronbach’s alpha (α) of >0.7, and all composites had factor loadings above 0.6. The standardized root mean residual score appropriately fitted the data with a value of 0.072. The intercorrelations among the patient safety composites ranged from 0.29 to 0.83. The proportion of pharmacy staff who categorized the grade of patient safety as “Good,” Very good,” or “Excellent” was 93%.

Conclusion:

The Arabic version of the pharmacy survey on patient safety culture questionnaire indicated suitable levels of reliability and validity. Also, the results demonstrated that the pharmacy staff surveyed in Kuwait have a positive perception of patient safety culture in their organizations.

Organizational learning and patient safety: hospital pharmacy settings

Purpose

The purpose of this paper is to explore the relationship between organizational learning and patient safety culture in hospital pharmacy settings as determined by the learning organization survey short-form (LOS-27) and pharmacy survey on patient safety culture instruments, and to further explore how dimensions of organizational learning relate to dimensions of pharmacy patient safety culture.

Design/methodology/approach

This study is a cross-sectional study. Data were obtained from three public hospital pharmacies and three private hospital pharmacies in Kuwait. Partial least square structural equation modeling was used to analyze the data.

Findings

A total of 272 surveys (59.1 percent response rate) were completed and returned. The results indicated a significant positive relationship between organizational learning and patient safety culture in hospital pharmacy settings (path coefficient of 0.826, p-value <0.05 and R2 of 0.683). Several dimensions of the organizational learning showed significant links to the various dimensions of the pharmacy patient safety culture. Specifically, training (TRN), management that reinforces learning (MRL) and supportive learning environment (SLE) had the strongest effects on the pharmacy patient safety culture dimensions. Moreover, these effects indicated that MRL, SLE and TRN were associated with improvements in most dimensions of pharmacy patient safety culture.

Originality/value

To the best of the authors’ knowledge, this is the first attempt to assess the relationship between organizational learning, patient safety culture and their dimensions in hospital pharmacy settings.

Assessment of patient safety culture: a nationwide survey of community pharmacists in Kuwait

BACKGROUND

Medication errors have been the largest component of medical errors threatening patient safety worldwide. Several international health bodies advocate measuring safety culture within healthcare organizations as an effective strategy for sustainable safety improvement. To the best of our knowledge, this is the first study conducted in a Middle Eastern country at the level of community pharmacy, to examine safety culture and to evaluate the extent to which patient safety is a strategic priority.

METHODS

A descriptive cross-sectional study was conducted. The Pharmacy Survey on Patient Safety Culture (PSOPSC), developed by the Agency for Healthcare Research and Quality (AHRQ), was used to collect data. PSOPSC is a self-administered questionnaire which was previously tested for validity and reliability. The questionnaire was distributed among pharmacists who work in community pharmacies from the five governorates of Kuwait (Capital, Hawalli, Farwaniya, Jahra, and Ahmadi). The Statistical Package for Social Science (SPSS) software, version 24 was used for analysing data.

RESULTS

A total of 255 community pharmacists from the five governorates were approached to participate in the study, of whom 253 returned a completed questionnaire, with the response rate of 99%. Results from the study showed that patient safety is a strategic priority in many aspects of patient safety standards at the level of community pharmacies. This was reflected by the high positive response rate (PRR) measures demonstrated in the domains of "Teamwork" (96.8%), "Organizational Learning-Continuous Improvement" (93.2%) and "Patient Counselling" (90.9%). On the other hand, the lowest PRR was given to the "Staffing, Work Pressure, and Pace" domain which scored 49.7%.

CONCLUSIONS

Understanding community pharmacists' perspectives of patient safety culture within their organization is critical. It can help identify areas of strength and those that require improvement, which can help support decision about actions to improve patient safety. The current study showed that urgent attention should be given to the areas of weakness, mainly in the dimension of "Staffing, Work Pressure and Pace." The pharmacists pointed the need for adequate breaks between shifts and less distractible work environment to perform their jobs accurately.

Determining nurses' perceptions of patient safety culture in palliative care centres

Background: Palliative care patients often do not have decision-making capacity at the end of life so this patient group is vulnerable to violations of patient safety.Aim: To determine the attitudes of nurses in palliative care centres in Turkey towards the patient safety culture and to identify factors affecting these.Method: A descriptive, cross-sectional design using self-report questionnaires was used.Results: The mean Patient Safety Culture Scale points of the whole group were 2.91 ± 0.44. In the sub-dimensions of the scale, the highest points were determined in Employee Training (2.99 ± 0.51) and the lowest in Unexpected Events and Error Reporting (2.81 ± 0.54).Conclusions: Patient safety culture is related to nurses' working conditions and the attitude of management towards errors, etc. The results of this study will provide a contribution to the development of healthcare and healthcare training policies for critical units vulnerable to patient safety violations.

Use of patient safety culture instruments in operating rooms: A systematic literature review

OBJECTIVE

To identify and qualitatively describe, in a literature review, how the instruments were used to evaluate patient safety culture in the operating rooms of published studies.

METHODS

Systematic searches of the literature were conducted using the major database including MEDLINE, EMbase, The Cochrane Library, and four Chinese databases including Chinese Biomedical Literature Database (CBM), Wanfang Data, Chinese Scientific Journal Database (VIP), and Chinese Journals Full-text Database (CNKI) for studies published up to March 2016. We summarized and analyzed the country scope, the instrument utilized in the study, the year when the instrument was used, and fields of operating rooms. Study populations, study settings, and the time span between baseline and follow-up phase were evaluated according to the study design.

RESULTS

We identified 1025 references, of which 99 were obtained for full-text assessment; 47 of these studies were deemed relevant and included in the literature review. Most of the studies were from the USA. The most commonly used patient safety culture instrument was Safety Attitude Questionnaire. All identified instruments were used after 2002 and across many fields. Most included studies on patient safety culture were conducted in teaching hospitals or university hospitals. The study population in the cross-sectional studies was much more than that in the before-after studies. The time span between baseline and follow-up phase of before-after studies were almost over three months.

CONCLUSION

Although patient safety culture is considered important in health care and patient safety, the number of studies in which patient safety culture has been estimated using the instruments in operating rooms, is fairly small.