Development Of Assessment Scale For Patient Safety Culture In ICU

Objective:The study is to develop an assessment scale for patient safety culture in ICU initially, and to confirm the reliability and validity of the assessment scale. Also, it can be used to understand further the level of safety attitudes of ICU clinical staff, to build safety culture, and ensure the patient safety and provide scientific and quantitative evaluation tools.Methods:1. The theoretical outline is based on Reason’s Swiss cheese theory and Vincent’s patient safety analytical work. Manuscript of items of the questionnaire was created by depth interview with ten ICU clinical staff literature review.2. The items of the questionnaire was under a two-round Delphi consultation by twenty one experts from Zhejiang Province, Hainan Province and Xinjiang Province.Then the Items were modified and screened according to advices given by the experts. The positive coefficient of experts and authoritative coefficient are used and the reliability is analyzed, and then the assessment scale for ICU patients safety culture is established.3. And then235ICU clinical staffs from the First Affiliated Hospital of Zhejiang University, No.1People’s Hospital of Hangzhou, and clinical staffs attending2013ICU annual meeting in Zhejiang province are pre surveyed. Subjective screening, project analysis and exploratory factor analysis were performed to screen the items and data that were collected to analyze the reliability and validity of the inventory. Finally, the ICU patient safety culture assessment scale was formed.Results:1. Qualitative interview resultsAccording to the interviewing results, combined with the review of the literature, with fully using of the safety attitude questionnaire (Safety Attitudes Questionnaire) of the ICU version and the ICU organizational safety culture management scale (Culture, Organization, and Management in Intensive Care), the ICU patient safety culture assessment scale of the initial item pool is formed, which includes teamwork climate (6items), safety climate (10items), job satisfaction and turnover intention (6items), perception of management and staffing (6items), stress recognition (5items), effective communication of information (7items), organizational learning and training (5items)7dimensions and45items, the above is the contents of the questionnaire as expert consultation.2. Delphy expert consultation resultsAfter two rounds of expert consultation,2new entry was added, entry3was deleted, with2entries combined, and11entries revised. Eventually formed an ICU patient safety culture assessment on the scaleteamwork climate (5items), safety climate (9items), job satisfaction and turnover intention (6items), management support and staffing (7items), stress recognition (5items), effective communication of information (5items), organizational learning and training (6items), altogether, with7dimensions and43items.3. Pre-survey results(1) Based on the pre-survey results, through the project analysis to delete7items, and using the exploratory factor analysis, deleted2items, a total of9items are deleted, finally formed a safety climate (13items), job satisfaction (7items), safety resources (4items), shift (2entries), teamwork climate (3items), communication (3items), fear of punishment (2items)7dimensions and34entries ICU patient safety culture evaluation scale.(2) Scale reliability:the scale of total Cronbach’s alpha coefficient was0.909; the split half reliability was0.832. Each dimension of Cronbach’s alpha coefficient is between0.481-0.909, and the split half reliability is0.481-0.866.(3) Construct validity of the scale①Content validity:on the one hand, scale development process will initially determine the entry of two rounds expert consultation. Through expert assessment, it is ensured that each entry can accurately express the evaluation content. On the other hand, through the analysis of the scores and total scores between two related to evaluate the content validity. The correlation coefficient is higher, and the better the scale content validity. The results of each factor and the total scale correlation coefficients is between0.35-0.93(p<0.01).②Construct validity:the correlation analysis and factor analysis are used in this article, with two methods to study the structural validity of the scale. Exploratory factor analysis revealed that the KMO value is0.885, Bartlett (Bartlett’s test of spherical test of sphericity) value is3554.092(P=0.000), so it is suitable for factor analysis. This article also use the principal component analysis to extract the common factor, characteristic value>1, remove the factor loading less than0.4or in the same factor on the same load entries, eventually extracted7factors, the cumulative contribution rate was59.347%. The theoretical structure is accord to the assumption which means that the scale is valid.③Discriminant validity:There are significant differences between each dimension and the overall score for different medical personnel. Which shows that the scale of patient safety culture of different technical staff level can be distinguished.(4) The feasibility of the scales:in pre surveys,235questionnaires were distributed, with235recycled, and the effective one was220, excluding15invalid questionnaires, the recovery rate is100%, with effective rate93.62%. Among the subjects,220can fully understand all the entries, accounted for95.9%The subject that can understand basically accounted for6.7%.No one said that he can’t fully understand the scale items.72.7%of the medical staff regarded that the number of entries in the scale is suitable. The time that the object to complete the scale is8-10minutes.Conclusion:1. The ICU patient safety culture evaluation made in this article contains safety climate, job satisfaction, safety resource, shift, teamwork, communication, fear of punishment, with7dimensions and34items.2. The "ICU patient safety culture questionnaire" has good reliability and validity, which can be used to evaluate the ICU patient safety culture atmosphere, and to provide reference to establish the patient safety culture assessment tools for domestic ICU.