Factors associated with patient safety implementation based on safety attitudes questionnaire in accredited hospital Jambi City Indonesia

Background : The nursing service are influenced by the behavior nurses in implementation of patient safety the contributes to adverse event or incident patient safety in accredited public hospital. This study aims to analyses most dominant determinant factors associated with patient safety implementation based on safety attitudes questionnaire (SAQ) in accredited hospital. Methods : This study is a cross sectional study with quantitative method conducted on nurses who work in accredited hospital. Samples of 190 nurses were included in this study by using proportional random sampling technique. The data were analyzed by using multiple logistic regression with backward LR method. Results : Total 190 participant were (22.1%) males and 148 (77.9%) females. Most participant had completed Diploma of vocational education 157 (82.6%). The most dominan factors associated with implementation of patient safety base on Safety Attitude Questionnaire is the work environment factor (p 0.001; OR 3.187). Conclusion : It is proven that a good work environment factor will improve the behavior of nurses in implementing patient safety. This research recommends to develop policy toward evaluation effort of implementation patient safety, as well as evaluation of all nursing procedures in terms of patient safety consideration to external or internal work environment.


BACKGROUND
Patient safety is a vital and important component of care and measures to improve the quality of service (1,2).Assessment of hospital quality is obtained through an accreditation system, one of which is patient safety goals as a priority for health services worldwide (3,4).One step to improve the quality of service through the implementation of patient safety in the hospital.
Based on several studies in the measurement of patient safety reporting at several hospitals in the world that have been accredited by Join Commission International (JCI).The research Pham, JC. et al., (5) of conducted in 11 hospitals from 5 countries there are 52 incident patient.safetythose are Hong Kong 31%, Australia 31%, India 23%, America 12% and Canada 10% While in Brazil the incident of adverse event in hospitals is estimated at 7,6% (6).Some of the results of this study that patient safety incidents are still widely found in various countries including in Indonesia.
Based on several studies related to the implementation of patient safety in hospitals that have been accredited 2012 version in Indonesia.the research of Nurmalia (7) in the public hospital in Semarang that 56,2% mentoring the implementation of patient safety is still not good, whereas in Panti Waluya Sawahan private hospital by Harus Bernadeta (9) reported KTD 9 incident (41%), KNC 6 incident (27%), KPC 5 incident (23%), KTC 2 incident (9%).Data on patient safety incidents are still widely found in both public and private hospitals, although they have passed the accreditation, which can have negative impact health service.
Impact caused by hospitals do not apply patient safety can be a decrease in hospital service quality.

METHOD Study design
A cross-sectional study was conducted to most dominant determine factors associated with patient safety implementation based on safety attitudes questionnaire (SAQ) in accredited hospital, Jambi city, Indonesia.

Population and Sample
The population in this study are nurses who work in accredited hospital with a version of the hospital accreditation committee and joint commission international in Jambi city, amounting to 355 nurses.The results of the calculation of the number of samples in this study were 190 nurses.A simple random sampling was used to select nurses.Inclusion criteria are; (1) minimum 6 months working period (2) Served in the inpatient room, (3) Served as Primary Nurse and Associate Nurse.

Measurement
The questionnaire consisted of two parts; part 1 general demographic information such as age, sex and education.Part 2 the instrument to measure the most Basok Buhari, Rizanda Machmud, Dorisnita Factors Associated with Patient Safety Implementation Based on Safety Attitudes Questionnaire in Accredited Hospital Jambi City Indonesia dominant factor of patient safety application using Safety Attitude Questionnaire (SAQ).The SAQ was specifically to measure patient safety.The SAQ instrument consists of six factors; team work climate, safety climate, job satisfaction, perceptions of management, stress recognition and work environment.Each item is measured on a 5point Likert scale (Agree strongly to Disagree strongly), which is then converted to a 0-100 scale.Each factor score equals the mean score of its component survey item.A positive score is defined as ≥75 out of 100.To calculate as a positive score for a given factor, the survey respondent must answer, on average, agree slightly or higher to all related item.

Ethical consideration
This

Data analysis
Data were analyzed by using statistical analysis with Statistical Package for the Social Sciences (SPSS) versi 16.The population characteristic was described by frequency and percentage.Multiple logistic regression was performed to most dominant determine factors associated with patient safety implementation based on safety attitudes questionnaire (SAQ) in accredited hospital.The independent variable that associated with intention to leave in bivariate test was include in model.The variables were selected in the final backward model.A p-value of less than 0.05 was considered as statistically significant.

RESULTS
Total  Based on the analysis of answers delivered by nurses, the management of accredited hospitals in the city of Jambi has been enough to improve human resources, this condition can be seen in the form of nurses statement about the work environment of accredited hospitals found most nurses stated that the hospital work environment has done a good job to train new personnel related patient safety.
Based on the statement of the nurses, it is seen that the accredited Hospital in Jambi City has implemented the important elements in implementation of patient safety by always carrying out supervision related to patient safety target training.However, in the implementation of individuals has a great responsibility to the safety of patients so that management needs to consider related to the pattern of resources needed in providing services thus the application of patient safety becomes more effective.
The problems that still cannot be resolved in every hospital both government and private that have passed the accreditation, one of which is the pattern of labor needs, according to the nurse's statement that almost half the nurses stated if the hospital staffing level is not sufficient enough to handle the number of patients, in Austin, M, et al., opinion (17) ensures that nurses and patient satisfaction will improve in a good working environment.However, there are negative factors such as increased workload, insufficient number of nurses, communication problems, insufficient equipment and lack of managerial support.
In a study conducted in several countries reported that assessment of common problems related to the quality of patient care and the application of patient safety.Although there are differences in health, funding and resorce delivery but the researches recommend that work environment factor should be improved to ensure the retention of qualified nursing personel and advance patient care outcomes regarding the application of patient safety (18).

CONCLUSION
Work environment is the dominant factor associated with the implementation of patient safety at accredited hospital in Jambi city Indonesia.Effort to improve patient safety require a nurse awareness raising strategy for the importance of applying patient care by upholding the right of patients.Less supportive working conditions for the implementation of patient safety may be influenced by the number and quality of human resources and facilities available for the implementation of patient care research has been approved by Ethics Commission of Faculty of Medicine,

Table 2
Multiple logistic regression analysis of the most dominant factors associated with patient safety implementation based on safety attitudes questionnaire (SAQ) in accredited hospital (n=190) ' s composite patient safety score for U .S .hospitals.J Patient Saf.2013;9(1):1-9.18. Aiken LH.Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States.BMJ.2012;