August 25, 2020

To outline the development and effect of an audit with feedback implementation strategy that intended to increase the rate of voluntary medication error reporting by nurses. BACKGROUND: Medication errors are a serious global health issue. Audit with feedback is a widely-used implementation strategy that has potential to modify nurses’ reporting behaviour and improve medication error reporting rates. DESIGN: Quasi-experimental implementation study (fulfilling the TIDieR checklist) with two pairs of matched wards at a private hospital in Australia was conducted from March 2015-September 2016. One ward from each pair was randomised to either the intervention or control group. METHOD: Nurses within intervention wards received audit with feedback on a quarterly basis over a 12-month implementation period. Control wards underwent quarterly audits only (without feedback). Feedback consisted of a one-page infographic poster, with content based on medication error data obtained from audits and the hospitals’ risk management system (RiskMan). The primary outcome – rate of medication errors reported per month – was determined in both groups at pre-implementation, implementation, and post-implementation phases. Differences between groups were compared using generalised linear mixed models with Poisson distribution and log link. RESULTS: A non-significant intervention effect was found for rate of medication errors reported per month. Interestingly, when combining data from both groups, a significant increasing time trend was observed for medication errors reported per month across pre-implementation and implementation phases (80% increase). CONCLUSIONS: The audit with feedback strategy developed in the present study did not effectively influence the voluntary reporting of medication errors by nurses. RELEVANCE TO CLINICAL PRACTICE: Despite the lack of intervention effects, the use of a published checklist to optimise the reporting quality of this study will contribute to the field by furthering the understanding of how to enhance audit with feedback implementation strategies for nurses.

To identify predictors of toxic leadership behaviour in nurse managers. BACKGROUND: Toxic leadership is becoming increasingly prevalent in nursing; however, the literature provides very limited evidence of the different factors that promote toxic leadership behaviour in nurse managers. METHODS: A descriptive, cross-sectional design was used. Two hundred and forty nurse managers from ten hospitals in Central Philippines were included in the study. Data were collected using the Nurse Information Form and the Toxic Leadership Behaviours of Nurse Managers Scale (ToxBH-NM). Hierarchical multiple regression was used to analyse the data collected. RESULTS: The mean of average item score of the ToxBH-NM was 1.250 (SD = 0.470). Multiple regression analyses identified the years of experience in a managerial role (β = -0.165, p = 0.031), job status (part time) (β = 0.177, p = 0.002), ward census (30 patients, 40 patients, and above 40 patients) [(β = 0.231, p = 0.005); (β = 0.345, p 3 units) [(β = 0.292, p < 0.001); (β = 0.235, p < 0.001), hospital type (private hospital) (β = 0.271, p = 0.007), and hospital level (secondary hospitals) (β = 0.226, p = 0.036) predicted toxic leadership behaviour in nurse managers. CONCLUSIONS: Overall, nurse managers were appraised as non-toxic leaders. Nurse Managers who held part time job status, had lower experience in the managerial role, and those who were assigned in wards or units with high patient admission reported increased toxic leadership behaviours. Further, nurse managers who managed more than 2 units, those who were employed in private hospitals, and those who worked in secondary hospitals reported increased toxic leadership behaviours. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse administrators can consider the different predictors identified when planning and developing leadership interventions and organizational strategies (e.g., limiting the number of units per nurse manager, provision of full time job employment, assignment of assistant nurse managers, formulation of policy specific to managing toxic behaviours) may assist in the determent of toxic behaviours in nurse managers.