Adverse Events Associated With
Organizational Factors of General Hospital
Inpatient Psychiatric Care Environments
Nancy P. Hanrahan, Ph.D., R.N.
Aparna Kumar, M.A., M.P.H.
Linda H. Aiken, Ph.D., R.N.
Objective: Although general hospitals receive nearly 60% of all inpatient psychiatric admissions, little is known about the care environment and related adverse events. The purpose of this study was to determine the occurrence of adverse events and examine the extent to which organizing factors of inpatient psychiatric care environments were associated with the occurrence of these events. The events examined were wrong medication, patient falls with injuries, complaints from patients and families, work-related staff injuries, and…show more content… Concurrently, an Institute of Medicine study titled Keeping
Patients Safe: Transforming the Work
Environment of Nurses concluded that there was ample evidence that deficient hospital care environments create patient safety hazards (2).
Research on adverse events in psychiatric inpatient care is limited to a few single-hospital or single–health system studies of medication errors
(7–9). These studies show high rates of medication errors. Grasso and colleagues (7) retrospectively examined the rate of medication errors in a state
psychiatric facility during 1,448 patient days from a randomly selected sample of discharged patients. Their study detected 2,194 medication errors, an error rate that is similar to rates reported for general medical care units. One recent survey revealed that among the various inpatient units within a large hospital, the highest rate of adverse drug events occurred within the inpatient psychiatric unit
(7,10,11). Rothschild and colleagues
(12) found that whereas nonpsychotropic drugs accounted for only
4% of nonpreventable adverse drug events in a psychiatric hospital setting, these medications were associated with nearly one-third of all preventable adverse drug errors, indicating that psychiatric providers may commit more medical errors when managing comorbid nonpsychiatric disorders, such as diabetes or cardiovascular disorders. Inpatient psychiatric care settings need to be evaluated.