J Nurs Manag. 2018;26:209–218. wileyonlinelibrary.com/journal/jonm
© 2017 John Wiley & Sons Ltd
Accepted: 5 July 2017
Health professional perspectives of patient safety issues in
intensive care units in Saudi Arabia
Adel Al Malki MN, RN
| Ruth Endacott PhD, MA, DipN (London), RN
Kelli Innes MN, PhD candidate, RN
Monash University, Nursing and Midwifery,
Frankston, Vic, Australia
School of Nursing and Midwifery, Plymouth
University, Devon, UK
Adel Al Malki, King Abdul-Aziz Specialist
Hospital-Taif, Saudi Arabia.
King Abdul-Aziz Specialist Hospital-Taif,
This study was supported by Ministry of
Education in Saudi Arabia [grant number
12159 & 13003, 2015]
Aim: To examine attitudes to patient safety in two intensive care units from the per-
spective of health care professionals in Saudi Arabia.
Background: Despite adverse errors leading to poor patient outcomes, there is a pau-
city of literature, including staff perceptions, on adverse errors in Saudi Arabian inten-
sive care units.
Methods: A descriptive cross- sectional design was used. Health professionals (n = 144)
completed the safety attitude questionnaire- intensive care unit.
Results: The scores from the six safety domains of the safety attitude questionnaire-
intensive care unit showed all respondents had a negative attitude towards patient
safety, with participants in one intensive care unit scoring lower in all domains. The
mean scores across all domains ranged from 47.1 to 70.3 on a 100- point scale, with
the lowest score reported in the “perceptions of management” domain. Respiratory
therapists reported a significantly higher job satisfaction score than nurses, and physi-
cians rated communication amongst themselves and nurses as high.
Conclusion: There are significant challenges for safety culture in this study, with nega-
tive attitudes across all domains.
Implication for Nursing Management: Managers may need to review and consider
policies relating to safety culture including workforce planning, leadership and patient
centred care. Further research into this global health priority is required to contribute
to improving patient safety in intensive care units.
communication, intensive care units, patient safety, safety management, Saudi Arabia, surveys
1 | INTRODUCTION
Patient safety in the intensive care unit (ICU) is considered an import-
ant challenge around the globe. The ICU is a demanding environment
compared with other units in a hospital due to the complexity of patient
illnesses and treatment required (Baruch & Messer, 2012). Therefore, a
consequence of this is the possibility of increased medical errors in the
ICU (Garrouste- Orgeas & Valentin, 2013). Failure to provide quality
care for patient led to an estimated 440,000 deaths annually in the
USA alone, mostly due to preventable hospital errors (James, 2013).
In addition, around 1.3 million patients worldwide per year are injured
and over 100,000 deaths were attributed to adverse hospital events
(Scott, Rogers, Hwang, & Zhang, 2006). Adverse events in ICUs are
common, serious, complex and preventable. Among 400 patients in
one ICU, around 20% had an adverse event and 50% of these were
preventable (Needham, 2010). In the Saudi Arabia health care system
there were a reported 25,000 medical errors between 2001 and 2006.
However, these errors were not broken down into specific locations