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Mekonnen et al. BMC Health Services Research (2025) 25:1191 https://doi.org/10.1186/s12913-025-13396-z

BMC Health Services Research

*Correspondence: Biset Asrade Mekonnen [email protected]

Full list of author information is available at the end of the article

Abstract Background Adverse events resulting from medical care continue to be a significant cause of morbidity and mortality globally. Many individuals experience harm due to medical errors, particularly in developing nations. The primary objective of this study was to evaluate the patient safety culture among pharmacy professionals employed in public hospitals within Bahir Dar City, Ethiopia.

Methods A descriptive institutional-based cross-sectional study was conducted between March 2024 and April 2024. The Pharmacy Survey on Patient Safety Culture (PSOPSC) assessment tool was administered to all pharmacy professionals working at the three public hospitals. The data was analysed using Statistical Package for the Social Sciences (SPSS) version 26, followed by univariable and multivariable logistic regression analyses to identify predictors. Variables with a P value < 0.05 at a 95% Cl in the multivariable analysis were declared statistically significant.

Results Of the 118 participants, 110 responded, resulting in a response rate of 93.2%. The positive response rates for the 11 patient safety culture dimensions varied from 40.91–70.61%. According to the Agency for Health Research and Quality (AHRQ) guidelines, the average positive response rate was moderate at 59.09%. The lowest positive response rate was for ‘communication about mistakes’ at 40.91%, while ‘teamwork within a unit area’ had the highest positive response rate of 70.61%. The seven dimensions that fell within the AHRQ standard had a moderate positive response rate, ranging from 50.3 to 69.69%, whereas ‘teamwork within a unit area’ (70.61%) and ‘response to mistakes’ (70.45%) had a high positive response rate within the high positive response rate of the AHRQ standard (≥ 70.0%). However, two other dimensions, ‘communication about mistakes’ (40.91%) and ‘communication openness’ (48.47%) had a low positive response rate within the low positive response rate of the AHRQ standards (< 50.0%). Of the participants, 30.9% reported at least one event over the past year, while 37.3% rated the level of patient safety as 'very good or excellent'. Several factors were found to have a significant association with the level of positive response rate on

Patient safety culture and associated factors among pharmacy professionals working in Bahir Dar City public hospitals using a pharmacy survey on patient safety culture (PSOPSC) Biset Asrade Mekonnen1* , Samrawit Girma2, Samuel Telay2 and Dagninet Derebe Abie3

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Introduction Medication errors are a major cause of patient harm within healthcare systems. These errors can occur at any stage of medication use, including prescription, dis- pensing, administration, and monitoring. According to the World Health Organisation (WHO) report, 5% of patients worldwide suffer from preventable medication- related harm. In Low and Middle Income Countries (LMICs), the incidence of preventable medication-related harm was 7%, whereas in High-Income Countries (HICs), it was 4%. Southeast Asia and Africa had the highest rates of preventable medication-related harm, occurring at 9% [1, 2].

Worldwide, approximately 53% of preventable med- ication-related related adverse effects occur at the pre- scribing/ordering stage, whereas an additional 36% occur during the monitoring/reporting stage. In LMICs, nearly 80% of preventable medication-related harm occurs dur- ing the ordering/prescribing stage [2].

Annual hospital incidents in LMICs are estimated to reach 134  million, leading to approximately 2.6 deaths. In nine African countries, approximately 8.4% of patients in hospitals experienced adverse drug reactions, with approximately 43.5% of these reactions being prevent- able. The analysis revealed significant challenges, includ- ing the fact that 57.4% of the prescriptions contained prescribing errors and 15.5% had dose-related issues [2, 3].

Medication-related harm is responsible for half of all preventable harm in the healthcare system. Antibiotics, antipsychotics, cardiovascular drugs, gastrointestinal drugs, and non-steroidal anti-inflammatory drugs are responsible for at least 10% of the medication-related harm [2]. Settings for elderly patient care experience the highest rate of preventable medication harm (11%). The level of preventable harm ranged from severe to mild, with 26% being classified as clinically severe or life-threatening, 40% as moderate, and 39% as mild. The stages of medication usage that lead to the highest rates of preventable harm are primarily the prescription stage,

accountable for 58% of cases, and the monitoring stage, which accounts for 47% of cases [1, 4].

An estimated 2 to 4  million non-lethal preventable harms occur each year, and up to 400,000 hospitalised patient deaths per year may result from preventable harm worldwide [1, 5–7]. This issue has a far-reaching impact, causing reputational damage to healthcare systems. Con- sequently, trust in healthcare services is eroded, and the morale and well-being of healthcare workers are adversely affected. Additionally, public opinion about the value of investing precious societal resources in health- care systems is also negatively impacted [7, 8].

Patient safety culture (PSC) is a multifaceted frame- work that encompasses various dimensions, which in turn influence a range of discretionary actions linked to patient safety [9]. Establishing a robust PSC is crucial, and it begins with a profound understanding of the val- ues, beliefs, and norms that dominate an Organisation. This involves acknowledging what is considered signifi- cant and which attitudes and behaviors related to patient safety are endorsed, recognized, and expected [10].

The overall level of positive PSC among healthcare providers in different public hospitals in Ethiopia ranged from 44.0 to 50.1% [11–22]. Limited research has been conducted to investigate patient safety culture within a hospital environment among healthcare professionals. However, none of these studies have focused on hospi- tal pharmacy environments in Ethiopia. This study is the first of its kind in Ethiopia to investigate patient safety culture in hospital pharmacy environments. The primary objective of this study was to assess the PSC among phar- macy professionals at public hospitals in Bahir Dar city using a PSOPSC assessment tool in the specified area of study. The results of this study are expected to provide insight into the healthcare system within the organisa- tions and a better understanding of PSC in the selected public hospitals, ultimately enhancing the quality of pharmaceutical care services.

patient safety culture, including educational level, years of working experience in the hospital and unit area, direct interaction with patients, patient safety training, and five dimensions of patient safety culture: staff training and skills, communication openness, communication about prescriptions across shifts, communication about mistakes, and physical space and environment.

Conclusions A moderate level of patient safety culture indicated that targeted interventions are required to address key areas contributing to this moderate positive response rate. To create effective hospital pharmacy settings, teamwork, leadership skills, effective communication, employee counseling, adequate staffing, prompt response procedures, and accurate reporting protocols are essential.

Keywords Patient safety, Patient safety culture, Healthcare quality, Adverse events reported, Patient safety grade, Hospital pharmacy, Ethiopia

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Methods Study area The study was conducted at public hospitals found in Bahir Dar city, on Tibebe Ghion Specialized Hospital, Felege Hiwot Comprehensive Specialized Hospital, and Addis Alem General Hospital. At the time of the study, a total of 60, 40, and 18 pharmacy professionals were avail- able in Tibebe Ghion Specialized Hospital, Felege Hiwot Comprehensive Specialized Hospital, and Addis Alem General Hospital, respectively.

Study design and period A descriptive institutional-based cross-sectional study was conducted from March 1, 2024 to April 30, 2024.

Inclusion and exclusion criteria Pharmacy professionals (pharmacist and pharmacy tech- nician) who had been employed in those hospitals for at least six months were included in the study, whereas those with less than six months of work experience, allied healthcare professionals (nurses, physicians, and labora- tory technicians), and personnel who did not have direct contact with patients (accountants and drivers) were excluded.

Independent variables Sociodemographic characteristics of the pharmacy pro- fessionals (gender, educational level, working unit area, working year in hospital and unit area, working hours per week, training, and direct interaction with patients).

Dependent variables The patient safety culture in hospital pharmacy settings encompasses various dimensions, including teamwork, physical space, training, leadership, communication, counseling, staffing, responding, and reporting.

Sample size determination and sampling procedures All pharmacy professionals working in the pharmacy setting of these selected hospitals in Bahir Dar city were involved in the study.

Data collection tool and procedures The PSOPSC tool, which is a standard instrument devel- oped by the AHRQ, was used to collect data [23–25]. It contains two sections: (1) the pharmacy professionals’ sociodemographic characteristics and (2) the PSC dimen- sions, which includes 36 items that evaluate 11 dimen- sions of organizational patient safety culture in hospital pharmacy settings. The questionnaire also included three questions that asked hospital pharmacy professionals to rate how frequently errors were reported/documented, and one question asked them to rate the overall patient safety grade [23, 24].

Both frequency scales (never to always) and five-point Likert scales (strongly agree to strongly disagree) were used to measure the portions’ questions. The question- naire was independently administered to 118 pharma- cists and pharmacy technicians in their respective units after obtaining verbal informed consent.

Data quality assurance A pretest was performed on 5% of randomly selected pharmacy professionals to ensure the feasibility of the study and the appropriateness and consistence of data collection tool. Following the computation, the Cron- bach’s alpha values for the composites ranged from 0.765 to 0.901, with an average of 0.828. The obtained Cron- bach’s alpha values are considered acceptable, as they exceed the threshold of 0.60 specified in the PSOPSC user’s guide [24]. It was found that each dimension met the required standard of reliability and the composites showed consistent results. Three data collectors attended a one-day training session that covered the basic prin- ciples of the questionnaire and its correct application. A supervisor who provided prompt feedback during the process and ensured that the data were complete and log- ically consistent at the end of each day oversaw the data collection process.

Data processing, analysis, and presentation Data were collected, checked for completeness and con- sistency, coded, and analysed using Microsoft Excel and SPSS version 26. The positive response rate was cal- culated according to the formula outlined in the user’s guide of the PSOPSC [25]. Reverse coding was applied to items with negative wording. Descriptive analysis was performed, and the results were presented in terms of frequency using tables and graphs. The Hosmer-Leme- show model fitness and multi-collinearity tests were per- formed to check the model fitness and the existence of multi-collinearity, respectively. The Hosmer-Lemeshow model fitness statistic (P < 0.05) and the collinearity sta- tistics (Variance inflation factor (VIF) > 10 and tolerance (T) < 0.1) were considered suggestive of the model does not fit well and the existence of multi-collinearity, respec- tively. In the multivariable analysis, predictors with a P value ≤ 0.25 that were associated with the outcome vari- able in the univariable analysis were selected. Variable in the multivariable analysis with a P value less than 0.05 was considered statistically significant.

Operational definitions Adverse events These are unintended and harmful outcomes that occur during or after the use of medical treatment or interva- tion [1, 2].

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The positive response rate was calculated by combin- ing the “strongly agree” and “agree” response categories, as well as the “always” and “most of the time” response categories [11–14].

The negative response rate was calculated by combin- ing the “strongly disagree” and “disagree” response cat- egories, as well as the “never” and “rarely” categories [11–14].

Accordance to the AHRQ recommended standards, a mean score of 70% or higher indicates a high positive response rate for patient safety culture. Scores ranging from 69 to 51% were classified as a moderately positive response rate for the HSOPSC questions. A mean score of below 50% on the HSOPSC questions suggests a low or inadequate level of positive responses regarding patient safety culture [11–14, 16, 17, 25–27].

Results Sociodemographic characteristics Of the 118 questionnaires administered to pharmacists and pharmacy technicians, 110 were completed and returned, resulting in a response rate of 93.2%. More than half, (54.5%) of the pharmacy professionals were

male, while 63 (57.3%) were pharmacists. More than two-thirds, 61 (73.5%) of them had worked in hospitals for one to five years. Every pharmacy professional had worked in a single working unit area for less than a year. Furthermore, 63 (75.9%) of those professionals did not receive any training on patient safety, and around two- thirds, 56 (67.5%), had direct patient interaction experi- ence (Table 1).

Patient safety culture dimensions The overall average positive response rate was 59.09%, with a range of 40.91–70.61%. The lowest positive response rate was observed in communication about mistakes (40.91%), whereas the highest positive response rates were seen in teamwork in the unit area (70.61%), followed by response to mistakes (70.45%) (Table  2; Fig. 1).

Number of events reported and patient safety grade Among the pharmacy professionals, 21 (19.09%) reported patient safety events most of the time or always within the unit area. In contrast, more than half of those pro- fessionals, 63 (57.27%), never reported any patient safety events (supplementary Table 1). Furthermore, 34 (30.9%) pharmacy professionals reported one or more patient safety events in the past 12 months, whereas 76 (69.1%) never reported any event (Fig. 2).

Half of the pharmacy professionals, 55 (50.0%), rated the level of patient safety grade as fair or good, whereas 41 (37.3%) of them rated Very good or Excellent. How- ever, 14 (12.7%) of the pharmacy professionals rated the patient safety grade as Poor (Fig. 3).

Factors that are associated with patient safety culture Logistic regression analysis was conducted involving both univariable and multivariable. This analysis aimed to assess the impact of participant sociodemographic factors and patient safety dimensions on the overall posi- tive response rate regarding the PSC. In the multivari- able analysis, it was found that five sociodemographic characteristics were significantly associated with the level of positive response rate on PSC. These characteristics included educational level, working year in the hospi- tal, working year in the unit area, direct interaction with patients, and patient safety training. The association was statistically significant at P < 0.05. Furthermore, 45.45% of the patient safety dimensions were significantly associ- ated with the level of positive response rate of PSC. These dimensions included staff training and skills, commu- nication openness, communication about prescription across shifts, communication about mistakes, and physi- cal space and environment. The association was also sta- tistically significant at P < 0.05 (Table 3).

Table 1 Sociodemographic characteristics of pharmacy professionals at public hospitals, Bahir dar, ethiopia, 2024 (n = 110) Variables Categories Frequency Percentage Gender Male 60 54.5

Female 50 45.5 Educational level

Pharmacist 63 57.3 Pharmacy Technician 57 42.7

Working Unit Area

Surgical 15 13.6 Gynecology 16 14.5 OPD 30 27.3 Medical 21 19.0 Emergency 20 18.2 Others 8 7.3

Working year in the Hospital

Less than 1 7 6.4 1–5 67 60.9 6–10 30 27.3 Greater than 11 6 5.5

Working year in the Unit Area

Less than 1 109 99.1 1–5 1 0.9 6–10 0 0 Greater than 11 0 0

Working hours per week

Less than 30 12 10.9 30–40 67 60.9 Greater than 40 31 28.2

Direct interac- tion with patients

Yes 70 63.6 No 40 36.4

Patient safety training

Yes 33 30.0 No 77 70.0

Total 110 100

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Individual Items and dimensions Nega- tive, n (%)

Neutral, n (%)

Posi- tive, n (%)

● Physical space and environment (Cronbach’s α = 0.813, VIR = 1.181, and PRR = 58.5)*

A1. This pharmacy is well organized 25 (22.7) 20 (18.2) 65 59.1) A5. This pharmacy is free of clutter 28 (25.5) 31 (28.2) 51 (46.4) A7. The physical layout of this pharmacy supports good workflow 23 (20.9) 10 (9.1) 77 (70.0) ● Teamwork in the unit area (Cronbach’s α = 0.806, VIR = 1.109, and PRR = 70.61)*

A2. Staff work together as an effective team 14 (12.7) 8 (7.3) 88 (80.0) A4. The staff in this pharmacy clearly understand their roles and responsibilities. 19 (17.3) 15 (13.6) 76 (69.1) A9. Staff treat each other with respect 26 (23.6) 15 (13.6) 69 (62.7) ● Staff training and skills (Cronbach’s α = 0.869, VIR = 1.532, and PRR = 59.09)*

A3. Technicians in this pharmacy receive the training they need to perform their jobs 39 (35.4) 19 (17.3) 52 (47.3) A6. Staff in this pharmacy have the skills they need to do their jobs well 10 (9.1) 20 (18.2) 80 (72.7) A8. Staff who are new to this pharmacy receive adequate orientation 25 (22.7) 19 (17.3) 65 (60.0) A10. The staff received enough training from this pharmacy 30 (27.3) 18 (16.4) 62 (56.4) ● Communication openness (Cronbach’s α = 0.765, VIR = 1.445, and PRR = 48.47)*

B1. Staff ideas and suggestions are valued in this pharmacy 20 (18.2) 14 (12.7) 76 (69.1) B5. Staff feel comfortable asking questions when they are unsure about something 45 (40.9) 30 (27.3) 35 (31.8) B10. It is easy for the staff to speak up to their supervisor/manager about patient safety concerns in this pharmacy.

38 (34.6) 23 (20.9) 44 (44.5)

● Patient counseling (Cronbach’s α = 0.832, VIR = 1.354, and PRR = 66.67)*

B2. They encourage patients to talk to pharmacists about their medications 16 (14.6) 12 (10.9) 82 (74.6) B7. Their pharmacists spend enough time talking to patients about how to use their medications 30 (27.3) 15 (13.6) 65 (59.1) B11. Their pharmacists tell patients important information about their new prescriptions 16 (14.6) 21 (19.1) 73 (66.4) ● Staffing, work pressure, and pace (Cronbach’s α = 0.851, VIR = 1.231, and PRR = 57.73)*

B3. Staff take adequate breaks during their shifts 31 (28.2) 15 (13.6) 64 (58.2) B9. They do not feel rushed when processing prescriptions 19 (17.3) 35 (31.8) 56 (50.9) B12. They have enough staff to handle the workload  29 (26.4)  15 (13.6)  66

(60.0) B16. Interruptions/distractions in this pharmacy (from phone calls, faxes, customers, etc.) doesn’t make it difficult for staff to work

 22 (20.0)  20 (18.2)  68 (61.8)

● Communication about prescription across shifts (Cronbach’s α = 0.791, VIR = 2.24, and PRR = 50.30)*

B4. They have clear expectations about the exchange of important prescription information across shifts 22 (20.0) 19 (17.3) 69 (62.7) B6. They have standard procedures for communicating prescription information across shifts 50 (45.5) 35 (31.8) 25 (22.7) B14. The status of problematic prescriptions is well communicated across shifts 18 (16.4) 20 (18.2) 72 (65.5) ● Communication about mistakes (Cronbach’s α = 0.801, VIR = 1.987, and PRR = 40.91)*

B8. Staff in this pharmacy discuss mistakes 41 (37.3) 30 (27.3) 39 (35.5) B13. When patient safety issues occur, the staff will discuss them 35 (31.8) 22 (22.7) 49 (45.5) B15. They talk about ways to prevent mistakes from happening again in this pharmacy 44 (40.0) 20 (18.2) 46 (41.8) ● Responses to mistakes (Cronbach’s α = 0.804, VIR = 1.012 and PRR = 70.45)*

C1. Staff are treated fairly when they make mistakes 20 (18.2) 13 (11.8) 77 (70.0) C4. This pharmacy helps staff learn from their mistakes rather than punishing them 12 (10.9) 28 (25.5) 70 (63.6) C7. They look at staff actions and the way they do things to understand why mistakes happen in this pharmacy 7 (6.4) 10 (9.1) 93 (84.5) C8. Staff feel like their mistakes are not held against them 15 (13.6) (22.7%) 70 (63.6) ● Organizational learning–continuous improvement (Cronbach’s α = 0.871, VIR = 1.221, and PRR = 58.18)*

C2. When a mistake happens, they try to figure out what problems in the work process led to the mistake 29 (26.4) 10 (9.1) 71 (64.5) C5. When the same mistake keeps happening, they change the way they do things 34 (30.9) 23 (20.9) 53 (48.2) C10. Mistakes have led to positive changes in this pharmacy 22 (20.0) 20 (18.2) 68 (61.8) ● Overall perceptions of patient safety (Cronbach’s α = 0.901, VIR = 1.009 and, PRR= 69.69)*

C3. This pharmacy places more emphasis on patient safety than on sales 8 (7.3) 11 (10.0) 91 (82.7) C6. This pharmacy is good at preventing mistakes 27 (24.5) 23 (20.9) 60 (54.6)

Table 2 Response rate of individual items and dimensions among pharmacy professionals at public hospitals, Bahir dar, ethiopia, 2024 (n = 110)

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Fig. 2 Number of Events Reported in the past 12 Months by pharmacy professionals at public hospitals, Bahir Dar, Ethiopia, 2024 (n = 110)

Fig. 1 Percent-positive response rate on PSC among pharmacy professionals by dimensions at public hospitals, Bahir Dar, Ethiopia, 2024 (n = 110)

Individual Items and dimensions Nega- tive, n (%)

Neutral, n (%)

Posi- tive, n (%)

C9. The way they do things in this pharmacy reflects a strong focus on patient safety 18 (16.4) 13 (11.8) 79 (71.8) Overall mean level of PSC (Cronbach’s α = 0.828 and VIR = 1.393)* 25 (22.73) 20 (18.18) 65

(59.09) *The Hosmer-Lemeshow model fitness statistic (P > 0.05) and the VIF of all variables is below 10 and tolerance (T) values are above 0.1, which indicates that the model is effective and the absence of multi-collinearity in the model

PRR Mean positive response rate, PSC Patient safety culture, A1-A10, B1-B16 and C1-C8 Correspond to AHRQ survey items, VIF Variance Inflation Factor

Table 2 (continued)

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Discussion This study is the first to use the PSOPSC to investigate patient safety culture within hospital pharmacy settings in Ethiopia. The comprehensive PSOPSC survey is spe- cifically designed for hospital pharmacy settings, provid- ing a suitable framework for assessing the patient safety climate from a hospital pharmacy perspective. The sur- vey will allow pharmacies to evaluate their patient safety culture’s strengths and identify areas for improvement within their quality improvement initiatives, ultimately reducing the risk of medication-related harm to patients.

The overall average Patient Reported Result (PRR) for the 11 Patient Safety Culture (PSC) dimensions in this study was 59.09%, with a range of 40.91% to 70.61. This falls within the Agency for Healthcare Research and Quality (AHRQ) moderate positive response rate stan- dard value of 69%−51% and is lower than other similar studies conducted in China and the USA (Table  4) [28, 29]. The overall average PRR for hospital pharmacy pro- fessionals in China across the 11 dimensions was 71.0%, with a range of 50.0–89% [28]. In the United States, the figure was 78.0%, ranging from 41 to 90% [29]. In the United States, patient counseling had the highest PRR (90.0%), followed by communication openness (87.0%). In contrast, in China, communication about prescrip- tion across shifts had the highest PRR (89.0%), followed by staff training and skills (88.0%). Conversely, in Bahir Dar city public hospitals, the dimension of teamwork in the unit area had the highest PRR (70.61%), followed by responses to mistakes (70.45%). Significant differences were observed between the remaining nine dimensions across each study area. This variation might be due to the differences in organizational behavior across countries,

including administrative values, organizational commit- ments, and leadership styles [28, 29].

In comparison to other studies conducted on com- munity pharmacies or healthcare providers in differ- ent parts of Ethiopia, such as those in the South Wollo zone, Bahir Dar City, Addis Ababa city, Bale Zone, Dessie town, Jimma Zone, Amhara region, and Gondar city, this study’s overall average PRR is higher than the rates found in the South Wollo zone (50.1%) [17], Bahir Dar City (50.9%) [30], Addis Ababa city (48.8%) [15], Bale Zone (44.0%) [14], Dessie town (44.8%) [12], Jimma Zone (46.7%) [11], Amhara region (46.0%) [13], and Gondar city (45.3%) [16]. This variation may be due to the dif- ferences in the study setting, the number of hospitals included in the study method, and the duration of the study.

In this study, there was substantial variability in the percentage of positive response rates across the 11 dimensions. While all dimensions had more than 50% of positive response rates, two dimensions stood out as hav- ing lower rates: communication about mistakes (40.91%) and communication openness (48.47%). Among the 11 dimensions, communication about mistakes had the lowest PRR, whereas teamwork within a unit area had the highest PRR (70.61%). This finding is consistent with similar studies conducted in Bale Zone Hospitals (73.4%) [14] and the Amhara region (72.0%) [13], suggesting that pharmacy professionals are generally positive about sup- porting one another and working together as a team to improve patient safety. However, the rate in this study was lower than that reported in other similar studies, such as those conducted in China (86.0%) [28], the USA (79.0%) [29], and various parts of Ethiopia, including the Jimma Zone (82.0%) [11], Dessie town (74.14%) [12],

Fig. 3 Overall patient safety culture grading among pharmacy professionals at public hospitals, Bahir Dar, Ethiopia, 2024 (n = 110)

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Addis Ababa city (77.7%) [15], and Gondar city (75.0%) [16]. Despite this, there is a need to strengthen teamwork among pharmacy staff, as it is crucial for promoting a collaborative and supportive work environment [31, 32].

The dimensions with the most potential for improve- ment in this study area were communication about mistakes and communication openness, with positive response rates of 40.91% and 48.47%, respectively. This is consistent with findings from other similar studies con- ducted in the Jimma zone and the Amhara region [11, 13].

Pharmacy professionals rated patient safety grades as fair (22.5%), good (27.5%), very good (21.8%), and excel- lent (15.5%), while 12.7% rated them as poor. The propor- tion of very good or excellent ratings in this study (37.3%) was slightly higher than that in the study conducted in Jimma zone (34.0%) [11] and Addis Ababa (35.7%) [15].

However, it is slightly lower than in other similar studies conducted in the Bale Zone (38.3%) [14].

Promoting adverse event reporting among pharmacists is essential for identifying and addressing potential risks in patient care. Notably, less than half of the participants (30.9%) reported at least one event, whereas more than two-thirds of the participants (69.1%) did not report a single event over the past year. The distribution of reported events among participants was as follows: 12.1% reported 1 to 2 events, 10.8% reported 3 to 5 events, 3.6% reported 6 to 10 events, and 4.4% reported 11 or more events. This finding is consistent with a similar study con- ducted in the Jimma Zone, which reported a comparable rate of 31.0% [11]. However, it is higher than the rate reported in the Bale Zone, which was 12.6% [14]. This may be attributed to insufficient training in safety-related matters, disparities in capacity, and a lack of encourage- ment for reporting errors. Establishing a secure report- ing environment, providing feedback on reported events, and maintaining confidentiality can contribute to higher reporting rates and facilitate the process of learning from mistakes to prevent similar occurrences in the future [11, 14].

The results of the multivariable logistic regression anal- ysis indicate that educational level, working year in the hospital, working year in the unit area, and direct interac- tion with patients were factors associated with a positive level of patient safety culture. Pharmacy professionals with a bachelor’s degree (AOR = 1.2, 95%CI: 0.98–1.5, P < 0.001) showed a significant difference in the positive level of patient safety culture compared to those with a diploma. In terms of years of service in the hospital,

Table 3 Association of sociodemographic characteristics and patient safety dimensions with the level of PSC among pharmacy professionals at public hospitals, Bahir dar, ethiopia, 2024 (n = 110) Variables Categories AOR (95%Cl) P-value Educational level Pharmacy Technician 1

Pharmacist 1.2 (0.98–1.5) 0.001** Working Year in the Hospital

Less than 1 1 1–5 1.0 (0.8–1.4) 0.06 6–10 1.1 (0.88–1.48) 0.01* Greater than 11 2.0 (1.4-3.0) < 0.001**

Working Year in the Unit Area

Less than 1 1 1–5 1.2 (0.95–1.6) 0.06 6–10 2.5 (1.6–3.8) 0.02* Greater than 11 2.8 (1.8–4.2) 0.001**

Direct Interaction with Patients

No 1 Yes 3.02 (2.6-5) < 0.001**

Patient safety training

No 1 Yes 1.8 (1.2–2.8) < 0.001**

Teamwork in the unit area

Positive response 1.3 (0.87–1.76) 0.09 Negative response 1

Staff training and skills

Positive response 1.5 (1.2-2.0) < 0.001** Negative response 1

Communication openness

Positive response 2.5 (1.5–3.8) 0.001** Negative response 1

Communication about prescription across shifts

Positive response 1.3 (0.95–1.85) 0.02* Negative response 1

Communication about mistakes

Positive response 3.0 (2.2-4.0) 0.001* Negative response 1

Responses to the mistakes

Positive response 1.4 (0.93–2.2) 0.08 Negative response 1

Physical space and environment

Positive response 3.8 (2.53–5.4) 0.001** Negative response 1

* statistically significant at p < 0.05

** Statistically significant at p 0.001

Table 4 Comparison of the positive response rate of patient safety culture among pharmacy professionals in Bahir Dar City public hospitals with other similar studies, 2024 (n = 110) PSOPSC dimensions USA China Bahir

Dar City

Teamwork in the unit area 79 86 70.61 Physical space and environment 72 69 58.5 Staff training and skills 79 88 59.09 Communication openness 87 64 48.47 Patient counseling 90 57 66.67 Staffing, work pressure, and pace 41 50 57.73 Communication about prescription across shifts

81 89 50.3

Communication about mistakes 79 62 40.91 Responses to the mistakes 79 65 70.45 Organizational learning – continuous improvement

83 84 58.18

Overall perceptions of patient safety 84 80 69.69 Overall level of patient safety culture 78 71 59.09 PSOPSC Pharmacy Survey on Patient Safety Culture, AHRQ Agency of Healthcare Research and Quality

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pharmacy professionals with more than 11 years of ser- vice (AOR = 2.0, 95% CI: 1.4-3.0, P < 0.001) and those with 6–10 years of service (AOR = 1.1, 95%CI: 0.88–1.48, P = 0.01) had a significant difference in the positive level of patient safety culture compared to those with less than one year of service. Similarly, pharmacy profes- sionals with more than 11 years of service in the unit area (AOR = 2.8, 95% CI: 1.8–4.2, P < 0.001) and those with 6–10 years of service (AOR = 2.5, 95% CI: 1.6–3.8, P = 0.02) had a significantly positive level of patient safety culture compared to those with less than one year of ser- vice in the unit area.

Those pharmacy professionals who had direct inter- action with patients had a significantly higher level of patient safety culture (AOR = 3.02, 95% CI: 2.6-5.0, P < 0.001) compared with those who did not. Similarly, pharmacy professionals who received patient safety training also demonstrated a significantly higher level of patient safety culture (AOR = 1.8, 95% CI: 1.2–2.8, P < 0.001) compared with those who did not receive train- ing. This indicates that factors such as educational level, working year in the hospital, working year in the unit area, direct interaction with patients, and patient safety training all have an impact on the level of positive patient safety culture among pharmacy professionals.

Of the 11 patient safety dimensions, five were signifi- cantly associated with a positive level of patient safety culture. These dimensions included staff training and skills, communication openness, communication about prescriptions across shifts, communication about mis- takes, and physical space and environment. Pharmacy professionals who responded positively to these dimen- sions were more likely to have a positive patient safety culture compared with those who responded nega- tively. The adjusted odds ratios (AOR) for these dimen- sions were as follows: staff training and skills (AOR = 1.5, 95% CI: 1.2-2.0, P < 0.001), communication openness (AOR = 2.5, 95% CI: 1.5–3.8, P < 0.001), communica- tion about prescriptions across shifts (AOR = 1.3, 95% CI: 0.95–1.85, P = 0.02), communication about mistakes (AOR = 3.0, 95% CI: 2.2-4.0, P < 0.001), and physical space and environment (AOR = 3.8, 95% CI: 2.53–5.4, P < 0.001). Improving these patient safety dimensions within the pharmacy department could enhance col- laboration, information sharing, and ultimately improve patient safety culture [33, 34].

Strengths and limitations of the study Strengths This study’s findings may not be generalizable to private healthcare settings, health centers, and clinics due to its limited scope to public hospitals. Additionally, the study’s reliance on the PSOPSC to measure PSC in a hospital pharmacy setting is a novel approach, making it difficult

to establish a baseline for comparison. Furthermore, the study’s focus on pharmacy professionals may not provide a comprehensive understanding of the safety culture, as the perspectives of other administrative bodies were not considered.

Limitations This study’s findings may not be generalizable to private healthcare settings, health centers, and clinics due to its limited scope to public hospitals. Additionally, the study’s reliance on the PSOPSC to measure PSC in a hospital pharmacy setting is a novel approach, making it difficult to establish a baseline for comparison. Furthermore, the study’s focus on pharmacy professionals may not provide a comprehensive understanding of the safety culture, as the perspectives of other administrative bodies were not considered.

Conclusion The results showed that the overall level of positive response rate for patient safety culture was moderate, according to the Agency for Health Research and Quality (AHRQ) recommended standards. The two dimensions, teamwork within a unit area and response to mistakes, had a high positive response rate. However, the other nine dimensions had a moderate positive response rate, with communication about mistakes and communication openness being the exceptions, as they had a low positive response rate according to standard values. Additionally, the trend of reporting adverse events and rating patient safety grade in the pharmacy settings of the hospital was also low. It was found that educational level, working year in the hospital, working year in the unit area, direct interaction with patients, and patient safety training, and the five patient safety dimensions, including staff train- ing and skills, communication openness, communication about prescriptions across shifts, communication about mistakes, and physical space and environment had a sig- nificant association with the level of positive response rate on patient safety culture.

Recommendation

• Encouraging open communication is crucial in hospital settings, particularly when it comes to the sharing of prescription information across shifts and discussing mistakes that occur. Regular feedback on performance is also essential for fostering a culture of transparency. By addressing these communication challenges, hospitals can promote a positive response rate for patient safety culture.

• Patient safety is significantly enhanced when pharmacy professionals are encouraged to report adverse events. This allows for the identification

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and addressing of potential risks, ultimately leading to improved patient safety. A safe reporting environment, coupled with feedback on reported events and confidentiality, can increase reporting rates and facilitate learning from errors.

• The selection of leaders or managers who prioritize patient safety sets the tone for a culture of safety within the pharmacy. By promoting a culture of continuous improvement, the attitudes and behaviors of pharmacy professionals toward patient safety culture can be positively influenced.

Abbreviations AHRQ Agency for Health Research and Quality LMICs Low and Middle Income Countries PRR Positive Response Rate PSC Patient Safety Culture PSOPSC Pharmacy Survey on Patient Safety Culture

Supplementary Information The online version contains supplementary material available at h t t p s : / / d o i . o r g / 1 0 . 1 1 8 6 / s 1 2 9 1 3 - 0 2 5 - 1 3 3 9 6 - z.

Supplementary Table 1: Reporting Patient Safety Events in unit/work area to patients’ safety culture.

Acknowledgements The authors extend their deepest gratitude to the data collector and the study participants.

Authors’ contributions All authors made a significant contribution to the work reported. BAM: conceptualisation, data curation, formal analysis, preparation of the original draft and revision and approval of its submission. SG, and ST, DD: conceptualisation, data collection, data curation, formal analysis and validation. BAM and DD: review and editing. All authors have agreed on the journal to which the article will be submitted and have given their final approval for publication.

Funding This study did not receive any specific project funding.

Data availability The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate Ethical approval was obtained from the Ethical Review Board of Bahir Dar University, College of Medicine and Health Science, School of Pharmacy (Ref.No. cmhs2879/20/15). Oral informed consent was obtained from the study participants before data collection, and to ensure the privacy of the participants, the study was strictly anonymous. This research was conducted in accordance with the national regulations and institutional policies on ethics and with the tenets of the Helsinki Declaration.

Consent for publication Not applicable.

Competing interests The authors declare no competing interests.

Author details 1Department of Pharmaceutical Analysis, School of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, P. O. Box 79, Bahir Dar, Ethiopia 2School of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, P. O. Box 79, Bahir Dar, Ethiopia 3Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, P. O. Box 79, Bahir Dar, Ethiopia

Received: 24 March 2025 / Accepted: 19 August 2025

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