The Correlation between Nurses’ Knowledge Regarding Patient Safety and Nurses’ Behaviors in Drug Management


 

 
Corresponding author: 
Anita Rachmawati 
anitarachmawati85@yahoo.com 
South East Asia Nursing Research, Vol 3 No 2, June 2021 
ISSN:2685-032X 
DOI: https://doi.org/10.26714/seanr.3.2.2021.51-58  

 
 

 
 
 
 
 

 

Original Research 
 

The Correlation between Nurses’ Knowledge Regarding Patient Safety and 
Nurses’ Behaviors in Drug Management  
 
Anita Rachmawati1 

1  Universitas Muhammadiyah Semarang, Indonesia 

 
Article Info  Abstract 

Article History: 
Submit May 26th, 2021 
Accepted June 9th, 2021 
Published June 23rd 2021 
 
Keywords:  
Behaviors; drug 
management; knowledge; 
patient safety 

 Nurses’ knowledge regarding patient safety affects nurses’ behaviors in 
managing drugs related to patient safety. A preliminary study at Sultan 
Agung Islamic Hospital Semarang showed that nurses’ knowledge regarding 
patient safety was still low, especially about drug management, including 
storing, ordering/prescribing and recording, administering, and monitoring 
drugs. This study aimed to determine the correlation between nurses’ 
knowledge regarding patient safety and nurses’ behaviors in drug 
management among nurses in the inpatient units of Sultan Agung Islamic 
Hospital, Semarang. This research was an observational study with a cross-
sectional design. The population was 178 nurses in the inpatient units of the 
specified hospital with a total sample of 123 respondents. The data were 
collected using a questionnaire and analyzed using Spearman’s rank 
correlation test. The results showed a correlation between nurses’ 
knowledge regarding patient safety and nurses’ behaviors in storing drugs 
(p=0.001 <ά=0.05), ordering and recording drugs (p=0.000 <ά=0.05), 
administering drugs (p=0.001 <ά=0.05), and monitoring drugs (p=0.003 
<ά=0.05). It is expected that nurses evaluate the drug management 
implementation in the inpatient units so that patient safety is guaranteed as 
well as plan and manage their behaviors in managing drugs in the hospital 
to ensure patient safety. 

 

INTRODUCTION  

Safety has become a global issue, including 
for hospitals. There are five important 
issues related to safety in hospitals, 
including patient safety, worker or health 
worker safety, building and equipment 
safety that affects patient and staff safety, 
environmental safety (green productivity) 
that affects environmental pollution, and 
hospital business safety that is related to the 
hospital survival.1 Implementing patient 
safety in hospitals is expected to minimize 

errors in handling patients in emergency 
units, inpatient units, and polyclinics.4 This 
target can be achieved by providing 
excellent services based on nursing codes of 
ethics to maintain patient safety; all of 
which should be carried out by health 
workers.2,3 

Health services are provided to save 
patients according to what Hippocrates 
stated 2,400 years ago, i.e., Primum, non 
nocere (First, do no harm). However, along 
with the development of science and 

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Anita Rachmawati / The Correlation between Nurses’ Knowledge Regarding Patient Safety and Nurses’ 
Behaviors in Drug Management 

technology, it is realized that health 
services, especially in hospitals, are 
becoming complex and have the potential 
for adverse events if not delivered carefully. 
Adverse events in hospitals can occur due to 
errors in administering drugs. There are 
hundreds of types of drugs, tests and 
procedures, tools with different 
technologies, and diverse professions and 
non-profession workers who are ready to 
provide 24-hour patient care. If not 
appropriately managed, the diversity and 
regularity of these services can lead to 
adverse events.4 

A study by Auburn University in 36 
hospitals and nursing homes in Colorado 
and Georgia, USA in 2002 showed that out 
of 3,216 types of drug administration, 43% 
were given at the wrong time, 30% were not 
given, 17% were given with a wrong dose, 
and 4% were given with wrong drugs. A 
study by the Institute of Medicine in 1999 
also stated that medical errors had caused 
more than one million injuries and 98,000 
deaths a year. The data obtained by JCAHO 
also showed that 44,000 and 98,000 deaths 
occur in hospitals each year due to medical 
errors. A report by the Institute of Medicine, 
USA, in 2000, “To Err Is Human: Building a 
Safer Health System,” followed by WHO data 
in 2004 from various countries, reported 
that there were 3-16% of adverse events in 
the provision of services to inpatients in 
hospitals. Such a statistic is relatively small 
but has a significant impact on patient 
safety.5,6 

Data on the report of adverse events in the 
inpatient units of Sultan Agung Islamic 
Hospital Semarang showed that in 2012, 
there were incidents of medication errors 
that led to allergies in two patients; one of 
them died due to this incident. 
Furthermore, in 2013, other incidents of 
medication errors also occurred in eight 
patients; six experienced wrong drug 
administration, and two experienced drug 
allergies. This statistic showed a significant 
increase by 200% in the number of 
medication errors from 2012 to 2013.7 The 

implementation of the patient safety 
program in the hospital related to drug 
management was still suboptimal. In this 
regards, the problems included the patients 
dying due to allergies and wrong drug 
administration, wrong procedures in 
administering drugs, incorrect writing of 
prescriptions, and switched drugs between 
patients in the hospital.5  

The results of observations and interviews 
with 12 nurses from four inpatient units in 
the hospital where this study too place 
showed that there were eight nurses 
(66.6%) who did not understand how to 
administer the right drugs. Problems of 
drug management in the inpatient units 
included problems of storing drugs. There 
were the Look-Alike Sound-Alike (LASA) 
drugs in the inpatient units, but the 
placement was not separated. This situation 
can lead to errors in taking medicine. 
Problems with ordering and recording 
drugs in the inpatient units were associated 
with unclear or unreadable doctor’s writing, 
making it difficult for nurses and 
pharmacists to immediately serve the 
patients’ drugs since they had to reconfirm 
with the doctor who wrote the prescription. 
Problems in administering drugs in the 
inpatient units were related to nurses who 
did not wash their hands and re-identify 
patients before giving drugs, as well as 
administering wrong medication to other 
patients. Meanwhile, problems in 
monitoring drugs in the inpatient units 
were associated with nurses who did not 
conduct initial assessments related to 
allergies that might occur in patients after 
the patients took medication, and if allergies 
occurred, the nurses just knew it after the 
patients and families reported the incidents 
regarding drug allergies.8 

METHODS 

This research was a quantitative and 
observational study with a cross-sectional 
approach. It was conducted to determine 
the correlation between nurses’ knowledge 
regarding patient safety and nurses’ 



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Anita Rachmawati / The Correlation between Nurses’ Knowledge Regarding Patient Safety and Nurses’ 
Behaviors in Drug Management 

behaviors in storing, ordering and 
recording, administering, and monitoring 
drugs.9 This study involved 123 nurses in 
inpatient units who met the inclusion and 
exclusion criteria. The exclusion criteria 
included: (a) nurses who were resting due 
to sickness and were unable to be involved 
in data collection, and (b) nurses who were 
on maternity leave. This study was 
conducted in the inpatient units of Sultan 
Agung Islamic Hospital Semarang.   

The study was conducted in May 2014 for 
two weeks (the first to the second week). 
The data were collected by using a self-
administered questionnaire. The validity of 
the instrument was tested using content 
validity and construct validity. The 
reliability in this study was carried out 
using one shot or one measurement. 
Bivariate analysis was carried out on two 
variables that were suspected to be 
correlated.10 The correlation test was 
conducted by ensuring whether the data 
had a normal or abnormal distribution. 
Since the number of samples was more than 
50, the Kolmogorov–Smirnov test was used 
to examine the data normality.11 

The result of the normality test showed a p-
value of 0.000 for nurses’ knowledge 
regarding patient safety and a p-value of 
0.032 and 0.041 for nurses’ behaviors in 
storing drugs and ordering and recording 
drugs, respectively. Furthermore, nurses’ 
behavior in administering drugs and 
monitoring drugs showed a p-value of 0.000 
and 0.010, respectively. It could be 
concluded that the data were abnormally 
distributed; therefore, the Spearman rank 
correlation was used to determine the 
correlation between the variables.   

RESULTS  

This study investigated the correlation 
between nurses’ knowledge regarding 
patient safety and nurses’ behavior in drug 
management in the inpatient units of Sultan 
Agung Islamic Hospital Semarang. This 
study involved 123 nurses from 10 

inpatient units in the specified hospital. The 
hospital where this study took place is an 
Islamic hospital with 302 beds and 178 
nurses12. 

Table 1 describes the characteristics of 
respondents. The mean age was 27.79 years 
old, the youngest was 22, and the oldest was 
55. The median was 26. The average 
working period was 4.53 years, the longest 
was 30 years, and the lowest was one year. 
Most nurses obtained D3 of nursing 
education (87.8%), while the remaining 
12.2% obtained a bachelor of nursing 
education. The majority were female (82.9), 
and the remaining were male (17.1%). 

Table 2 illustrates the median value of the 
nurses’ behavior in drug management, 
including storing (Median=27; Min-
Max=16-32), ordering and recording 
(Median=26; Min-Max=15-32), 
administering (Median=18; Min-Max=8-
20), and monitoring (Median=24; Min-
Max=7- 28). Furthermore, the median value 
of nurses’ knowledge regarding patient 
safety was 10 (Min-Max=2-12). 

The correlation between nurses’ 
knowledge regarding patient safety and 
nurses’ behavior in storing drugs in the 
inpatient unit 

Table 3 shows a correlation between 
nurses’ knowledge regarding patient safety 
and nurses’ behavior in storing drugs in the 
inpatient units. The correlation coefficient 
of the Spearman test was 0.304, showing a 
moderate and positive correlation between 
nurses’ knowledge regarding patient safety 
and nurses’ behavior in storing drugs; the 
better the nurses’ knowledge, the better 
their behavior in storing drugs.  

The correlation between nurses’ 
knowledge regarding patient safety and 
nurses’ behaviors in ordering and 
recording drugs in the inpatient unit   

Table 4 shows a correlation between 
nurses’ knowledge regarding patient safety 



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Anita Rachmawati / The Correlation between Nurses’ Knowledge Regarding Patient Safety and Nurses’ 
Behaviors in Drug Management 

and nurses’ behavior in ordering and 
recording drugs in the inpatient unit. The 
correlation coefficient value of the 
Spearman test was 0.436, indicating that the 
correlation was moderate and positive. It 
means that the better the nurses’ 
knowledge regarding patient safety, the 
better their behavior in ordering and 
recording drugs.  

The correlation between nurses’ 
knowledge regarding patient safety and 
nurses’ behavior in administering drugs 
in the inpatient unit  

Table 5 shows a correlation between 
nurses’ knowledge regarding patient safety 
and nurses’ behavior in administering drugs 
in the inpatient unit. The correlation 
coefficient value of the Spearman rank test 
was 0.288, indicating that the correlation 

was weak and positive. It implies that the 
better the nurses’ knowledge regarding 
patient safety, the better their behavior in 
administering drugs. 

The correlation between nurses’ 
knowledge regarding patient safety and 
nurses’ behavior in monitoring drugs in 
the inpatient unit  

Table 6 shows a correlation between 
nurses’ knowledge regarding patient safety 
and nurses’ behavior in monitoring drugs in 
the inpatient unit. The correlation 
coefficient value of the Spearman rank test 
was 0.270, which means that the correlation 
was weak and positive. It implies that the 
better the nurses’ knowledge regarding 
patient safety, the better their behavior in 
monitoring drugs. 

Table 1 
Characteristics of respondents (n=123) 

Characteristics  f % Mean ± SD (min-max) 
Age    27.79 ± 3.88 (22-55) 
Length of work   4.53 ± 3.50 (1-30) 
Gender  

Male  
Female  

 
21 
102 

 
17.1 
82.9 

 

Education  
D3 
S1 

 
108 
15 

 
87.8 
12.2 

 

 
 

Table 2 
Characteristics of variables (n=123) 

Variable Mean ± SD Median Modus Min-Max 
Storing  26.72 ± 4.193 27.00 32.00 16 - 32 
Ordering  26.45 ± 3.978 26.00 31.00 15 - 32 
Administering  17.44 ± 2.63 18.00 20.00 8 - 20 
Monitoring 24.22 ± 3.599 24.00 28.00 7 - 28 
Knowledge  10.08 ± 1.528 10.00 10.00 2 - 12 

 
Table 3 

The correlation between nurses’ knowledge regarding patient safety and nurses’ behavior in storing drugs 
r-count z-count p-value 

0.304 3.36 0.001 

 
 
 
 
 
 
 
 
 



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Anita Rachmawati / The Correlation between Nurses’ Knowledge Regarding Patient Safety and Nurses’ 
Behaviors in Drug Management 

Table 4 
The correlation between nurses’ knowledge regarding patient safety and nurses’ behavior in ordering and 

recording drugs 
r-count  z-count  p-value 

0.436 4.82 0.000 

 
 

Table 5 
The correlation between nurses’ knowledge regarding patient safety and nurses’ behavior in 

administering drugs 
r-count  z-count  p-value 

0.288 3.18 0.001 

 
 

Table 6 
The correlation between nurses’ knowledge regarding patient safety and nurses’ behavior in monitoring 

drugs 
r-count  z-count p-value 

0.270 2.98 0.003 

 

 

DISCUSSION  

The correlation between nurses’ 
knowledge regarding patient safety and 
nurses’ behavior in storing drugs in the 
inpatient unit 

The result of the study showed that the 
correlation coefficient value of the 
Spearman rank test was 0.304, which 
means that there was a moderate and 
positive correlation between nurses’ 
knowledge regarding patient safety and 
nurses’ behavior in storing drugs in the 
inpatient unit. It means that the better the 
nurses’ knowledge regarding patient safety, 
the better their behavior in storing drugs.  

The nurses’ behavior regarding patient 
safety programs is determined by their 
knowledge, attitudes, beliefs, and traditions. 
Also, the availability of facilities, attitudes, 
and behaviors of health workers will 
support and reinforce the formation of 
specified behaviors. Nurses who do not 
want to implement patient safety maybe 
because they do not know the benefits of the 
patient safety program for themselves 
(predisposing factors). Other reasons are 
probably because the facilities are not 
available and the equipment is incomplete 

(enabling factors), and that health workers 
or other community leaders around them 
have never provided examples/counseling 
about patient safety programs (reinforcing 
factors).8 

Nurses who have good knowledge 
regarding patient safety will demonstrate 
good behavior in storing drugs so that the 
implementation of the patient safety 
program in the hospital can be achieved.  

The result of the study regarding nurses' 
behavior in storing drugs in the inpatient 
unit showed that 113 (91.9%) nurses 
always checked the names of similar types 
of drugs every day in the inpatient units. 
This is in line with the standard operating 
procedure (SOP) in the hospital, which 
states that the pharmacy officers provide 
the “Look-Alike Sound-Alike (LASA)” label 
on the drug container or package by making 
the drug name with a dose of more than one 
type in all pharmaceutical centers visible.   

The result of the study also showed that 48 
(39%) nurses always checked the 
completeness of the types of emergency 
drugs in the inpatient unit. This is in line 
with the SOP in the hospital in this study. 
Pharmacy officers, nurses, and midwives 



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Anita Rachmawati / The Correlation between Nurses’ Knowledge Regarding Patient Safety and Nurses’ 
Behaviors in Drug Management 

increase their awareness of specially 
labeled drugs that will be given to patients. 

The correlation between nurses’ 
knowledge regarding patient safety and 
nurses’ behavior in ordering and 
recording drugs in inpatient unit 

The results of this study showed that the 
Spearman test’s correlation coefficient 
value was 0.436, which means that there 
was a moderate and positive correlation 
between nurses’ knowledge regarding 
patient safety and nurses’ behavior in 
ordering and recording drugs in the 
inpatient unit. It indicates that the better the 
nurses’ knowledge regarding patient safety, 
the better their behavior in ordering and 
recording drugs. 

The selection of drugs for patient treatment 
requires specific knowledge and 
experience. Each hospital is responsible for 
identifying knowledgeable and experienced 
persons according to the required 
standards and are also permitted under 
license, certification, statute, or regulation 
to prescribe or order medication. The 
hospital can set limits for prescribing or 
ordering drugs by individuals, such as 
controlled substances, chemotherapy 
agents, or radioactive and investigative 
drugs. The workers who are allowed to 
prescribe and order drugs are recognized 
by the pharmacy service or other people 
that dispense drugs. In emergency 
situations, the hospital can identify 
additional personnel who are permitted to 
prescribe or order drugs.8 

Nurses with good knowledge will show 
good behavior in ordering and recording 
drugs in the hospital. In recording each 
patient receiving the drug, the medical 
record will contain a list of the drugs 
prescribed or ordered for the patient along 
with the dosage and the number of times the 
drug is administered, including the ‘if 
necessary’ drugs. If this information is 
recorded on a separate medication sheet, 
this sheet should be inserted in the patient’s 

medical record when discharged or 
transferred.8 

This study also showed that nurses 
separated the emergency drug substitutes 
from doctors after used by patients. This is 
in accordance with the SOP at the hospital, 
which states that pharmaceutical officers 
should separate drugs with more than one 
dosage according to the type of the drug 
supply.  

The correlation between nurses’ 
knowledge regarding patient safety and 
nurses’ behavior in administering drugs 
in the inpatient unit  

The results of this study showed that the 
Spearman test’s correlation coefficient 
value was 0.288, indicating a weak and 
positive correlation between nurses’ 
knowledge regarding patient safety and 
nurses’ behavior in administering drugs in 
the inpatient unit. It implies that the better 
the nurses’ knowledge regarding patient 
safety, the better their behavior in 
administering drugs. 

In managing drugs related to patient safety, 
nurses need to pay attention to the six 
correct principles of drug administration. 
These principles include: (1) the right 
patient, (2) the right drug, (3) the right dose, 
(4) the right time, (5) the right route, and 
(6) the right documentation. Such 
principles are required by nurses as a 
guideline for their actions as in the inpatient 
unit, nurses have to give various kinds of 
drugs to several different patients. The 
administration of drugs by nurses that 
considers the six right principles will affect 
the success of the patients’ treatment and 
recovery.1 

Administering drugs to treat a patient 
requires specific knowledge and 
experience. Each hospital is responsible for 
identifying any knowledgeable and 
experienced persons according to the 
required standards and are also permitted 
under license, certification, statute, or 



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Anita Rachmawati / The Correlation between Nurses’ Knowledge Regarding Patient Safety and Nurses’ 
Behaviors in Drug Management 

regulation to administer drugs. The hospital 
can set limits for prescribing or ordering 
drugs by individuals, such as controlled 
substances, chemotherapy agents, or 
radioactive and investigative drugs. In 
emergency situations, the hospital can 
identify any additional personnel who are 
permitted to administer drugs.8  

The result of the study regarding nurses’ 
behavior in storing drugs in the inpatient 
unit revealed that nurses always double-
checked the name of the drug between the 
prescription and the doctor’s instructions 
every day. This is in line with the SOP in the 
hospital, which states that nurses review 
the drugs according to the SOP. This review 
includes checking the drugs with the seven 
correct principles (correct patient, correct 
drug, correct dose, correct time, correct 
method of administration, correct 
documentation, and correct information), 
ensuring the correctness of the patient and 
the drug by matching the patient’s name 
and date of birth, visiting the patient’s room 
while taking the drug to be delivered, and 
providing a written information sheet about 
the drug to the patient. 

The correlation between nurses’ 
knowledge regarding patient safety and 
nurses’ behavior in monitoring drugs in 
the inpatient unit 

The result of the study showed that the 
Spearman test’s correlation coefficient 
value was 0.270, indicating that the 
correlation between nurses’ knowledge 
regarding patient safety and nurses’ 
behavior in monitoring drugs in the 
inpatient unit was at a weak level. The 
direction was positive, which means the 
better the nurses’ knowledge regarding 
patient safety, the better the nurses’ 
behavior in monitoring drugs. 

Nurses who have good knowledge will be 
able to perform the task to evaluate the 
effect of the treatment on patients’ 
symptoms or disease, as well as blood 
count, kidney function, liver function, and 

other monitoring for selective drugs. Nurses 
will also be able to evaluate patients for 
adverse events based on monitoring and 
make an adjustment on the dose or type of 
drug, if necessary. Nurses should closely 
monitor the patient’s response to the first 
dose of the drug given to this patient. Such 
monitoring is intended to identify the 
anticipated therapeutic responses and 
allergic reactions, unanticipated drug 
interactions, and changes in patient balance 
that will increase the risk of falls.8 

The results of the study regarding nurses' 
behavior in storing drugs in the inpatient 
unit also showed that every time a nurse 
received a new patient, the nurse did an 
initial detection of drug side effects in the 
inpatient room. The nurse provided 
information and education to the patient 
and family about drugs causing side effects. 
The nurse also wrote in the medical record 
when the side effect of certain drugs 
occurred in the patient; the nurse recorded 
the drug side effect in a particular sheet. 
This is in accordance with the SOP in the 
hospital, which states that nurses open the 
patients’ records and write on the 
pharmaceutical care sheet regarding the 
data related to the therapy (drugs, 
laboratory data, clinical data, diagnosis, and 
others). Nurses examine the drugs that the 
patients receive and make an analysis on 
the appropriateness of the choice of 
therapy, the effectiveness of the therapy, 
and the side effects that have occurred or 
are likely to occur. 

CONCLUSION  

This study concluded that there was a 
correlation between nurses’ knowledge 
regarding patient safety and nurses’ 
behavior in storing drugs, ordering and 
recording drugs, administering drugs, and 
monitoring drugs in the inpatient units in 
the hospitals.  

 

 



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Anita Rachmawati / The Correlation between Nurses’ Knowledge Regarding Patient Safety and Nurses’ 
Behaviors in Drug Management 

ACKNOWLEDGMENTS 

The researcher would like to say thank you 
to all the participated as research 
respondents. 

CONFLICTS OF INTEREST 

Neither of the authors has any conflicts of 
interest that would bias the findings 
presented here. 

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