Patient safety is critical to high-quality patient care. However, it is liable to medication errors (MEs). Therefore, this study assessed perceptions of patient safety culture (PSC) and barriers to reporting MEs among nursing students in Hail City, Saudi Arabia. The researchers conducted a cross-sectional study among 360 convenience students at the College of Nursing, University of Hail, in 2023. We collected data using questions about the characteristics of students, the Health Professional Education in Patient Safety Survey (H-PEPSS) questionnaire, and the Medication Error Reporting questionnaire. Students' mean PSC perception scores were calculated and compared based on their characteristics using the independent-samples t-test or one-way analysis of variance (ANOVA) was used as appropriate. We used Paired samples t-test to compare the mean scores of self-reported perceptions of PSC between classroom and clinical settings, with a significance level of <0.05. The overall PSC perception score was significantly higher in the classroom than in the clinical setting (p = 0.017). Students in the classroom setting scored significantly higher on the domains of "clinical safety skills" (p < 0.001), "effective communication" (p = 0.039), and "safety risk management" (p = 0.008) than those in the clinical setting. Conversely, students in the clinical setting scored significantly higher on the domains of "teamwork with other HCPs" (p < 0.001), "understanding human and environmental factors" (p = 0.039), and "recognizing and responding to immediate hazards" (p < 0.001). Female students and those who were in their second level, had PSC training, desired to participate in PSC training, and reported the presence of an error reporting system scored significantly higher on PSC perceptions in both settings. Most students (95.8 %) believed in the benefits of discovering and reporting MEs. However, a considerable proportion also expressed concerns about ME reporting, including fears of disciplinary action (87.5 %), blame for errors (87.2 %), and loss of respect from colleagues (85.6 %). Most students (97.5 %) also believed that MEs should be reported. However, only 11.1 % of students reported the occurrence of MEs, and 6.7 % experienced these errors. Discrepancies exist in PSC perceptions among nursing students in Hail City between academic and real-world contexts, being consistently higher in the classroom compared to the clinical setting. PSC training and the presence of an error reporting system should be considered when developing interventions to improve PSC perceptions. This study revealed that many barriers were rated in a high percentages for reporting the medication, particularly fears of disciplinary action, blame for errors and loss of respect from colleagues, should be addressed.

Objective This study aimed to assess nurses’ perceptions of patient safety culture (PSC) and its relationship with adverse events in Hail City, Saudi Arabia. Design A cross-sectional study was conducted between 1 August 2023 and the end of November 2023 at 4 governmental hospitals and 28 primary healthcare centres. Setting Hail City, Saudi Arabia. Participants Data were collected from 336 nurses using 3 instruments: demographic and work-related questions, PSC and adverse events. Results Nurses had positive responses in the dimensions of ‘teamwork within units’ (76.86%) and ‘frequency of events reported’ (77.87%) but negative responses in the dimensions of ‘handoffs and transitions’ (18.75%), ‘staffing’ (20.90%), ‘non-punitive response to errors’ (31.83%), ‘teamwork across units’ (34.15%), ‘supervisor/manager expectations’ (43.22%) and ‘overall perception of patient safety’ (43.23%). Significant associations were found between nationality, experience, current position and total safety culture, with p values of 0.015, 0.046 and 0.027, respectively. Nurses with high-ranking perceptions of PSC in ‘handoffs and transitions,’ ‘staffing’ and ‘teamwork across hospital units’ reported a lower incidence of adverse events than those with low-ranking perceptions, particularly in reporting pressure ulcers (OR 0.86, 95% CI 0.78 to 0.94, OR 0.82, 95% CI 0.71 to 0.94 and OR 0.83, 95% CI 0.70 to 0.99, respectively) (p<0.05). Nurses with high-ranking perceptions of PSC in UK ‘handoffs and transitions’ reported a lower incidence of patient falls. Similarly, those with high-ranking perceptions in both ‘handoffs and transitions’ and ‘overall perception of patient safety reported a lower incidence of adverse events compared with those with low-ranking perceptions, especially in reporting adverse drug events (OR 0.83, 95% CI 0.76 to 0.91 and OR 0.75, 95% CI 0.61 to 0.92, respectively) (p<0.05). Conclusion From a nursing perspective, hospital PSCs have both strengths and weaknesses. Examples include low trust in leadership, staffing, error-reporting and handoffs. Therefore, to improve staffing, communication, handoffs, teamwork, and leadership, interventions should focus on weak areas of low confidence and high rates of adverse events.