OBJECTIVE: To explore whether attitudes and opinions in areas of importance to patient safety expressed by nurses with medical responsibility were related to the knowledge of diabetes among home care personnel.

DESIGN: A questionnaire survey was used to evaluate the knowledge of diabetes among 3144 nurses' aides' and assistant nurses working in 15 municipalities in Sweden. In each municipality a nurse with medical responsibility answered another questionnaire dealing with patient safety matters in general and diabetes in particular.

RESULTS: There were large differences in the knowledge of diabetes among home care personnel on the municipality level. Attitudes and opinions of the nurses with medical responsibility in the areas of leadership, guidance and continuing education were significantly related to the knowledge of diabetes among nurses' aides' and assistant nurses.

CONCLUSIONS: Our study shows that factors that are related to attitudes and opinions about patient safety among nurses with medical responsibility can increase the risk of home care personnel to make mistakes in the direct care of patients with diabetes.

OBJECTIVE: To assess the influence of knowledge about diabetes on the performance of diabetes care for the elderly involving insulin treatment, with special attention to aspects of patient safety in home care.

DESIGN: A questionnaire was administered to nurse's aides and assistant nurses (n = 3144). Answers to questions about knowledge of diabetes were related to "relevant" or "risky measures" as judged from a hypothetical diabetes case. A 94% response rate was obtained. The study took place in January 1997 in 15 of Sweden's 289 municipalities.

RESULTS: Insufficient theoretical knowledge about how the blood sugar is related to an insulin reaction led to an almost threefold increased risk of taking a "risky measure". Insufficient knowledge about reasons for an insulin reaction also resulted in a higher risk, as was the case for personnel working in home based care in contrast to those working solely in Institutional care. In addition, the risk that a nurse's aide would take a "risky measure" was higher than that for an assistant nurse. This may indicate that the basic theoretical knowledge of nurse's aides is inadequate.

CONCLUSION: Deficiencies in basic knowledge of diabetes among nurse's aides and assistant nurses constitute a major cause of potentially serious mishaps in home care of elderly diabetic patients treated with insulin.

This study is based on semi-structured interviews focusing on staff members' opinions about potential risk factors that could threaten patient safety. The aim was to acquire more in-depth knowledge about the causes of patient injuries. The study, which was conducted at a children's hospital, has a qualitative approach that is influenced by the critical incident technique. A total of 28 persons were interviewed. Analysis of the data resulted in five qualitatively differentiated categories of potential risk factors: a large influx of patients, a lack of professional experience, a lack of inter-professional communication and cooperation, and deficiencies related to work hours and to the physical environment. The results reflect a complex picture where the risks, as described by the informants, can either alone or in concert directly or indirectly affect the individual in the practice of his or her profession or contribute to a mistake.