PONE-D-24-50882Status and Related Factors of Medication Safety Behavior of Nurses in Operating Room: A Cross-Sectional Survey in ChinaPLOS ONE

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PLOS ONE

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Additional Editor Comments:

Dear Dr. Chen,

Thank you for submitting your manuscript titled Status and Related Factors of Medication Safety Behavior of Nurses in Operating Room: A Cross-Sectional Survey in China to PLOS ONE. The reviewers have provided valuable feedback, and after careful consideration, I have decided that the manuscript requires major revisions before it can be considered further for publication.

Below, I have outlined the key areas that must be addressed:

References and Content Clarification:

- Conduct a thorough revision of the English language to address grammatical and stylistic errors. Consider professional editing services.

- Ensure the study's objectives are clearly addressed in the abstract.

-Replace Reference 9 (Cooper et al., 1984) as it is outdated and pertains to anesthesiologists rather than operating room nurses. Ensure all references are current and relevant to the context of OR nurses in China.

Address the findings by Song et al. (2022) regarding the most common medical errors in operating room settings (e.g., surgical instruments, sterilization) and clarify the relevance of medication errors to your study.

Unreferenced Sections (Lines 67-76):

- Add appropriate references to substantiate claims, particularly those involving medication safety practices.

Clarify whether administration of anesthetic drugs is performed by nurses in the study setting.

- Sample Size and Variables: Clearly justify the sample size and explain how it is sufficient for the study's 11 variables.

- Provide details on the sampling technique used.

- Ethical Considerations: Clarify whether informed consent was obtained from all study participants.

- Include confidence intervals and p-values for all statistically significant results.

- Expand the discussion to provide deeper insights into your findings and align them with relevant current literature.

- Practical Significance: Reassess the practical significance of your findings given the sample size limitations. Discuss any implications for real-world applications.

- Review the manuscript carefully to ensure adherence to PLOS ONE's formatting and writing guidelines.

Best of luck in your revision.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: No

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Review Comments

Line 56-59: The content mentioned in Reference 9 states that anesthesiologists are responsible for single use of drugs in the operating room, without a double-checking step. The following points need clarification:

The content in Reference 9 (Cooper JB, Newbower RS, Kitz RJ. An analysis of major errors and equipment failures in anesthesia management: considerations for prevention and detection. Anesthesiology 1984; 60: 34–42) is based on a 1984 study. In China, as of 2024, it is rare for anesthesiologists to administer drugs without double-checking; almost all perform double checks.

The study subjects in Reference 9 were anesthesiologists, not operating room nurses, who are the subjects of this article. Recent investigations into medical errors among operating room nurses (Song Q, Tang J, Wei Z, Sun L. Prevalence and associated factors of self-reported medical errors and adverse events among operating room nurses in China. Front Public Health. 2022;10:988134. doi: 10.3389/fpubh.2022.988134) show that the most common medical errors stem from surgical instruments (9.1%), sterilization (9.0%), equipment and consumables (8.9%), and specimen management (7.8%). Thus, medication errors are not among the most common medical errors in the operating room.

Line 67-71: There is no reference to support this section. Considering the previous discussion pertains to anesthesiologists rather than operating room nurses, I suspect the author intended to refer to MAEs caused by anesthesiologists rather than operating room nurses. This leads to a lack of basis for this study and suggests that the author should review this section.

Line 72-76: There is no reference to support this section. It is unclear whether the administration of anesthetic drugs is performed by nurses.

Line 95: The study's 11 variables do not match the research variable count, indicating an insufficient sample size.

Informed Consent: It is unclear whether the study subjects signed informed consent forms.

Correlation Analysis Results: Even if the correlation analysis results are significant, the small sample size means that the observed associations have minimal practical significance in real-world applications.

Reviewer #2: Dear author/s,

The manuscript had the aim to explore the current status and related factors regarding medication safety behavior of operating room nurses in China. The study is important; however, the study has some limitations.

Abstract

The objective of this study was to explore the current status and related factors regarding medication safety behavior of operating room nurses. But, in my opinion, the objectives of this study are not answered well.

Result: It is better to write with confidence intervals and/or p-values of those listed as statistically significant factors.

Keywords: Please write the keywords based on MeSH terms.

I believe that a revision of the English language is necessary because there are a lot of grammatical errors throughout the document.

The authors should consider a review of cited data and follow the PlOS ONE journal authors writing guidelines.

The authors do not write with clear sample size calculation and sampling techniques. Please clarify that.

The result of this study needs revision.

The discussion is poor. The findings could have been better discussed.

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Reviewer #1: No

Reviewer #2: No

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Status and Related Factors of Medication Safety Behavior of Nurses in Operating Room: A Cross-Sectional Survey in China

PONE-D-24-50882R1

Dear Dr.

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We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Othman A. Alfuqaha, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear authors,

I am pleased to inform you that your manuscript, "Status and Related Factors of Medication Safety Behavior of Nurses in Operating Room: A Cross-Sectional Survey in China," has been accepted for publication.

Congratulations on this achievement! Your work provides valuable insights into medication safety behavior among nurses, and I am confident it will contribute significantly to the field.

Wishing you continued success in your research endeavors.

Best regards,

Dr. Alfuqaha

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: (No Response)

Reviewer #3: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: (No Response)

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: (No Response)

Reviewer #3: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: (No Response)

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: (No Response)

Reviewer #3: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: Dear authors, Thank you so much for your invaluable work. My comments were fully addressed and will be accepted for publication.

Reviewer #3: After careful review, I am pleased to inform you that all concerns have been adequately addressed. The improvements in statistical justifications, discussion clarity, results presentation, and language refinement have strengthened the manuscript.

I am happy to recommend its acceptance in the current form. Congratulations on your work!

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #2: No

Reviewer #3: Yes:  Mohd Ismail Ibrahim

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