Impact of Audit‐Based Implementation of Professional Safety Standards on Safety Climate and Nursing Errors in Emergency Departments: A Quasi‐Experimental Study

BACKGROUND: Nursing errors remain a major patient safety concern in emergency departments. Audit-based implementation of professional safety standards has been proposed to improve safety climate and reduce errors, but its effectiveness has not been fully established. AIM: Nurses' safety and professional performance directly influence patient outcomes, particularly in high-pressure emergency departments (EDs). This study evaluated the impact of auditing the implementation of professional safety standards on the safety climate and nursing errors among ED nurses. STUDY DESIGN: A quasi-experimental pre- and post-intervention study was conducted among emergency nurses at Baqiyatallah Hospital in Tehran, Iran. Safety climate was appraised using the Safety Climate Questionnaire (SCQ), and nursing errors were measured by the Nursing Error Questionnaire (NEQ). These validated instruments were administered pre- and post-intervention. The intervention consisted of a structured online audit-based education programme with a focus on professional safety standards, supplemented by the introduction of a 'Common Emergency Department Procedures Handbook'. RESULTS: A total of 115 nurses completed both the pre- and post-intervention assessments and were included in the final analysis. The total safety climate score significantly improved post-intervention (p = 0.006). However, this improvement was driven mainly by the nursing education dimension (p < 0.001), while other domains (including supervisor attitudes, communication, burnout and error reporting) showed no statistically significant changes. The total nursing error score diminished marginally (91.96 vs. 90.90), but this reduction was not statistically significant (p = 0.729). CONCLUSIONS: Audit-based education was associated with an improvement in the overall safety climate score, largely driven by the nursing education domain. However, isolated audit-based educational interventions may have limited influence on underlying organisational and communication-related factors and did not significantly reduce nursing errors. Sustainable improvements may require combining audit and education with system-level strategies, managerial engagement and workload management within emergency departments. RELEVANCE TO CLINICAL PRACTICE: Audit-based education may improve safety climate among emergency nurses, but reducing nursing errors may require broader organizational and communication-based strategies.