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Solleiro Rodríguez J, Juanes Méndez JA, Blaya Haro F. Ergonomics appraisals in operating rooms. Clinics (Sao Paulo) 2024; 79:100439. [PMID: 38996722 DOI: 10.1016/j.clinsp.2024.100439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 06/09/2024] [Accepted: 06/16/2024] [Indexed: 07/14/2024] Open
Abstract
This document presents the ergonomic assessments carried out by Spanish surgeons on the materials used within an operating room. With the objective of disseminating and raising awareness of the importance of ergonomics, this working group has compiled information from a previously conducted survey on musculoskeletal disorders associated with surgical work from the year 2022, obtaining feedback from 131 surgeons from 17 distinct specialties. A noteworthy 80.2 % of surveyed surgeons reported having experienced forced postures during surgery, and 96.9 % believe that their physical discomfort is a result of the posture adopted during operations. Such postures can result in the development of pathologies and may have a direct impact on work performance and even in extreme cases, it can lead to sick leave or early retirement. By providing their insights on electronic devices, surgical furniture, and instrumentation, surgeons can help identify areas for improvement in the practice of their profession.
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Affiliation(s)
- Jaime Solleiro Rodríguez
- Doctoral Programme Education in the Knowledge Society, University of Salamanca, Salamanca, Spain.
| | | | - Fernando Blaya Haro
- Analysis and Optical Characterization of Materials, Polytechnic University of Madrid, Madrid, Spain
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2
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Fell SE, Bowie P, Spalding K, Medves J. Preliminary adaptation of the systems thinking for everyday work cue card set in a US healthcare system: a pragmatic and participatory co-design approach. BMJ Open Qual 2024; 13:e002655. [PMID: 38782484 PMCID: PMC11116854 DOI: 10.1136/bmjoq-2023-002655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Healthcare is a highly complex adaptive system, requiring a systems approach to understand its behaviour better. We adapt the Systems Thinking for Everyday Work (STEW) cue cards, initially introduced as a systems approach tool in the UK, in a US healthcare system as part of a study investigating the feasibility of a systems thinking approach for front-line workers. METHODS The original STEW cards were adapted using consensus-building methods with front-line staff and safety leaders. RESULTS Each card was examined for relevance, applicability, language and aesthetics (colour, style, visual cues and size). Two sets of cards were created due to the recognition that systems thinking was relatively new in healthcare and that the successful use of the principles on the cards would need initial facilitation to ensure their effective application. Six principles were agreed on and are presented in the cards: Your System outlines the need to agree that problems belong to a system and that the system must be defined. Viewpoints ensure that multiple voices are heard within the discussion. Work Condition highlights the resources, constraints and barriers that exist in the system and contribute to the system's functions. Interactions ask participants to understand how parts of the system interact to perform the work. Performance guides users to understand how work can be performed daily. Finally, Understanding seeks to promote a just cultural environment of appreciating that people do what makes sense to them. The two final sets of cards were scored using a content validity survey, with a final score of 1. CONCLUSIONS The cards provide an easy-to-use guide to help users understand the system being studied, learn from problems encountered and understand the everyday work involved in providing excellent care. The cards offer a practical 'systems approach' for use within complex healthcare systems.
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Affiliation(s)
- Samantha E Fell
- Healthcare Quality, Queen's University, Kingston, Ontario, Canada
| | - Paul Bowie
- NHS Education for Scotland, Edinburgh, UK
| | | | - Jennifer Medves
- School of Nursing, Queens University, Kingston, Ontario, Canada
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Candidori S, Dozio N, Osouli K, Graziosi S, Zanini AA, Costantino ML, De Gaetano F. Improving maternal safety: Usability and performance assessment of a new medical device for the treatment of postpartum haemorrhage. APPLIED ERGONOMICS 2024; 117:104223. [PMID: 38219376 DOI: 10.1016/j.apergo.2023.104223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024]
Abstract
Postpartum haemorrhage (PPH) is an obstetric emergency causing nearly one-quarter of maternal deaths worldwide, 99% of these in low-resource settings (LRSs). Uterine balloon tamponade (UBT) devices are a non-surgical treatment to stop PPH. In LRSs, low-cost versions of UBT devices are based on the condom balloon tamponade (CBT) technique, but their effectiveness is limited. This paper discusses the experimental study to assess the usability and performance of a medical device, BAMBI, designed as an alternative to current CBT devices. The testing phase involved medical and non-medical personnel and was focused on testing BAMBI's usability and effectiveness compared to a standard CBT solution. We collected measures of the execution time and the procedure outcome. Different training procedures were also compared. Results show a significant preference for the BAMBI device. Besides, medical and non-medical subjects reached comparable outcomes. This aspect is highly relevant in LRSs where the availability of medical personnel could be limited.
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Affiliation(s)
- Sara Candidori
- Department of Mechanical Engineering, Politecnico di Milano, Via La Masa 1, 20156, Milan, Italy.
| | - Nicolò Dozio
- Department of Mechanical Engineering, Politecnico di Milano, Via La Masa 1, 20156, Milan, Italy.
| | - Kasra Osouli
- Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Milano, Piazza Leonardo da Vinci 31, 20133, Milan, Italy.
| | - Serena Graziosi
- Department of Mechanical Engineering, Politecnico di Milano, Via La Masa 1, 20156, Milan, Italy.
| | | | - Maria Laura Costantino
- Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Milano, Piazza Leonardo da Vinci 31, 20133, Milan, Italy.
| | - Francesco De Gaetano
- Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Milano, Piazza Leonardo da Vinci 31, 20133, Milan, Italy.
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Huang YM, Wang YH, Chan HY, Ho YF. A Qualitative Approach to Exploring Workflow and Cost Factors of Dispensing Services in Community Pharmacies in Taiwan. J Multidiscip Healthc 2023; 16:3179-3188. [PMID: 37915978 PMCID: PMC10617403 DOI: 10.2147/jmdh.s432828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023] Open
Abstract
Purpose This study aimed to thoroughly document the process and cost factors involved in dispensing services within a community pharmacy. Methods Using a cross-sectional design, this study incorporated a pragmatic and descriptive qualitative approach to outline pharmacists' viewpoints on providing dispensing services in community settings. A purposive sampling was employed to recruit pharmacists from geographically different community pharmacies, spanning from March to July 2022. Semi-structured interviews with direct content analysis were conducted through face-to-face interactions to gather firsthand insights into pharmacists' professional dispensing services. The data underwent analysis through descriptive and in vivo coding techniques to categorize, define, and label themes, thereby identifying key steps and cost components in the prescription dispensing process. The qualitative data management software, MAXQDA 2020, was utilized for data management and maintenance. Results Ten community pharmacists participated in the study, cooperatively completing the interview process. Of these, 7 were male and 3 were female, with age ranging from 29 to 62 years. The average length of pharmacy practice experience was 11.4 years. The study revealed six integral steps in the dispensing process: (1) receiving and clarifying legality and completeness of prescriptions, (2) profiling and verifying patient prescriptions, (3) preparing prescription labels and containers, (4) dispensing right medications with right quantity, (5) inspecting dispensing accuracy, (6) handing over medications and providing counseling. Along with these processes, pharmacists emphasized that pharmacy manpower, representing a substantial portion of the associated costs, determines the success and quality of the dispensing service. Additionally, rental, utilities, consumables, and physical equipment were identified as other important cost factors associated with carrying out pharmacy dispensing services. Conclusion The study offers a comprehensive understanding of the dispensing service workflow within community pharmacies. The findings may inform key stakeholders and policymakers about required resources for enhancing and sustaining quality dispensing services for the public in Taiwan.
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Affiliation(s)
- Yen-Ming Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, 100025, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, 100025, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, 100229, Taiwan
| | - Yao-Hsing Wang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, 100025, Taiwan
- Honest Pharmacy, Taichung, 408483, Taiwan
| | - Hsun-Yu Chan
- Department of Industrial Education, National Taiwan Normal University, Taipei, 106308, Taiwan
| | - Yunn-Fang Ho
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, 100025, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, 100025, Taiwan
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Barton HJ, Pflaster E, Loganathar S, Werner A, Tarfa A, Wilkins D, Ehlenbach ML, Katz B, Coller RJ, Valdez R, Werner NE. What makes a home? Designing home personas to represent the homes of families caring for children with medical complexity. APPLIED ERGONOMICS 2023; 106:103900. [PMID: 36122551 PMCID: PMC10072316 DOI: 10.1016/j.apergo.2022.103900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/22/2022] [Accepted: 09/05/2022] [Indexed: 06/15/2023]
Abstract
Personas are widely recognized as valuable design tools for communicating dimensions of individuals, yet they often lack critical contextual factors. For those people managing chronic health conditions, the home is a critical context of their patient work system (PWS). We propose the development of 'home personas' to convey essential aspects of the home context to those tasked with designing technologies and interventions to fit it. We used an iterative, multi-stakeholder design process to design 'home personas' for a model population, families caring for children with medical complexity. Each of the four resultant home personas-Multi-level, Customized, Ranch, and Rental-has a unique home layout, pain points, and are described on three dimensions that emerged from the data. This study builds on a foundation of work in the emerging field of Patient Ergonomics, describing a mechanism for distilling rich descriptions of the PWS into brief yet informative design tools.
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Affiliation(s)
- Hanna J Barton
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Ellen Pflaster
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Shanmugapriya Loganathar
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Allison Werner
- School of Human Ecology, University of Wisconsin-Madison, United States
| | - Adati Tarfa
- School of Pharmacy, University of Wisconsin-Madison, United States
| | - David Wilkins
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Mary L Ehlenbach
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, United States
| | | | - Ryan J Coller
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, United States
| | - Rupa Valdez
- Department of Public Health Sciences and Department of Engineering Systems and Environment, University of Virginia, United States
| | - Nicole E Werner
- Department of Health and Wellness Design, Indiana University School of Public Health-Bloomington, United States.
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Tase A, Vadhwana B, Buckle P, Hanna GB. Usability challenges in the use of medical devices in the home environment: A systematic review of literature. APPLIED ERGONOMICS 2022; 103:103769. [PMID: 35430424 DOI: 10.1016/j.apergo.2022.103769] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Home care medical devices are the fastest-growing segment of the medical device industry with associated safety and usability challenges. Human factor studies in the home environment present many difficulties resulting in limited knowledge of device use in this setting. This systematic review aims to identify usability challenges reported directly by end-users in the home environment. METHODS A systematic review of the literature was conducted concentrating on studies involving end user reporting. Reported challenges were grouped into a) device-user, b) device use environment and c) device-user interface challenges. RESULTS 3471 studies were screened and 202 underwent full-text review. Only twelve studies had direct involvement of end users. Multiple challenges were identified, with device-user interface problems being the most common. No effective, standardised method was found to collect patient/user feedback on usability challenges in the post-market stage, leading to a knowledge gap. CONCLUSIONS This study brought together multiple usability challenges reported by individual studies. Involvement of medical device end-users in usability studies is essential and their experiences must be effectively utilised in device design.
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Carayon P, Hose BZ, Wooldridge A, Brazelton TB, Dean SM, Eithun BL, Kelly MM, Kohler JE, Ross J, Rusy DA, Hoonakker PLT. Human-centered design of team health IT for pediatric trauma care transitions. Int J Med Inform 2022; 162:104727. [PMID: 35305517 PMCID: PMC9437147 DOI: 10.1016/j.ijmedinf.2022.104727] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/20/2022] [Accepted: 02/21/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND As problems of acceptance, usability and workflow integration continue to emerge with health information technologies (IT), it is critical to incorporate human factors and ergonomics (HFE) methods and design principles. Human-centered design (HCD) provides an approach to integrate HFE and produce usable technologies. However, HCD has been rarely used for designing team health IT, even though team-based care is expanding. OBJECTIVE To describe the HCD process used to develop a usable team health IT (T3 or Teamwork Transition Technology) that provides cognitive support to pediatric trauma care teams during transitions from the emergency department to the operating room and the pediatric intensive care unit. METHODS The HCD process included seven steps in three phases of analysis, design activities and feedback. RESULTS The HCD process involved multiple perspectives and clinical roles that were engaged in inter-related activities, leading to design requirements, i.e., goals for the technology, a set of 47 information elements, and a list of HFE design principles applied to T3. Results of the evaluation showed a high usability score for T3. CONCLUSIONS HFE can be integrated in the HCD process through a range of methods and design principles. That design process can produce a usable technology that provides cognitive support to a large diverse team involved in pediatric trauma care transitions. Future research should continue to focus on HFE-based design of team health IT.
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Affiliation(s)
- Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, United States.
| | - Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania, United States
| | - Abigail Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, United States
| | - Thomas B Brazelton
- American Family Children's Hospital, UW Health, United States; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, United States
| | - Shannon M Dean
- Department of Pediatric Medicine, St Jude's Hospital, United States
| | - Ben L Eithun
- American Family Children's Hospital, UW Health, United States
| | - Michelle M Kelly
- American Family Children's Hospital, UW Health, United States; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, United States
| | | | - Joshua Ross
- American Family Children's Hospital, UW Health, United States; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, United States; Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, United States
| | - Deborah A Rusy
- American Family Children's Hospital, UW Health, United States; Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, United States
| | - Peter L T Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, United States
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Klarich A, Noonan TZ, Reichlen C, Barbara SMJ, Cullen L, Pennathur PR. Usability of smart infusion pumps: A heuristic evaluation. APPLIED ERGONOMICS 2022; 98:103584. [PMID: 34562782 DOI: 10.1016/j.apergo.2021.103584] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 07/31/2021] [Accepted: 09/07/2021] [Indexed: 06/13/2023]
Abstract
Although smart infusion pumps were built to eliminate medication errors, new types of usability errors have arisen. The purposes of this study were to determine potential risks when using smart pumps during secondary medication administration and to identify opportunities for design improvements. We observed and analyzed nurses when they interacted with smart pumps and heuristically evaluated the smart pump to identify usability problems. Forty-three usability problems were identified with the smart pump. The usability problems have the potential to create high cognitive burden on nurses and to increase the likelihood of mistakes. We discuss design and process improvement recommendations for each major finding from this study.
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Affiliation(s)
- Amelia Klarich
- Department of Industrial and Systems Engineering, University of Iowa, Iowa City, 52242, USA
| | - Thomas Z Noonan
- Department of Industrial and Systems Engineering, University of Iowa, Iowa City, 52242, USA
| | - Chris Reichlen
- Department of Industrial and Systems Engineering, University of Iowa, Iowa City, 52242, USA
| | | | - Laura Cullen
- Office of Nursing Research and Evidence-Based Practice, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Priyadarshini R Pennathur
- Department of Industrial and Systems Engineering, University of Iowa, Iowa City, 52242, USA; Department of Internal Medicine, University of Iowa, Iowa City, 52242, USA.
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Stevens EL, Hulme A, Salmon PM. The impact of power on health care team performance and patient safety: a review of the literature. ERGONOMICS 2021; 64:1072-1090. [PMID: 33775234 DOI: 10.1080/00140139.2021.1906454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
Communication failure within health care teams is a major cause of patient harm across health care settings. Factors which contribute to communication failure include actual or perceived 'power'. Whilst a great deal of ergonomics research has focussed on teamwork in health care, the role of power in relation to measurable patient safety and performance outcomes remains relatively unknown. This article presents the findings from a review of the literature on power within multidisciplinary health care team settings. Following a systematic literature search, nineteen studies were evaluated in terms of research design, methods and analyses across the included studies. The main impacts resulting from power imbalances include negative effects on team collaboration, decision-making, communication and overall performance. Wider patient safety research, and more specifically the ergonomics discipline, is encouraged to address the complex interplay between power and teamwork in the health care sector.Practitioner Statement: We conducted a review of studies focussed on the influence of power on teamwork in health care. The findings show that power can have negative impacts on collaboration, decision-making, communication, and team performance. We conclude that power represents an important area for ergonomics, both in health care and other settings.Abbreviations: CRM: crew resource management; TEM: threat and error management; SNA: social network analysis; EAST: event analysis of systemic teamwork.
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Affiliation(s)
- Erin L Stevens
- Centre for Human Factors and Sociotechnical Systems, Faculty of Arts, Business and Law, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Adam Hulme
- Centre for Human Factors and Sociotechnical Systems, Faculty of Arts, Business and Law, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Paul M Salmon
- Centre for Human Factors and Sociotechnical Systems, Faculty of Arts, Business and Law, University of the Sunshine Coast, Sunshine Coast, Australia
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Holden RJ, Cornet VP, Valdez RS. Patient ergonomics: 10-year mapping review of patient-centered human factors. APPLIED ERGONOMICS 2020; 82:102972. [PMID: 31654954 DOI: 10.1016/j.apergo.2019.102972] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 07/01/2019] [Accepted: 10/02/2019] [Indexed: 05/09/2023]
Abstract
Patient ergonomics is the application of human factors or related disciplines to study and improve patients' and other non-professionals' performance of effortful work activities in pursuit of health goals. We performed a mapping review of 212 full-text patient ergonomics publications in two conference proceedings, 2007-2017. The review revealed a robust and growing body of literature on patient ergonomics, particularly in the areas of aging and chronic disease, tools and technologies, and evaluations of patient-centered interventions on outcomes such as usability, user acceptance, and performance. Findings highlighted gaps deserving future research, including research with understudied populations such as children, informal caregivers, networks and collectives (groups), and marginalized populations; on topics such as health promotion and transitions of care; and using longitudinal and experimental study designs. The growth of patient-centeredness in general and of patient ergonomics in particular compel other more focused reviews, new primary research, and developing a roadmap for future patient ergonomics research.
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Affiliation(s)
- Richard J Holden
- Department of Medicine, Indiana University School of Medicine, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc, USA.
| | - Victor P Cornet
- Department of Human-Centered Computing, IUPUI School of Informatics and Computing, USA
| | - Rupa S Valdez
- Department of Public Health Sciences, University of Virginia School of Medicine, USA
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Asan O, Nattinger AB, Gurses AP, Tyszka JT, Yen TWF. Oncologists' Views Regarding the Role of Electronic Health Records in Care Coordination. JCO Clin Cancer Inform 2019; 2:1-12. [PMID: 30652555 DOI: 10.1200/cci.17.00118] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Electronic health records (EHRs) play a significant role in complex health care processes, especially in information transfer with patients and care coordination among providers. EHRs may also generate unintended consequences, introducing new patient safety risks. To date, little investigation has been performed in oncology settings, despite the need for quality provider-patient communication and information transfer during oncology visits. In this qualitative study, we focused on oncology providers' perceptions of EHRs for supporting communication with patients and coordination of care with other providers. METHODS We conducted semistructured interviews with oncologists from an urban academic medical center to learn their perceptions of the use of EHRs before, during, and after clinic visits with patients. Our interview guide was developed on the basis of the work system model. We coded transcripts using inductive content analysis. RESULTS Data analysis yielded four main themes regarding oncologists' practices in using the EHR and perceptions about EHRs: (1) EHR use for care coordination (eg, timeliness of receiving information, SmartSet documentation); (2) EHR use in the clinic visit (eg, educating patients, using as a reinforcement tool); (3) safety hazards in care coordination associated with EHRs (eg, incomplete documentation, error propagating, no filtering mechanism to capture errors); and (4) suggestions for improvements (eg, improved SmartSet functionalities, simplification of user interface). CONCLUSION Current EHRs do not adequately support teamwork of oncology providers, which could lead to potential hazards in the care of patients with cancer. Redesigning EHR features that are tailored to support oncology care and addressing the concerns regarding information overload, improved organization of flagging abnormal results, and documentation-related workload are needed to minimize potential safety hazards.
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Affiliation(s)
- Onur Asan
- Onur Asan, Ann B. Nattinger, Jeanne T. Tyszka, and Tina W. F. Yen, Medical College of Wisconsin, Milwaukee, WI; and Ayse P. Gurses, Johns Hopkins University, Baltimore, MD
| | - Ann B Nattinger
- Onur Asan, Ann B. Nattinger, Jeanne T. Tyszka, and Tina W. F. Yen, Medical College of Wisconsin, Milwaukee, WI; and Ayse P. Gurses, Johns Hopkins University, Baltimore, MD
| | - Ayse P Gurses
- Onur Asan, Ann B. Nattinger, Jeanne T. Tyszka, and Tina W. F. Yen, Medical College of Wisconsin, Milwaukee, WI; and Ayse P. Gurses, Johns Hopkins University, Baltimore, MD
| | - Jeanne T Tyszka
- Onur Asan, Ann B. Nattinger, Jeanne T. Tyszka, and Tina W. F. Yen, Medical College of Wisconsin, Milwaukee, WI; and Ayse P. Gurses, Johns Hopkins University, Baltimore, MD
| | - Tina W F Yen
- Onur Asan, Ann B. Nattinger, Jeanne T. Tyszka, and Tina W. F. Yen, Medical College of Wisconsin, Milwaukee, WI; and Ayse P. Gurses, Johns Hopkins University, Baltimore, MD
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12
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Weir NM, Newham R, Bennie M. A literature review of human factors and ergonomics within the pharmacy dispensing process. Res Social Adm Pharm 2019; 16:637-645. [PMID: 31444123 DOI: 10.1016/j.sapharm.2019.08.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/07/2019] [Accepted: 08/11/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Within healthcare, Human Factors explores the fit between people and their working environment to improve safety, performance and wellbeing. The pharmacy setting is an area of particular interest considering the high-risk nature of the work activities in relation to dispensing errors. Internationally, the pharmacy setting is experiencing significant workforce changes, including the introduction of pharmacy technicians performing accuracy checks, and the adoption of novel technologies such as automated dispensing. OBJECTIVE A literature review was conducted to identify studies which have explored the pharmacy dispensing process from a Human Factors perspective. METHODS The databases Medline, EMBASE and PsycINFO were searched on the 27th of November 2018. All study designs were eligible for inclusion from community and hospital settings. Key study findings were extracted and reported using a descriptive narrative synthesis method. RESULTS Thirty-two studies were identified, with most published from 2010 onwards. The review identified that a myriad of aspects influence safety within the dispensing process; that the dispensing process is complex in nature and can be depicted in many different ways; and lastly, that deviations from intended practice appear commonplace. Most studies used two or more data collection sources, and various theories, models and frameworks were applied. Although the focus of all studies was within the wider domain of Human Factors, 14 studies did not explicitly refer to a Human Factors approach within the manuscript. CONCLUSIONS The complexity of the pharmacy dispensing setting suggests that adopting a Human Factors approach to explore this context is appropriate. Future Human Factors research should explore the implementation of new technology and services and focus on obtaining empirical evidence that adopting a Human Factors approach improves safety and/or efficiency within pharmacy practice. Clear guidance on how to apply the range of Human Factors approaches would help support such research and facilitate the development of sound theory.
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Affiliation(s)
- Natalie M Weir
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Robertson Trust Wing, 161 Cathedral St, University of Strathclyde, Glasgow, G4 0RE, United Kingdom.
| | - Rosemary Newham
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Robertson Trust Wing, 161 Cathedral St, University of Strathclyde, Glasgow, G4 0RE, United Kingdom.
| | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Robertson Trust Wing, 161 Cathedral St, University of Strathclyde, Glasgow, G4 0RE, United Kingdom; Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, United Kingdom.
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13
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Schnittker R, Marshall SD, Horberry T, Young K. Decision-centred design in healthcare: The process of identifying a decision support tool for airway management. APPLIED ERGONOMICS 2019; 77:70-82. [PMID: 30832780 DOI: 10.1016/j.apergo.2019.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/15/2018] [Accepted: 01/19/2019] [Indexed: 06/09/2023]
Abstract
Current decision support interventions for airway management in anaesthesia lack the application of Human Factors Engineering; leading to interventions that can be disruptive, inefficient and error-inducing. This study followed a decision-centred design process to identify decision support that can assist anaesthesia teams with challenging airway management situations. Field observations, Critical Decision Method interviews and focus groups were conducted to identify the most difficult decisions and their requirements. Data triangulation narrowed the focus to key decisions related to preparation and planning, and the transitioning between airway techniques during difficulties. Five decision-support interventions were identified and positively rated by anaesthesia team members in relation to their perceived effectiveness. An organized airway equipment trolley was chosen as the most beneficial decision support intervention. This study reiterated the key importance of both Human Factors Engineering and data triangulation when designing for healthcare.
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Affiliation(s)
- R Schnittker
- Monash University Accident Research Centre, 21 Alliance Lane, Building 70, Monash University, Clayton Campus, 3800, Victoria, Australia; Department of Anaesthesia and Perioperative Medicine, Central Clinical School, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, Victoria, Australia.
| | - S D Marshall
- Department of Anaesthesia and Perioperative Medicine, Central Clinical School, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, Victoria, Australia.
| | - T Horberry
- Monash University Accident Research Centre, 21 Alliance Lane, Building 70, Monash University, Clayton Campus, 3800, Victoria, Australia.
| | - K Young
- Monash University Accident Research Centre, 21 Alliance Lane, Building 70, Monash University, Clayton Campus, 3800, Victoria, Australia.
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Lyons I, Blandford A. Safer healthcare at home: Detecting, correcting and learning from incidents involving infusion devices. APPLIED ERGONOMICS 2018; 67:104-114. [PMID: 29122181 DOI: 10.1016/j.apergo.2017.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 09/11/2017] [Accepted: 09/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Complex medical devices such as infusion pumps are increasingly being used in patients' homes with little known about the impact on patient safety. Our aim was to better understand the risks to patient safety in this situation and how these risks might be minimised, by reference to incident reports. DESIGN We identified 606 records of incidents associated with infusion devices that had occurred in a private home and were reported to the UK National Reporting and Learning Service (2005-2015 inclusive). We used thematic analysis to identify key themes. RESULTS In this paper we focus on two emergent themes: detecting and diagnosing incidents; and locating the patient, lay caregivers and their family in incident reports. The majority of incidents were attributed to device malfunction, and resulted in the patient being under-dosed. Delays in recognising and responding to problems were identified, alongside challenges in identifying the cause. We propose a process model for fault diagnosis and correction. Patients and caregivers did not feature strongly in reports; we highlight how the device is in the home but of the care system, and propose an agent model to describe this; we also identify ways of mitigating this disjoint. CONCLUSION Devices need to be appropriately tailored to the setting in which they are employed, and within a system of care that ensures they are used optimally and safely. Suggested features to improve patient safety include devices that can provide better feedback to identify problems and support resolution, alongside greater monitoring and technical support by care providers for both patients and frontline professionals. The proposed process and agent models provide a structure for reviewing safety and learning from incidents in home health care.
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Affiliation(s)
- Imogen Lyons
- UCL Institute of Digital Health & UCL Interaction Centre, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Ann Blandford
- UCL Institute of Digital Health & UCL Interaction Centre, University College London, Gower Street, London, WC1E 6BT, UK.
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