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Marshall SD, Rush C, Elliott L, Wadman H, Dang J, St John A, Kelly FE. Reducing the time to activation of the emergency call system in operating theatres: effect of installing vertical red line indicators. Br J Anaesth 2024; 133:118-124. [PMID: 38724325 DOI: 10.1016/j.bja.2024.03.030] [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: 12/20/2023] [Revised: 02/10/2024] [Accepted: 03/15/2024] [Indexed: 06/17/2024] Open
Abstract
BACKGROUND The 7th National Audit Project of the Royal College of Anaesthetists (NAP7) recommended that an emergency call system be immediately accessible in all anaesthesia locations. It is essential that all theatre team members can rapidly call for help to reduce the risk of patient harm. However, the ability of staff to activate this system in a timely manner can be affected by cluttered or unfamiliar environments and cognitive overload. One proposed strategy to enable rapid identification and activation of emergency call systems is to install a red vertical painted stripe on the wall from the ceiling to the activation button. We investigated the effect of introducing this vertical red line on activation times in operating theatres in the UK and Australia. METHODS Operating theatre team members, including anaesthetists, surgeons, anaesthetic nurses, surgical and theatre nurses, operating theatre practitioners, and technicians, were approached without prior warning and asked to simulate activation of an emergency call. Vertical red lines were installed, and data collection repeated in the same operating theatres 4-12 months later. RESULTS After installation of vertical red lines, the proportion of activations taking >10 s decreased from 31.9% (30/94) to 13.6% (17/125, P=0.001), and >20 s decreased from 19.1% (18/94) to 4.8% (6/125, P<0.001). The longest duration pre-installation was 120 s, and post-installation 35 s. CONCLUSIONS This simple, safe, and inexpensive design intervention should be considered as a design standard in all operating theatres to minimise delays in calling for help.
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Affiliation(s)
- Stuart D Marshall
- Peninsula Health - Frankston Hospital, Frankston, VIC, Australia; Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.
| | - Cameron Rush
- Peninsula Health - Frankston Hospital, Frankston, VIC, Australia
| | - Lucy Elliott
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Harry Wadman
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Jane Dang
- Monash Health, Melbourne, VIC, Australia
| | | | - Fiona E Kelly
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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2
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Webster CS. Psychology in the operating theatre: the importance of colour and cognition in the redesign of clinical systems for medication safety. Br J Anaesth 2024; 132:837-839. [PMID: 38418333 DOI: 10.1016/j.bja.2024.02.003] [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: 01/14/2024] [Accepted: 02/06/2024] [Indexed: 03/01/2024] Open
Abstract
Medication errors in anaesthesia remain a leading cause of patient harm. Compared with conventional methods, use of the international colour-code standard on syringes and medication trays allows significantly more errors to be detected, and does so under conditions of cognitive load. Testing methods from experimental psychology provide important new insights for human factors research in anaesthesia and health care.
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Affiliation(s)
- Craig S Webster
- Department of Anaesthesiology and Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand.
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3
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Laxton V, Maratos FA, Hewson DW, Baird A, Archer S, Stupple EJN. Effects of colour-coded compartmentalised syringe trays on anaesthetic drug error detection under cognitive load. Br J Anaesth 2024; 132:911-917. [PMID: 38336517 PMCID: PMC11103169 DOI: 10.1016/j.bja.2023.12.033] [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: 09/21/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Anaesthetic drug administration is complex, and typical clinical environments can entail significant cognitive load. Colour-coded anaesthetic drug trays have shown promising results for error identification and reducing cognitive load. METHODS We used experimental psychology methods to test the potential benefits of colour-coded compartmentalised trays compared with conventional trays in a simulated visual search task. Effects of cognitive load were also explored through an accompanying working memory-based task. We hypothesised that colour-coded compartmentalised trays would improve drug-detection error, reduce search time, and reduce cognitive load. This comprised a cognitive load memory task presented alongside a visual search task to detect drug errors. RESULTS All 53 participants completed 36 trials, which were counterbalanced across the two tray types and 18 different vignettes. There were 16 error-present and 20 error-absent trials, with 18 trials presented for each preloaded tray type. Syringe errors were detected more often in the colour-coded trays than in the conventional trays (91% vs 83%, respectively; P=0.006). In signal detection analysis, colour-coded trays resulted in more sensitivity to the error signal (2.28 vs 1.50, respectively; P<0.001). Confidence in response accuracy correlated more strongly with task performance for the colour-coded tray condition, indicating improved metacognitive sensitivity to task performance (r=0.696 vs r=0.447). CONCLUSIONS Colour coding and compartmentalisation enhanced visual search efficacy of drug trays. This is further evidence that introducing standardised colour-coded trays into operating theatres and procedural suites would add an additional layer of safety for anaesthetic procedures.
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Affiliation(s)
| | - Frances A Maratos
- School of Psychology, College of Health, Psychology and Social Care, University of Derby, Derby, UK
| | - David W Hewson
- Department of Anaesthesia, Academic Unit of Injury, Recovery and Inflammation Science, School of Medicine, University of Nottingham, Nottingham, UK; Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Baird
- School of Psychology, College of Health, Psychology and Social Care, University of Derby, Derby, UK
| | - Stephanie Archer
- Department of Psychology, University of Cambridge, Cambridge, UK; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Faculty of Medicine, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Edward J N Stupple
- School of Psychology, College of Health, Psychology and Social Care, University of Derby, Derby, UK.
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Nunes GDK, Antunes LMS, da Silva RN, da Silva RC. Labelling of intravenous drug delivery devices in critically ill patients: A scoping review. Nurs Crit Care 2024; 29:274-286. [PMID: 37882508 DOI: 10.1111/nicc.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Labelling is a strategy that contributes to the correct and faster identification of drugs, minimizing misidentification. There is a gap in knowledge on optimal labelling standards for intravenous (IV) devices applied to the care of critically ill patients. AIM The goal of this article was to map existing knowledge on the labelling of IV drug delivery devices in critically ill patients for the prevention of medication errors. STUDY DESIGN This was a scoping review conducted according to the JBI methodology in the LILACS, MEDLINE, CINAHL, IBECS, Scopus, Embase and Web of Science databases, and on the websites of specialized institutions. Searches were conducted up to December 2022 for scientific articles and grey literature that addressed the labelling of IV devices in intensive care units, emergency departments, and anaesthesia units. The data were collected using a structured form and were later classified, summarized, and aggregated to map the knowledge related to the review question. RESULTS Twenty-one documents were included, which demonstrated variability in label use with IV drug delivery devices. The following features of structure and design stood out: printed format, colour coding, letter size differentiation, and the use of sturdy material. In terms of information, the name of the drug, dose, date and time of preparation, identification of the patient, and who prepared it were found. CONCLUSIONS The identified patterns contributed to the reduction of drug misidentification and the development of timelier drug labelling and administration. RELEVANCE TO CLINICAL PRACTICE The evidence supports the development of standardized labels for the prevention of medication errors.
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Affiliation(s)
- Geovane de Kassio Nunes
- Federal University of Rio de Janeiro, Anna Nery School of Nursing, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucas Malta Souza Antunes
- Federal University of Rio de Janeiro, Anna Nery School of Nursing, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo Nogueira da Silva
- Federal University of Rio de Janeiro, Anna Nery School of Nursing, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Celestino da Silva
- Federal University of Rio de Janeiro, Anna Nery School of Nursing, Rio de Janeiro, Rio de Janeiro, Brazil
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Sheldrake I, Kerton M. A national survey of current practices in the preparation of pre-hospital emergency anaesthesia drugs. Br J Anaesth 2024; 132:448-449. [PMID: 38097417 DOI: 10.1016/j.bja.2023.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 01/21/2024] Open
Affiliation(s)
- Ian Sheldrake
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Matthew Kerton
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Kinsella SM, Boaden B, El-Ghazali S, Ferguson K, Kirkpatrick G, Meek T, Misra U, Pandit JJ, Young PJ. Handling injectable medications in anaesthesia: Guidelines from the Association of Anaesthetists. Anaesthesia 2023; 78:1285-1294. [PMID: 37492905 DOI: 10.1111/anae.16095] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/27/2023]
Abstract
Peri-operative medication safety is complex. Avoidance of medication errors is both system- and practitioner-based, and many departments within the hospital contribute to safe and effective systems. For the individual anaesthetist, drawing up, labelling and then the correct administration of medications are key components in a patient's peri-operative journey. These guidelines aim to provide pragmatic safety steps for the practitioner and other individuals within the operative environment, as well as short- to long-term goals for development of a collaborative approach to reducing errors. The aim is that they will be used as a basis for instilling good practice.
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Affiliation(s)
- S M Kinsella
- Department of Anaesthesia, University Hospitals Bristol and Weston, Bristol, UK
| | | | - S El-Ghazali
- Department of Anaesthesia and Intensive Care, London North West University Hospital Trust, London, UK
| | - K Ferguson
- Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - T Meek
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - U Misra
- Department of Anaesthesia, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - J J Pandit
- University of Oxford, Oxford, UK
- Nuffield Department of Anaesthesia, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - P J Young
- Department of Anaesthesia, Queen Elizabeth Hospital, Kings Lynn, UK
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7
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Laxton V, Maratos FA, Hewson DW, Baird A, Stupple EJN. 5S solutions to promote medication efficiency and safety. Comment on Br J Anaesth 2023; 130: e416-8. Br J Anaesth 2023; 130:e492-e493. [PMID: 37031023 PMCID: PMC10078938 DOI: 10.1016/j.bja.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 04/10/2023] Open
Affiliation(s)
- Victoria Laxton
- College of Health, Psychology and Social Care, University of Derby, Derby, UK; TRL, Wokingham, UK
| | - Frances A Maratos
- College of Health, Psychology and Social Care, University of Derby, Derby, UK
| | - David W Hewson
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK; Department of Anaesthesia and Critical Care, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Andrew Baird
- College of Health, Psychology and Social Care, University of Derby, Derby, UK
| | - Edward J N Stupple
- College of Health, Psychology and Social Care, University of Derby, Derby, UK
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