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PubMed2005

Medication errors in intravenous drug preparation and administration: a multicentre audit in the UK, Germany and France.

BACKGROUND: Previous studies have identified medication errors in preparing and administering intravenous medicines of 13-84% in hospitals in individual countries. OBJECTIVE: To compare the effect of the design and implementation of systems for the preparation and administration of intravenous therapy in hospitals in three European countries on the number of observed medication errors. To gain a better understanding of these risks and the methods used in each country to manage them. DESIGN: Prospective audit. SETTING: Six hospital departments in the UK, Germany and France willing to participate in the audit as part of a quality improvement programme. METHODS: Direct observation of the preparation and the administration of intravenous drugs made by a single observer in each country. MAIN OUTCOME MEASURES: Medication process errors. RESULTS: 824 doses were prepared and 798 doses administered. The product was either not labelled or incorrectly labelled in 43%, 99%, and 20% of doses administered in the UK, German and French hospitals, respectively. The wrong diluent was used in 1%, 49% and 18% of cases, respectively, and the wrong rate of administration was selected for 49%, 21% and 5% of doses observed, respectively. At least one deviation from aseptic technique was observed among 100%, 58%, and 19% of cases in the three countries. CONCLUSION: Uncontrolled risks in the intravenous systems studied were observed in all three countries. Intravenous therapy must be regarded as a high risk activity where the use of risk management procedures to minimise risk to patients is seen as a high priority by all those involved with these duties. There is a requirement to develop better national (possibly international) procedures for safe intravenous practice.

Confidence Intervals↗
PubMed2006

Work system design for patient safety: the SEIPS model.

Models and methods of work system design need to be developed and implemented to advance research in and design for patient safety. In this paper we describe how the Systems Engineering Initiative for Patient Safety (SEIPS) model of work system and patient safety, which provides a framework for understanding the structures, processes and outcomes in health care and their relationships, can be used toward these ends. An application of the SEIPS model in one particular care setting (outpatient surgery) is presented and other practical and research applications of the model are described.

Ergonomics↗
PubMed1980

Caring for old people in New York and London: the "nurses' aide' interviews.

As part of a comparative study of the institutionalized elderly in London and New York, random samples of nurses' aides, nursing assistants and care assistants were interviewed. It is shown that the two long-term care `systems' employ very similar people to provide basic care services, but far more in-service training is provided for New York staff. A detailed analysis of tasks performed suggests that New York staff may be more likely than their London counterparts to carry out technical `nursing' procedures and to be actively involved in physical rehabilitation. The preferences of staff in caring for more or less dependent people showed considerable cross-national agreement, almost half of the total respondents reporting that they preferred immobile patients. Some of the reasons they gave are presented and the implications of this finding discussed.

Aged↗
PubMed1993

A task contingent model of medical practice organization.

The treatment of acute episodes of morbidities in hospitalized patients is a complex and uncertain task. To accomplish this task, physicians organize themselves into teams in an effort to overcome two constraints: the necessity to offer both complete care and continuous care. This study examines the extent to which the nature and size of medical teams is explained by task difficulty and task variability, which are two dimensions of task uncertainty. The results support globally the hypothesis that the organization of medical practice is contingent upon the nature of the task defined in terms of uncertainty. However, the results also suggest that the task contingent model should be adjusted to take into account the fact that formal organizational characteristics may have an a priori influence on team structure.

Analysis of Variance↗
PubMed2006

Nurse telephone triage in out-of-hours GP practice: determinants of independent advice and return consultation.

BACKGROUND: Nowadays, nurses play a central role in telephone triage in Dutch out-of-hours primary care. The percentage of calls that is handled through nurse telephone advice alone (NTAA) appears to vary substantially between GP cooperatives. This study aims to explore which determinants are associated with NTAA and with subsequent return consultations to the GP. METHODS: For the ten most frequently presented problems, a two-week follow-up cohort study took place in one cooperative run by 25 GPs and 8 nurses, serving a population of 62,291 people. Random effects logistic regression analysis was used to study the determinants of NTAA and return consultation rates. The effect of NTAA on hospital referral rates was also studied as a proxy for severity of illness. RESULTS: The mean NTAA rate was 27.5%--ranging from 15.5% to 39.4% for the eight nurses. It was higher during the night (RR 1.63, CI 1.48-1.76) and lower with increasing age (RR 0.96, CI 0.93-0.99, per ten years) or when the patient presented >2 problems (RR 0.65; CI 0.51-0.83). Using cough as reference category, NTAA was highest for earache (RR 1.49; CI 1.18-1.78) and lowest for chest pain (RR 0.18; CI 0.06-0.47). After correction for differences in case mix, significant variation in NTAA between nurses remained (p < 0.001). Return consultations after NTAA were higher after nightly calls (RR 1.23; CI 1.04-1.40). During first return consultations, the hospital referral rate after NTAA was 1.5% versus 3.8% for non-NTAA (difference -2.2%; CI -4.0 to -0.5). CONCLUSION: Important inter-nurse variability may indicate differences in perception on tasks and/or differences in skill to handle telephone calls alone. Future research should focus more on modifiable determinants of NTAA rates.

Adult↗
PubMed1988

Multifactor prediction of hospital service workload.

Prediction of workload for hospital departments is a forecasting problem. Most forecasting techniques use time series methods. However, the unpredictability of hospital utilization which occurs because of environmental turbulence requires that predictions be based on strategic plans. Regression models developed from cross-sectional data can provide a methodology for linking predictions of service workload to strategic plans. The methodology is illustrated and evaluated in a pilot study, which produced models predicting measures of workload such as laboratory tests (R2 = .85), doses of medication given to inpatients (R2 = .43), outpatient prescriptions (R2 = .79), and x-rays (R2 = .86).

Forecasting↗
PubMed2002

Why better operators receive worse warnings.

Descriptions of a dynamic warning system usually assign the system certain diagnostic values. Operators should adjust their responses to these values when considering the output of the system for their decisions. This approach is not necessarily appropriate for complex systems that are controlled by human operators. Here the operators' actions are likely to change the frequency of events that should trigger a warning. Consequently the operator will change the predictive value of a warning system that is imperfectly correlated with the monitored events. In general its diagnostic value decreases for better operators. This phenomenon is demonstrated on the example of binary warnings about binary events, and an empirical demonstration of the phenomenon is provided in an experimental study of a process control task. Actual or potential applications of this research include improved understanding of the determinants of operators' responses to warnings, which should help in the design of better warning systems.

Attention↗
PubMed2005

Objects and mappings: incompatible principles of display design - a critique of Marino and Mahan.

Representation aiding (and similar approaches that share the general orientation) has a great deal of utility, predictive ability, and explanatory power. Marino and Mahan (2005) discuss principles that are critical to the RA approach (configurality, emergent features, and mappings) in a reasonable fashion. However, the application of these principles is far from reasonable. The authors explicitly realize the potential for interactions between nutrients: "The nutritional quality of a food product is a multidimensional concept, and higher order interactions between nutrients may exist" (p. 126). However, they made no effort to discover the nature of these interactions: "No attempt was made to identify contingent interactions between nutrients" (p. 126). Despite not knowing the nature of the interactions between nutrients, they purposely chose a highly configural display that produced numerous emergent features dependent upon these interactions: "A radial spoke display was selected because of the strong configural properties of such display formats (Bennett & Flach, 1992)" (p. 124). Finally, the authors show apparent disdain for the specific mappings among domain, agent, and display that are fundamental to the RA approach: "[O]ther configural display formats could have been used" (p. 124). It is impossible to reconcile these statements and the RA approach to display design. However, these statements make perfect sense if a perceptual object is a guiding principle in one's approach to display design. Marino and Mahan (2005) draw heavily upon the principle of a perceptual object in their design justifications, experimental predictions, and interpretations of results. As we have indicated here and elsewhere (Bennett & Flach, 1992), we believe that these two sets of organizing principles for display design (i.e., objects and mappings) are incompatible. Display design will never be an exact science; there will always be elements of art and creativity. However, the guiding principles have moved well beyond the simple strategy of throwing variables into a geometric object format and relying upon the human agent's powerful perceptual systems to carry the design.

Computer Graphics↗
PubMed1998

Empirical models based on free-modulus magnitude estimation of perceived presence in virtual environments.

A series of 3 studies was conducted to test free-modulus magnitude estimation as a measure of perceived presence in virtual environments (VEs) and to model the first- and second-order effects of 11 VE system parameters on perceived presence across 5 subtasks. Sequential experimentation techniques were used to build 4 empirical models using polynomial regression. An integrated empirical model of data combined across 2 experiments demonstrated that all significant factors had a positive effect on perceived presence. Three of these parameters--field of view, sound, and head tracking--had almost 3 times as much influence on presence than the other 4 significant parameters, which were visual display resolution, texture mapping, stereopsis, and scene update rate. Sequential experimentation was an efficient tool for building empirical models of perceived presence, but the subjective nature of this phenomenon and individual differences made data bridging across sequential studies problematic. It was concluded that magnitude estimation is a useful measure of perceived presence, and the resulting polynomial regression models can be used to facilitate VE system design decisions. This research has broad application in the selection and design of VE system components and overall design of VE systems.

Adolescent↗
PubMed1999

Target-directed head movements in a head-coupled virtual environment: predicting the effects of lags using Fitts' law.

Two experiments have investigated the effects of lag on discrete target-directed head movements in a virtual environment. Both the target and a head-slaved pointer (subjected to lag) were presented on a head-mounted display. Target-directed head movements in the presence of a constant time lag were shown to obey Fitts' law (R2 > .93). A previously reported interaction between the effects of lag and the effects of index-of-difficulty on hand movement time could not be found in head movement time when the target width was kept constant. Further experiments suggested that there is a significant interaction between the effects of target width and lag but not between target distance and lag. A model predicting head movement strategy in the presence of lag is proposed to explain the experimental findings. This model predicts, and experiments verified, that for a target width from 1 degree to 8 degrees and a target distance range of 2.5 degrees to 30 degrees, the effect of lag (up to 267 ms) on target-directed head movement is independent of target distance but dependent on target width. Actual or potential applications of this research include the design of virtual control panel and its layout in a Virtual Reality simulator.

Adult↗
PubMedDate not supplied

An emergency department perspective: Part II. Process review.

Webster defines process as a "series of actions or operations conducting to an end." Each of the many processes that may be involved with providing a service or procedure comprises many smaller steps. It is the monitoring of those steps that we call a process review. The process review for quality management begins when a patient perceives the need to receive emergency care. It embodies the technical and interpersonal aspects of the patients, and the staff's interpersonal relationships.

Emergency Service, Hospital↗
PubMed1993

Correlation of employees' perception of workload with workload indicators.

In this study, the measurement of perception of pharmacists' workload did not correlate well with any workload indicators studied. Generally, census on the study date correlated well for pharmacy technicians working in various areas of the pharmacy. If it is agreed that perception of workload is the real measure of activity--that is, how busy the employees believe it is--then the indicators used in this study are not useful. Similar research using other indicators is warranted.

Analysis of Variance↗