Ergonomics in Healthcare Delivery
Transcript of Ergonomics in Healthcare Delivery
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http://www2.fpm.wisc.edu/seips/
Ergonomics in Healthcare DeliveryPascale Carayon, Ph.D.
Center for Quality and Productivity ImprovementDepartment of Industrial and Systems Engineering
University of Wisconsin-Madison
email: [email protected] / tel: 608-265-0503
June 15-16, 2006 – Healthcare Systems Engineering Workshop
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HSE at University of Wisconsin-Madison! CHESS:
" Computer support system! CHSRA:
" Measurement of quality in long-term care! CQPI/SEIPS:
" Human factors engineering and systems engineering in patient safety
! Two ISyE faculty are IOM members.! AHRQ training grant (with Population Health Sciences)! Graduate certificate in patient safety! Interdisciplinary HSE courses (pharmacy, population
health sciences, medical physics)! Mentoring of physicians
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Ergonomics in Healthcare DeliveryResearch needs! Major issues facing health care and patient
safety:"Workload of healthcare providers"Medical errors and adverse events: identification,
management, review, recovery"Reliability of systems, processes and technologies"Patient safety in a variety of settings"Transitions of care"Medical devices and healthcare information technology
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- Work system and patient safety -SEIPS model (Carayon et al., 2003)
Bar Coding Medication AdministrationSmart IV Pump
CPOEEHR
SEIPS = Systems Engineering Initiative for Patient Safetyhttp://www2.fpm.wisc.edu/seips/
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Task sequences observed – BCMA medication administration
scan self
obtain meds
check med vs device
enter pt room
scan med
scan med
doc admin
double check
enter pt room
M (1)
give med to pt
scan pt ID band
doc admin
N (1)
give med to pt
scan pt ID band
enter pt room
scan med
scan pt ID
banddoc
admin
give medto pt
O (1)
scan med
check med vs device
enter pt room
scan ptID band
Q(1)
give med to pt
doc admin
P (1)
scan ptID band
D(22)
E (1)doc
admin
doc admin
give medto pt
give medto pt
F (17)
give medto patient
G(1)scan pt ID band
docadmin
I(1)doc
admin
H(2)
double check by RN
scan pt ID band
give med to pt
docadmin
J(1)
enter pt room
docadmin
give med to pt
K(2)
START
obtain meds
scan pt ID band
A(1)
give med to pt
docadmin
scan self enter pt room
check med vsdevice
scan med enter pt room
enter ptroom
scan ptID band
give medto pt
docadmin
B(1)
scan self
check medvs device
scan med
scan pt ID band
give med to
ptdoc
admin
C(2)
scan pt ID band
docadmin
enter pt room
L (1)
give med to pt
enter ptroom
scan pt ID band
doc admin
R (1)
give medto pt
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02/04/2006
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Work system factors observed in BCMA medication administration
! Tasks:"Potentially unsafe med. admin.
! Person:"Patient in isolation
! Environment:"Messy, insufficient light
! Technology:"Automation surprises,
malfunctions! Organization:
" interruptions
Technologyand Tools
Organization
EnvironmentTasks
Person
Technologyand Tools
Organization
EnvironmentTasks
Person
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- Work system and patient safety -SEIPS model (Carayon et al., 2003)
Outpatient surgery
SEIPS = Systems Engineering Initiative for Patient Safetyhttp://www2.fpm.wisc.edu/seips/
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- Work system and patient safety -SEIPS model (Carayon et al., 2003)
SEIPS = Systems Engineering Initiative for Patient Safetyhttp://www2.fpm.wisc.edu/seips/
Inpatient carePediatric hospital
Outpatient surgeryPrimary careIntensive care
Medication safetyInfection controlQuality of care
Perceived quality/safety of care
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Study of ICU nurses
! 298 nurses from 17 ICUs of 7 hospitals located in Wisconsin
! Data collection between February and August 2004
! ICUs with different specialties (trauma, medical, surgical, cardiac, cardiothoracic, neurosurgery, burn, pediatric, neonatal)
! Overall response rate: 77% (ranging from 40% to 100%)
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0
20
40
60noise
distractions family
hectic work envt
crowded work envt
delay meds pharmacy
family needs
teaching familiesequipment unavailable
pt rooms not well-stocked
inadequate workspace
searching supplies
searching pt charts
many calls from families
delay seeing new orders
Technologyand Tools
Organization
EnvironmentTasks
Person
Technologyand Tools
Organization
EnvironmentTasks
Person
298 ICU nurses – 7 Wisconsin hospitalsPerformance obstacles at end of shift
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Lucian Leape in Ergonomics in Design – Summer’2004
!“Given the complexity of health care and the formidable obstacles it presents to change, to overcome those barriers and create a safe culture does indeed seem to
be the ultimate challenge for those who specialize in human factors.”
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Human Factors and Ergonomics
IEA [International Ergonomics Association] definition (www.iea.cc):"Ergonomics (or human factors) is the scientific discipline
concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance.
Physical ergonomicsCognitive ergonomicsOrganizational ergonomics
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Ergonomics expertise in healthcare organizations
Employee health:occupational safety & health, ergonomics
Purchasing of equipment:usability
Quality improvement:
process analysis
Risk management:incident reporting, event
analysis
OR and critical care:teamwork,
communication
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Ergonomics in Healthcare DeliveryResearch needs! Major issues facing health care and patient
safety:"Workload of healthcare providers"Medical errors and adverse events: identification,
management, review, recovery"Reliability of systems, processes and technologies"Patient safety in a variety of settings"Transitions of care"Medical devices and healthcare information technology
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What kind of ergonomics/HSE research?
!Collaboration with healthcare researchers, professionals and organizations
!Remember the unique characteristics of healthcare:"Complexity"Criticality"People-intensiveness
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Probably the first (modern) study on medication errors…
… was conducted by Alphonse Chapanis (1960).