Use of Laboratory and Other Simulations in Assessing Drug Name Confusion Tony Grasha (dec)...
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Transcript of Use of Laboratory and Other Simulations in Assessing Drug Name Confusion Tony Grasha (dec)...
Use of Laboratory and Use of Laboratory and Other Simulations in Other Simulations in
Assessing Drug Name Assessing Drug Name ConfusionConfusion
Tony Grasha (dec)University of Cincinnati
Kraig SchellAngelo State University
The Current State As We See It…
Current means of assessing drug
name confusion are primarily
rational and reductionistic FMEA/RCA Computer phonological analysis Expert teams and committees
Careful consideration must be paid to drug name confusion to avoid patient injury and to avoid financial loss by companies
Our Approach to the Problem The problem of name confusability is broader
and less rational than might be assumed In addition to the physical characteristics of the
name, other factors may play a role such as: Workplace stress and fatigue Outside of the workplace stress and tension Time of day Frequency of prescriptions Workload and work rate Complex and conflicting information Personality characteristics/individual differences
Our Approach to the Problem…
Major assumptions and observations Drugs that look similar, sound similar, and are
spelled in similar ways are not confused with each other or misfilled 100% of the time
Phonological and perceptual factors are important contributors to the problem and are “necessary” but are not “necessary and sufficient” explanations for why the problem exists
The process of human error is not a rational process and cannot be completely reduced to rules and formulae
The Use of Simulations
Simulating all or part of a
dispensing or drug distribution
process can yield important
information about:
• “human factors” that interact with the physical characteristics of a drug name
• work environments within whichparticular drug names are more
confusable than others
A Hierarchy of Simulations
Lab Simulation
Full Scale Pharmacy Simulation“Movie Set Metaphor”
Simulations in Pharmacy Schools
Error MonitoringStations Around the Country
CO
NT
RO
L
RE
ALI
SM
H
H
L
L
Characteristics of Simulations Both objective errors and subjective errors can
be observed Subjective errors include the drug name’s ability
to create “process errors”or “process deviations” that may contribute sporadically to actual errors
Process errors represent mistakes made and corrected but also are indicative of our cognitive system moving into an “error mode.”
A 6:1 average ratio of process errors to those that get by normal verification processes has occurred across a number of settings: laboratory, retail pharmacy, outpatient hospital pharmacy
Characteristics of Simulations
Safe environment for assessing effects of drug names on performance
Allow the use of controlled experimental designs, quasi-experimental designs, case studies of individuals and teams, naturalistic observations of performance
Provide opportunities to insert drug names to be evaluated into a mix of normal products dispensed
Three Laboratory ApproachesFull-scale dispensing task
Simulated products are dispensed from mock scripts
Verification task Simulated prescriptions are checked for
accuracy against “pharmacy records”
Drug name perception task Following the methods of Lambert and
colleagues, drug name confusion can be connected to specific individual difference factors
Drug Name Confusion Task
Computer-based simulation (currently under construction)
Names are presented to participants, who must navigate through a “virtual shelf” to retrieve the correct product
Many parameters of the task are modifiable (i.e., duration of name presentation, inclusion of informational context such as dosage, feedback conditions, etc.)
Laboratory Simulation
Pros Strict control over
IVs/DVs Name testing can be
tailored as necessary Other factors (work
pace/workload, etc.) can be varied systematically
Customizable products
Cons Lack of realism Shorter versions of
the task tend to be overly simplistic
Some causes of name confusion may be controlled for in the experimental design
“Movie Set” Simulation Pharmacists/technicians would fill/check scripts in a fluid
and dynamic environment resembling actual pharmacy or variations on it
Emphasis on duplicating the workflow and other likely conditions under which prescription filling/checking would occur
Both objective (errors) and subjective (observational) data collected
“Movie Set” Simulation
The name would be tested in a simulated environment that includes estimable factors that could impact performance: Phone calls/interruptions Customer complaints Insurance paperwork Working with multiple scripts at once Induced stress/fatigue
“Movie Set” Simulation Name confusion could be tested using several
“exercises” based around these potential confounding factors: The “insurance fiasco” exercise The “multiple script” exercise The “similar preceding name” exercise The “frequent prescription” exercise The “stressed out” exercise The “irate customer” exercise, etc.
Exercise creation would be informed by the drug name confusion laboratory task described previously
Simulations in Colleges of Pharmacy
Use of existing simulated environment Possible to do some of the things done in the
“movie set” simulation” May not be as flexible for manipulating some
psychosocial factors
The Error Monitoring Station
Especially in automated pharmacies, the pharmacist’s role has largely switched from filling to verification
This test would insert the new drug into an existing pharmacy strategically placed around the United States
Controls in place to insure that the new drug is not actually dispensed to a customer
Two types of data: pharmacist/technician self-monitoring, objective (end-result) data