Patient safety in the operating room: Work environment and operating room nursing

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenMarkmið rannsóknarinnar var að afla þekkingar á því hvernig stuðlað er að öryggi sjúklinga sem fara í skurðaðgerðir og hvað hjúkrunarfræðingar á skurðstofum álíta að ógni öryggi. Rannsóknin var eigindleg og gagna var aflað með viðtölum við skurðhjúkrunarfræðinga og með umræðum í rýnihópum. Þátttakendur voru hjúkrunarfræðingar á tveimur skurðstofum Landspítala – háskólasjúkrahúss. Gögn voru greind með túlkandi innihaldsgreiningu. Niðurstöður lýsa þáttum sem styrkja öryggi sjúklinga, svo sem áherslu á fyrirbyggingu í skurðhjúkrun, skipulagi starfa skurðhjúkrunarfræðinga í sérhæfð teymi og áhrifum góðs samstarfs á skurðstofum. Þáttum, sem geta ógnað öryggi sjúklinga, var einnig lýst. Það eru fyrst og fremst þættir sem lúta að skipulagi og vinnuumhverfi, svo sem miklum hraða, auknum kröfum um afköst, vinnuálagi, ójafnvægi í mönnun og því að hafa ekki stjórn á aðstæðum. Atvik, sem upp hafa komið, voru rædd í rýnihópunum. Gildi rannsóknarinnar felst í því að þáttum í starfsemi skurðstofa, sem hjúkrunarfræðingar telja að styrki öryggi sjúklinga og ástæða er til að hlúa að, er lýst sem og þáttum sem ógna öryggi.The aim of this study was to gain knowledge of what enhances the safety of patients undergoing operations and what OR nurses perceive as threats to their safety. This was a qualitative study based on interviews with OR nurses and focus group discussions among them. Participants were nurses on two of the OR units at Landspitali University Hospital. Data were analysed using an interpretive content analysis. They reflect factors in OR nursing that enhance patient safety such as the emphasis placed on prevention of mistakes, the organization of the work into specialized teams and good collaboration in the teams. Factors that threaten patient safety were mainly related to the organization of the work and the conditions under which the work took place. The speed at which the work is performed, demands increased efficiency and output, instability in staffing and lack of control over the conditions of work were all mentioned. Insidents that have occured were discussed in the focus groups. This study has added to current knowledge and understanding by outlining factors in the OR work environment that OR nurses consider strengthening for patient safety and should therefore be enhanced as well as describing factors that threaten patient safety

Dealing with unforeseen complexity in the OR: the role of heedful interrelating in medical teams

Highly complex operations such as paediatric cardiac surgery operations are characterised by many non-routine events. This study looked in detail at 40 paediatric cardiac cases in order to study how a highly competent team deals with the unforeseen complexity arising during these cases. A multi-method approach was used, employing questionnaires and direct team observations. Our results show that this particular team relied to a large extent on explicit coordination processes in order to deal with non-routine events. Non-routine events were strong predictors of explicit coordination processes, even when we controlled for the duration of the operation. Most non-routine events were noticed and dealt with through routine procedures. For dealing with the remaining difficult problems, processes such as heedful interrelating are required

Shaped by Design "How User-Interface Design Influences Medical Decision Making: The Role of Monitoring Equipment in Anesthetic Practice"

abstract: Objective: The aim of this research is to uncover, via a comprehensive cross study analysis, data patterns that could potentially point to a positive correlation between two main variables: anesthetic monitoring equipment and anesthetic decision making. Of particular interest is the equipment's monitor screen and the extent to which its user interface design influences anesthetic situation awareness (SA) and hence, decision making. It is hypothesized that poor anesthetic diagnosis from inadequate SA may be largely attributable to patient data displays lacking in human factors design considerations. Methods: A systematic search was conducted of existing empirical studies pertaining to patient physiologic monitoring that spanned across interrelated domains, namely, ergonomics, medical informatics, visual computing, cognitive psychology, human factors, clinical monitoring, intensive care medicine, and intelligent systems etc. all published in scholarly research journals between 1970 to August 2012. Anesthetic-related keywords were queried i.e. anesthetic mishaps, patient physiological data displays, anesthetic vigilance etc. (found in Appendix A). This approach yielded a few thousand results, of which 65 empirical studies were pulled. Further extraction of articles having direct connection to the use of data displays within the anesthetic context produced a total of 20 empirical studies. These studies were grouped under two broad categories of Monitoring and Monitors whereby factors directly contributing to the studies' results were identified with the aim to find emerging themes that provide insights involving interface design and medical decision making. Results: There is a direct correlation between user-interface design and decision making. The situation awareness (SA) required for decision making heavily relies upon data displays oriented towards information extraction and integration. In the systematic assessment of empirical studies, it is undeniable how strikingly prominent visual attributes show up as contributing factors to subjects' enhanced performance in the studies. Conclusions: How and to what users direct their perceptual and cognitive resources necessarily influence their perception of the environment, and by extension, their development of situation awareness (SA). Although patient monitoring equipment employed in anesthetic practice has proven to be indispensable in quality patient care, graphical representations of patient data is still far from optimal in the clinical setting. User-interfaces that lend decision support to facilitate SA and subsequent decision making is critical in crisis management.Dissertation/ThesisM.S.D. Design 201

The Use of Human Factors Training to Improve the Quality of Decision-­‐Making in Nurse Anesthesia Trainees

In the U.S, an estimated 44,000-­‐98,000 deaths occur annually due to medical errors. Adverse events can occur as anesthesia providers face a complex environment of high acuity patients undergoing interventions in a variety of locations. Production pressure, new equipment and medications, and constant turnover of personnel contribute to a hazardous working environment. Human factors educational training in cognitive errors, metacognition, and de-­‐biasing strategies has been proposed as a solution to help prevent medical errors in anesthesia practice The study of human factors has been integrated into safety culture industries such as aviation and nuclear power plants, but its incorporation into the medical field has been slow. Nurse anesthesia trainees are in the ideal position to receive human factors training because of their vulnerability to the demands and stressors involved in clinical residency. In this project, a needs assessment survey was distributed to gain expert feedback on the most common and most dangerous human factors errors observed in nurse anesthesia trainees. A human factors seminar was developed that included information on how human factors contribute to errors, avoidance strategies for the human factors identified in the needs assessment survey, and a mental model to help improve decision-­‐making. Post seminar evaluation demonstrated that nurse anesthesia trainees found the seminar content to be applicable to their practice, useful in the operating room environment, and effective in influencing their clinical decision-­‐making

Human Factors and Neurophysiological Metrics in Air Traffic Control: a Critical Review

International audienceThis article provides the reader a focused and organised review of the research progresses on neurophysiological indicators, also called “neurometrics”, to show how neurometrics could effectively address some of the most important Human Factors (HFs) needs in the Air Traffic Management (ATM) field. The state of the art on the most involved HFs and related cognitive processes (e.g. mental workload, cognitive training) is presented together with examples of possible applications in the current and future ATM scenarios, in order to better understand and highlight the available opportunities of such neuroscientific applications. Furthermore, the paper will discuss the potential enhancement that further research and development activities could bring to the efficiency and safety of the ATM service

Protocol for Usability Testing and Validation of the ISO Draft International Standard 19223 for Lung Ventilators

©Dev Minotra, Steven L Dain, Catherine M Burns. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 08.09.2017. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.Background: Clinicians, such as respiratory therapists and physicians, are often required to set up pieces of medical equipment that use inconsistent terminology. Current lung ventilator terminology that is used by different manufacturers contributes to the risk of usage errors, and in turn the risk of ventilator-associated lung injuries and other conditions. Human factors and communication issues are often associated with ventilator-related sentinel events, and inconsistent ventilator terminology compounds these issues. This paper describes our proposed protocol, which will be implemented at the University of Waterloo, Canada when this project is externally funded. Objective: We propose to determine whether a standardized vocabulary improves the ease of use, safety, and utility as it relates to the usability of medical devices, compared to legacy medical devices from multiple manufacturers, which use different terms. Methods: We hypothesize that usage errors by clinicians will be lower when standardization is consistently applied by all manufacturers. The proposed study will experimentally examine the impact of standardized nomenclature on performance declines in the use of an unfamiliar ventilator product in clinically relevant scenarios. Participants will be respiratory therapy practitioners and trainees, and we propose studying approximately 60 participants. Results: The work reported here is in the proposal phase. Once the protocol is implemented, we will report the results in a follow-up paper. Conclusions: The proposed study will help us better understand the effects of standardization on medical device usability. The study will also help identify any terms in the International Organization for Standardization (ISO) Draft International Standard (DIS) 19223 that may be associated with recurrent errors. Amendments to the standard will be proposed if recurrent errors are identified. This report contributes a protocol that can be used to assess the effect of standardization in any given domain that involves equipment, multiple manufacturers, inconsistent vocabulary, symbology, audio tones, or patterns in interface navigation. Second, the protocol can be used to experimentally evaluate the ISO DIS 19223 for its effectiveness, as researchers around the world may wish to conduct such tests and compare results.We are thankful for funding support from the Natural Sciences and Engineering Research Council discovery grant 132995 and from a Telus Health contract

Mapping registered nurse anaesthetists' intraoperative work: tasks, multitasking, interruptions and their causes, and interactions: a prospective observational study

Introduction Safe anaesthesia care is a fundamental part of healthcare. In a previous study, registered nurse anaesthetists (RNAs) had the highest task frequency, with the largest amount of multitasking and interruptions among all professionals working in a surgical team. There is a lack of knowledge on how these factors are distributed during the intraoperative anaesthesia care process, and what implications they might have on safety and quality of care. Objective To map the RNAs' work as done in practice, including tasks, multitasking, interruptions and their causes, and interactions, during all phases of the intraoperative anaesthesia work process. Methods Structured observations of RNAs (n=8) conducted during 30 procedures lasting a total of 73 hours in an operating department at a county hospital in Sweden, using the Work Observation Method By Activity Timing tool. Results High task intensity and multitasking were revealed during preparation for anaesthesia induction (79 tasks/hour, 61.9% of task time spent multitasking), anaesthesia induction (98 tasks/hour, 50.7%) and preparation for anaesthesia maintenance (86 tasks/hour, 80.2%). Frequent interruptions took place during preoperative preparation (4.7 /hour), anaesthesia induction (6.2 /hour) and preparation for anaesthesia maintenance (4.3 /hour). The interruptions were most often related to medication care (n=54, 19.8%), equipment issues (n=40, 14.7%) or the procedure itself (n=39, 14.3%). RNAs' work was conducted mostly independently (58.4%), but RNAs interacted with multiple professionals in and outside the operating room during anaesthesia. Conclusion The tasks, multitasking, interruptions and their causes, and interactions during different phases illustrated the RNAs' work as done, as part of a complex adaptive system. Management of safety in the most intense phases-preparing for anaesthesia induction, induction and preparing for anaesthesia maintenance-should be investigated further. The complexity and adaptivity of the nature of RNAs' work should be taken into consideration in future management, development, research and education.</p

Use of a Portable Functional Near-Infrared Spectroscopy (fNIRS) System to Examine Team Experience During Crisis Event Management in Clinical Simulations

Objective: The aim of this study was to investigate the utilization of a portable functional near-infrared spectroscopy (fNIRS) system, the fNIRS PioneerTM, to examine team experience in high-fidelity simulation-based crisis event management (CEM) training for anesthesiologists in operating rooms.Background: Effective evaluation of team performance and experience in CEM simulations is essential for healthcare training and research. Neurophysiological measures with wearable devices can provide useful indicators of team experience to compliment traditional self-report, observer ratings, and behavioral performance measures. fNIRS measured brain blood oxygenation levels and neural synchrony can be used as indicators of workload and team engagement, which is vital for optimal team performance.Methods: Thirty-three anesthesiologists, who were attending CEM training in two-person teams, participated in this study. The participants varied in their expertise level and the simulation scenarios varied in difficulty level. The oxygenated and de-oxygenated hemoglobin (HbO and HbR) levels in the participants’ prefrontal cortex were derived from data recorded by a portable one-channel fNIRS system worn by all participants throughout CEM training. Team neural synchrony was measured by HbO/HbR wavelet transformation coherence (WTC). Observer-rated workload and self-reported workload and mood were also collected.Results: At the individual level, the pattern of HbR level corresponded to changes of workload for the individuals in different roles during different phases of a scenario; but this was not the case for HbO level. Thus, HbR level may be a better indicator for individual workload in the studied setting. However, HbR level was insensitive to differences in scenario difficulty and did not correlate with observer-rated or self-reported workload. At the team level, high levels of HbO and HbR WTC were observed during active teamwork. Furthermore, HbO WTC was sensitive to levels of scenario difficulty.Conclusion: This study showed that it was feasible to use a portable fNIRS system to study workload and team engagement in high-fidelity clinical simulations. However, more work is needed to establish the sensitivity, reliability, and validity of fNIRS measures as indicators of team experience

De que forma é que a magnitude da mudança influencia a forma como as equipas de bombeiros se coordenam e adaptam após um imprevisto durante uma extração

Dissertação de Mestrado apresentada no ISPA – Instituto Universitário de Ciências Psicológicas, Sociais e da Vida, para obtenção do grau de Mestre na especialidade de Psicologia Social e das Organizações.Este estudo visa compreender de que modo é que a magnitude da mudança influencia a forma como as equipas de bombeiros se coordenam e se adaptam após um imprevisto durante a extração. A amostra é composta por 140 recrutas pertencentes ao Regimento de Sapadores Bombeiros Lisboa. Estes 140 participantes estão distribuídos por 28 equipas, constituídas por 6 elementos (Técnico 1, Técnico 2, Técnico 3, Técnico 4, Socorrista, Chefe). De modo a avaliar as variáveis de coordenação (implícita e explicita), foi desenvolvida uma grelha de codificação com o objetivo de codificar os comportamentos de coordenação ocorridos durante a tarefa de extração. Para avaliar o desempenho adaptativo da equipa, foi utilizada uma versão da escala de Pulakos et al. (2000), adaptada para a população portuguesa por Marques-Quinteiro, Ramos-Villagrasa, Passos e Curral (2015). Os resultados demonstram que algumas das hipóteses não foram corroboradas. No entanto, sugerem que existe uma relação significativa entre a adoção de comportamentos de coordenação implícita e a duração da tarefa. Porém, os resultados parecem indicar que não existe qualquer relação entre a coordenação explicita e implícita com a adaptação avaliada pelo líder. Verificou-se que a magnitude da mudança exerce uma influência sobre a coordenação implícita e esta, tem uma especial importância nas tarefas de rotina.This study aims to understand how the magnitude of change influences the way fire crews coordinate and adapt after an unexpected event during an extraction. The sample include 140 recruits from the Firefighters Regiment of the Command and Training Headquarters in Marvila, Lisbon. These 140 participants are distributed by 28 teams, consisting of 6 elements, (Technic 1, Technic 2, Technic 3, Technic 4, Paramedic, Leader). In order to evaluate the coordination (implicit and explicit) variables, a research grid was developed with the objective of codifying the coordination results that occurred during the extraction task. To assess the adaptive performance of the team, a version of the scale by Pulakos et al. (2000), was adapted for the Portuguese population by Marques-Quinteiro, Ramos-Villagrasa, Passos and Curral (2015). The results demonstrate that the hypotheses were not confirmed. However, they suggest that there is a significant relationship between the adoption of implicit coordination behaviors and the duration of the task. However, the results seem to indicate that there is no relationship between explicit and implicit coordination with the adaptation evaluated by the leader. It was found that the magnitude of the change has an influence on the implicit coordination, and this has a special importance in routine tasks