Explaining drug-resistant infection in community pharmacies through effective information design

This paper describes a research project in which information design, human factors, architecture and pharmacy academics worked with pharmacy professionals and pharmacy users to consider how to present information about antimicrobial resistance (AMR) in a community pharmacy setting. Project outcomes – as a result of an innovative design competition – included five different design solutions that explain aspects of AMR within the context of a community pharmacy. The project raised awareness in pharmacy professionals of how design can be used to challenge ideas and encourage new ways of thinking to communicate public health messages. Two winning prototype solutions were installed in a Day Lewis pharmacy in Reading and evaluated by pharmacists and pharmacy users. We make preliminary recommendations for effective health communication in community pharmacies

Conflicting benefits and hazards hospital style bed rails

This paper reviews the design and use of hospital-style bed rails. Rails were originally used as a safety feature for psychiatric patients at risk of falling in the 1800s. There are benefits, for example security in transit, facilitating repositioning, but also hazards, including deaths and injuries associated with entrapment. The developments in the technological specification of hospital beds (electric) has increased with their functionality. However, a survey in England and Wales found that patients on electric beds / pressure mattresses were three times more likely to have their rails raised. This may lead to an increase in the exposure to the risks associated with bed rails and presents a conflict for designers, staff and patients

Can inclusive environmental design be achieved in acute hospitals?

The effectiveness of healthcare delivery is determined, in part, by the design of the physical environment and the spatial organisation of work. This paper will consider firstly whether ergonomic input to provide recommendations for work space requirements may restrict patient autonomy and secondly, whether design developments for patient benefit may lead to difficulties in providing clinical care. The findings from two research studies are used to discuss the impact of physical layout on work systems with respect to staff well-being (space to work), patient care (monitoring) and patient experience (privacy and dignity). Several approaches to design and ward layout are considered, including Harness, Nucleus, AEDET, Planetree and Sengetun. Finally, the involvement of both staff and patients through a participatory ergonomics framework in building design is explored. It is suggested that mapping criteria for user participation in building design briefing with the participatory ergonomics framework may offer potential to improve and enhance patient involvement in hospital design

Musculoskeletal injury risks for ambulance workers

The provision of emergency and urgent care has been recognised for many years as exposing ambulance workers to high risks of musculoskeletal injuries (Turnbull et al, 1992; Rodgers, 1998; ROSPA, 2000; Lavender et al, 2000; Maguire et al, 2005). Although the tasks and job roles may vary in different countries (e.g. combination of paramedic and fire fighter roles), the evidence seems to be compelling that ‘ambulance workers [are] at a relatively higher risk of permanent medical impairment and early retirement on medical grounds than other occupational groups’ and have more ‘somatic health problems’ (e.g. musculoskeletal disorders) than the general population (Sterud et al, 2006). Recent research indicates that the prevalence of musculoskeletal discomfort and injuries may not have significantly reduced since the 1990s with over 50% of paramedics continuing to have musculoskeletal pain or discomfort on a regular basis (Arial et al, 2014); it seems reasonable to suggest that these problems may still be contributing to early retirement on medical grounds (Rodgers, 1998)

Using qualitative methodology in ergonomics: theoretical background and practical examples

Qualitative methodology offers the opportunity for ergonomists to investigate work problems and research questions using context-sensitive tools for data collection and analysis. This is particularly useful in contexts with complex social and cultural dimensions, for example the high level of emotional and intimate personal interactions between staff and patients in the health care industry. Two aims have been achieved in this thesis. The first is to set out a clear process for using qualitative methodology in ergonomics by taking a middle ground position with respect to the background philosophy. A generic process for carrying out qualitative research is described and shown in detail in the two case studies. The ergonomists case study found that there was considerable interest in expanding the ergonomics tool box to include qualitative methodology. However concerns were raised about a perceived lack of knowledge with respect to the process for doing qualitative research. This needs to be addressed by including teaching qualitative methodology in ergonomics courses. The second aim is use qualitative methodology to identify characteristics of hospitals with respect to the practice of ergonomics. Three themes emerged: organisational issues (complexity and size); staff issues (multiplicity of professionals and gender); and patient issues (dirty and emotional work; patient expectations; and life, death and mistakes). These themes were also found in the practical case study on manual handling problems in occupational therapy. This suggests that knowledge of the characteristics of an industry can help the ergonomist to understand the context of the work problem or research question. A final dynamic model of ergonomics is proposed to bring together the internal dimensions of a person (representing physical, cognitive and spiritual levels) and the external dimensions of their interactions at a micro level (e. g. tasks) and at wider organisational and societal levels (macro). This model shows the importance of using qualitative methodology to achieve a more complete understanding of human interactions: the basis of the definition of ergonomics

Silver bullets or buckshot? Patient falls and a systems model in healthcare facility design

Falls are associated with increased length of stay in hospitals and higher healthcare costs connected to additional care, discharges to institutional care and litigation claims. Under current US reimbursement programs, organizations are penalized for hospital-acquired conditions, including falls with injury not present on admission. This paper presents the results from a systematic mixed methods literature review on the correlates and interventions for patient falls. While the review is focused on conditions of the physical environment, these must be considered in the context of organizational and people-based factors to fully address the system complexity. A model for systems integration is proposed. Practitioner Summary: Healthcare organizations continue to struggle with preventing patient falls. Because of the multifactorial contributions to fall risk, falls reduction programs include multiple solutions with no ability to quantify the effectiveness of any particular component, and yet, the question is always asked, “What really worked?” Rather than seek silver bullets, we should establish frameworks that account for the interactions within the system that also a proactive approach to healthcare facility design

The NHS health check for developing HFE competencies.

Patient safety is an emergent property of complex sociotechnical healthcare systems. Human Factors and Ergonomics (HFE), with its design-based systems focus, offers frameworks for developing resilient systems, although use in healthcare has been limited to date. Most healthcare educational curricula articulate requirements for students to develop patient safety competencies, but there is scant direction as to how this might be achieved. The authors have produced guidance on embedding HFE in healthcare curricula, but recognise that examples of effective HFE teaching would further support educational practice. This case study outlines a related set of activities based around the NHS Health Check, a population-wide screening programme designed to identify and manage cardiovascular risk. The Health Check represents a cardiovascular risk management system and is amenable to analysis using HFE frameworks. The educational activities described support students in developing a deep awareness of HFE theory, and early development of HFE competencies. The Health Check is a highly relevant professional activity for pharmacy students but would also be relevant to medical and nursing students, as well as healthcare management staff. This case study will form the focus of a discussion that will provide delegates with an opportunity to share experiences of different approaches to HFE education

A tool to compare all patient handling interventions

Patient handling intervention strategies are many and varied. The focus of interventions has primarily been on the health, safety and welfare of care givers. Data from 4 EU focus groups and 2 world-wide expert panels were used to evaluate whether other types of outcomes were perceived as having relative importance. Qualitative and quantitative analysis showed that organisational and patient outcomes were also highly rated by the participants. The data showed 12 outcomes as being of the highest priority with good agreement between the 4 EU sources (Kendall’s Concordance significant at 0.005). In parallel, a systematic analysis of patient handling intervention literature was considered to evaluate the qualities of each study. Using the 12 most important outcomes from the initial study and the most appropriate and accessible measurement tools from the literature analysis, the Intervention Evaluation Tool (IET) is proposed. The IET is a single set of measurements that can be used for evaluating all organisational and individual patient handling interventions. The IET has been trialled at 2 sites in 4 EU countries

Manual handling in healthcare

Patient handling is a known cause of musculoskeletal risk for healthcare staff. A range of ergonomic and other approaches have been used to try to reduce the effects of these tasks, e.g. risk assessment and management, training, equipment provision, culture change. A European collaboration (European Panel on Patient Handling Ergonomics) was formed in 2004 to share information about research on patient handling and develop research ideas for European collaborations. Three collaborations will be described. The first reviewed the implementation of the European Union Directive on Manual handling for patient handling; the second reports the development of a Technical Report (TR ISO/CD 12296) for the manual handling of people in the healthcare sector; and the third describes an Intervention Evaluation Tool that has been produced to allow the evaluation of both single factor and multi-faceted interventions for patient handling

Factors influencing the development of effective error management competencies in undergraduate UK pharmacy students

Patient safety (PS) is a key healthcare goal, yet health professionals struggle to acquire appropriate expertise, including Human Factors/Ergonomics skills, reflected in undergraduate curricula content. More than 50% of adverse events are medicines-related, yet focus on pharmacists as experts in medicines is scant. This pilot investigation used focus groups and interviews to explore undergraduate PS teaching in purposively-selected UK pharmacy schools. Results revealed barriers to PS teaching including risk-averse pharmacist ‘personality’ and Educational Standards negatively influencing students’ error-management behaviours