Medication Safety in Emergency Medical Services: Approaching an Evidence-Based Method of Verification to Reduce Errors

Lack of verification is often cited as a root cause of medication errors; however, medication errors occur in spite of conventional verification practices and it appears that human factors engineering (HFE) can inform the design of a more effective method. To this end, an HFE-driven process was designed and implemented in an urban, Midwestern emergency medical service agency. Medication error data were collected over a 54-month period, 27 months before and after implementation. A decrease in the average monthly error rate was realized for all medications administered (49.0%) during the post-intervention time period. The average monthly error rate for fentanyl, a commonly administered analgesic, demonstrated a 71.1% error rate decrease. This study is the first to evaluate the effectiveness of a team-based cross-check process for medication verification to prevent errors in the prehospital setting

Multicenter Handoff Collaborative

Communication and team-based care are at the heart of patient safety. As anesthesia professionals, we witness this at its very best and worst when transferring patients to and from the operating room (see article by Dr. Lorinc on types of transfers in this issue). In response, we have an opportunity to take a leading role in redesigning the most ubiquitous teaming event in hospitals in a manner that promotes team-based behaviors. The impact of unreliable handoffs on communication failures and medical errors is well known. To combat this issue, mandates by The Joint Commission (TJC) in 2006 and the American Council for Graduate Medical Education (ACGME) in 2013 established requirements for creating a more structured handoff process. However, like much of the quality improvement movement, progress has been slow. This isn’t necessarily due to lack of tactics and technology, but appears to be related to the culture and infrastructure needed to address problems of this scope and complexity. In other words, we need to change our approach to managing our collective efforts

Evaluating System Usability, Workload Suitability, and User Experience of Game-Based Virtual Reality in Spaceflight Education and Training

Game-based instruction and immersive virtual reality are enhanced pedagogical methods beneficial in training environments involving complex disciplines, ranging from medical applications to construction engineering technology. This study investigated the use of game-based virtual reality (GBVR) when applied to the complex field of spaceflight education and training. As modern society places increasing demand on space-based amenities, the need for proficient satellite operators will also increase, requiring more accessible and advanced training options. Satellite ground control training scenarios, immersed in the GBVR environment, were developed and deployed to university student participants. Multiple validated scales were employed to measure the GBVR system regarding three main attributes: system usability, workload suitability, and user experience. Results revealed that the GBVR system usability scores ranked above average on the System Usability Scale (SUS). Secondly, the workload suitability ranked within the accepted mean value range of the National Aeronautics and Space Administration (NASA) Task Load Index (TLX). And lastly, the user experience scores were similar to popular video game scores on the Game User Experience Satisfaction Scale (GUESS-18). Even with a small sample size (n = 10), the findings indicate that GBVR is a feasible tool when applied to a complex discipline such as spaceflight education and training

Trends of Non-Fatal HEMS Accident-Related Injuries

We conducted an investigation into non-fatal helicopter emergency medical service accidents from January 26, 1991 to April 26, 2018 via the National Transportation Safety Board aviation accident database. Over this 28-year timeframe 247 accidents results in 251 fatalities and 179 non-fatal injuries. Exploratory analysis of the data indicate that more non-fatal injuries occurred in September compared to any other month during the study timeframe. Exploratory correlational analysis via elastic net logistic regression concluded that no linear relationship of NTSB accident database data provide insights into what factors are correlated with an increased likelihood of non-fatal injuries. Further, no linear relationships of available variables provide insights into the increased number of non-fatal injuries in September during this investigation’s timeframe. Future research should identify if these null results are due to a true lack or no relationship between available data and non-fatal injuries or if these results are due to inaccessibility to relevant data

The Need for Recategorized Video Game Labels: A Quantitative Approach

Prior research has suggested that video game genre labels are an ineffective method of communicating a game\u27s experience. Our investigation serves to provide a quantitative means of assessing experience communication effectiveness. We assessed game similarities by their associated game genre labels. The ratio between the small number of available developer-generated labels and the number of games led to too few labels to effectively delineate between similar and dissimilar games. The ratio between the large number of user-generated labels and the number of games led to too many labels to effectively cluster similar games with one another. However, games that had matching genres (e.g., direct sequels to each other) led to direct clustering. The result from this analysis provides evidence that this novel method of assessing games\u27 communication experience works as intended and may be used by future research to assess the effectiveness of alternative categorization systems

Human Factors Applied to Perioperative Process Improvement

Human factors/ergonomics (HF/E) is its own scientific discipline that can be applied to understanding performance in perioperative medicine. Humans are not perfect decision makers and are affected by a variety of factors that can greatly harm their ability to perform, including attention, bias, stress, and fatigue. HF/E has a unique perspective on human error, and HF/E can illustrate how moving away from blame can enhance safety. HF/E offers strategies for undertaking a systematic approach to assessment of work processes in perioperative medicine that can be used to increase safety and wellbeing of patients and providers

The Influence of Personality, Safety Attitudes, and Risk Perception of Pilots: A Modeling and Mediation Perspective

Objective: The purpose of the current study was to assess the influence of personality traits on safety attitudes and risk perceptions. Background: The ability to accurately assess risk remains a focal point of aviation training. This research seeks to understand if safety attitudes serve as a mediator. Method: Using a sample of 2,857 pilots, a statistical model was created through two independent stages. In stage 1, approximately 50% of the data were used to create the model using structural equation modeling techniques, and in stage 2, the model was independently validated. Results: The findings indicated that personality factors positively influenced risk perception, whereas personality increased, so did the pilot\u27s perception of the risk level. Self-confidence was negatively related to risk perceptions, indicating that a pilot\u27s self-confidence increases their perception of risk decreases. Additionally, self-confidence was a significant mediator to the relationship between personality factors and risk perception. Conclusion: The original scales had some validity issues, but the re-specified model provided some meaningful findings, especially in the relationships between personality traits, self-confidence, and risk perception. The model explained 26.4% of the variance in self-confidence and 9.5% of risk perception variance. Application: The findings highlight the importance for pilots to be aware of how increased self-confidence may influence their perceptions of risk. As pilots gain experience and self-confidence, care needs to be given to ensure greater risks are not taken, offsetting the value of the experience and self-confidence

Telemedicine Security: Challenges and Solutions

The proliferation of telemedicine spurred by the COVID-19 pandemic has come with a variety of human factors challenges. Such challenges include mitigating potential risks associated with the quick transition to virtual care. We identify challenges and solutions related to telemedicine security, and analyze our results using Schlarman’s People, Policy, Technology framework (2001). Our systematic literature review synthe-sizes gray literature (white papers, news articles, and blog posts) in addition to formal (published) litera-ture. This methodology closes the gap between academic research and professional practice and aids in providing timely, practical insights related to cybersecurity and safety in virtual care environments. As the transition from traditional care continues to develop, we seek to better understand emerging vulnerabilities, identify crucial cyber hygiene practices, and provide insights on how to improve the safety of paitent data in virtiual care. Telemedicine is here to stay, and lessons learned from the pandemic are likely to remain useful

Recategorization of Video Game Genres

While the categories that are typically used to discriminate games have been useful in the past, more recently game mechanics have become utilized by a wider range of games, leading to earlier definitions becoming a less valuable categorization tool. This paper attempts to provide various ways games could be classified by focusing on the types of emotions they evoke, the skills they require or their relations with personality or cognitive variables. A description of those categories and the challenge in using them to define games is outlined as well as five alternate methods that may help make distinctions between games clearer

The Development and Validation of a Universal Enjoyment Measure: The Enjoy Scale

For decades, the concept of enjoyment has been used to measure the psychological benefits of activities and has been shown to determine future behavior toward activities and objects of interest. However, there has been little consensus on the definition and dimensionality of enjoyment. This study introduced a new measure of enjoyment with scale development and validation reported. CFA and EFA findings from 1466 participants across 739 different activities were reported. The instrument developed measured enjoyment across activities, with demonstrated content validity, internal consistency, discriminant and convergent validity. The final 25-item version of the ENJOY scale is composed of 5 factors: pleasure, relatedness, competence, challenge/improvement, and engagement. Discussion of the ENJOY Scale places it within the conceptual framework of Self-Determination Theory