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)

The SCOPE of hospital falls: a systematic mixed studies review

Purpose: This systematic mixed studies review (MSR) on hospital falls is aimed to facilitate proactive decision-making for patient safety during the healthcare facility design. Background: Falls were identified by the Centers for Medicare & Medicaid Services (CMS) as a non-reimbursed hospital acquired condition (HAC) due to volume and cost, and additional financial penalties were introduced with the 2014 US hospital acquired condition (HAC) reduction program. In 2015, a Joint Commission alert identified patient falls as one of the top reported sentinel events, and the Occupational Safety and Health Administration (OSHA) added slips, trips, and falls as a focus for investigators' healthcare inspections. Variations in fall rates at both the hospital and the unit level is indicative of an ongoing challenge. The built environment can act as a barrier or enhancement to achieving the desired results in safety complexity that includes the organization, people and environment (SCOPE). Methods: The systematic literature review used MeSH terms and key word alternates for hospital falls with searches in MEDLINE, Web of Science, and CINAHL. The search was limited to English-language papers. Results: Following full text review, 27 papers were included and critically appraised using a dual method mixed methods critical appraisal tool. Themes were coded by broad categories of factors for organization (policy/operations), people (caregivers/staff, patients); and the environment (healthcare facility design). Subcategories were developed to define the physical environment and consider the potential interventions in the context of relative stability. Conclusions: Conditions of hospital falls were identified and evaluated through the literature review. A theoretical model was developed to propose a human factors framework, while considering the permanence of solutions

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

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

Smaller, lighter, faster? Reducing the carbon footprint of ambulances

This paper outlines a feasibility project investigating the potential for smaller, lighter rapid response vehicles (RRVs) in reducing the carbon footprint and response times of ambulances. Five stakeholder consultations were held with two ambulance trusts, an ambulance manufacturer, a paramedic and the Ultra-Light Vehicle Group to generate three novel design concepts for RRVs, which were then reviewed by four UK fleet managers and four clinicians. The results indicated that the integrated clinician service model could create a future market for smaller, lighter vehicles. Reducing carbon emissions in the short term will most likely be achieved using lower emission engines and improving engine and power management for dual-crewed ambulances. In the medium term (5–10 years), there will be a demand for low emission, composite light-weight dual-crewed ambulances

Ergonomics /human factors education in United Kingdom

This paper presents a summary of the Ergonomics and Human Factors (EHF) professional accreditation process in the UK. EHF education can be accredited by the Chartered Institute of Ergonomics and Human Factors (CIEHF) as qualifying courses and as short (training) courses. A framework is used as professional competencies (5 units) with expected levels of proficiency to support career development through membership grades (student, graduate, registered, fellow). An example of education is given with the 5 postgraduate programmes (MSc, Postgraduate Diploma, Postgraduate Certificate) at Loughborough University: Ergonomics and Human Factors, Human Factors in Transport. Human Factors for Inclusive Design, Ergonomics in Health and Community Care, and Human Factors and Ergonomics for Patient Safety. Finally, an opportunity is offered to explore competency with an affiliate discipline (Unser Experience) in the context of usability testing for medical devices

Using patient handling equipment to manage mobility in and around a bed.

Using patient handling equipment to manage mobility in and around a bed

Reducing inpatient falls: Human factors & ergonomics offers a novel solution by designing safety from the patients’ perspective

Patients feel safe in the hospital and perceive they are less likely to fall whereas the opposite can be true if weakness, confusion and/or altered elimination issues are experienced as a result of symptoms, medication and/or procedures. A previous editorial from Grealish and Chaboyer (2015) outlined the scale and scope of this problem with an excellent argument for improving nursing care by valuing essential needs including ambulation, hydration, nutrition and elimination. However, despite many interventions (and models of nursing care) to improve assessment, monitoring and communication (Hignett, 2010), there has been little evidence of sustained reductions in either the number of falls or severity of injuries over the last 60 years (Oliver et al., 2007)