130225L - WHAT IS HUMAN FACTORS AND WHY IS IT IMPORTANT TO PATIENT SAFETY?

Presented to 1^st Year Postgraduate Medical Students at the Faculty of Medicine King Fahad Medical City, Riyadh on February 25, 2013 by Professor Omar Hasan Kasule Sr.

Key words: Human factors, ergonomics, systems, human performance.

LEARNING OBJECTIVES

·         Overall: Understand human factors and its relationship to patient safety.

·         Knowledge and performance What a student needs to know(knowledge requirements): (a) explain the meaning of the term“human factors”; (b) explain the relationship between human factors and patient safety.

·         What a student needs to do (performance requirement):• apply human factors thinking to your work environment.

DEFINITION

·         Human factors examines the relationship between human beings and the systems with which they interact

·         It focuses on improving efficiency, creativity, productivity and job satisfaction, with the goal of minimizing errors.

·         A failure to apply human factors principles is a key aspect of most adverse events in health care.all health-care workers need to have a basic understanding of human factors principles.

THE MEANING OF THE TERMS “HUMAN FACTORS” AND “ERGONOMICS”

·         The terms human factors and ergonomics (as it is sometimes called) are used to describe interactions between three interrelated aspects: individuals at work, the task at hand and the workplace itself.

·         We define human factors as: the study of all the factors that make it easier to do the work in the right way.

·         Another definition of human factors is the study of the interrelationship between humans, the tools and equipment they use in the workplace, and the environment in which they work.

HUMAN FACTORS IN HEALTH CARE 1

·         In health care, human factors knowledge can help design processes that make it easier for doctors and nurses to do the job right.

·         Human factors applications are highly relevant to patient safety because embedded in the discipline of human factors engineering are the basic sciences of safety.

·         Human factors can show us how to make sure we use safe prescribing practices, communicate well in teams and hand over information to other health-care professionals. These tasks, once thought to be basic, have become quite complicated as a result of the increasing complexity of health-care services and systems.

·         Much of health care is dependent on the humans—the doctors and nurses—providing the care.

·         Human factors experts believe that mistakes can be reduced by focusing on the health-care providers and studying how they interact with and are part of the environment.

HUMAN FACTORS EXPERTISE IN HEALTH CARE 2

·         Human factors experts use evidence-based guidelines and principles to design ways to make it easier to safely and efficiently do things such as: (i) order medications; (ii) hand off (hand over) information; (iii) move patients; and (iv) chart medications and other orders electronically.

·         If these tasks were made easier for the health-care practitioner, then they would be able to provide safer health care.

·         These tasks require design solutions that include software (computer order entry systems), hardware (IV pumps), tools (scalpels, syringes, patient beds) and the physical layout, including lighting of work environments.

·         The technological revolution in health care has increased the relevance of human factors in errors because the potential for harm is great when technology is mishandled.

HUMAN FACTORS ENGINEERING

·         Human factors incorporates the human–machine interactions (including equipment design)

·         Human factors include human–human interactions such as communication, teamwork and organizational culture.

·         Human factors engineering seeks to identify and promote the best fit between people and the world within which they live and work

·         The workplace needs to be designed and organized to minimize the likelihood of errors occurring and the impact of errors when they do occur.

·         While we cannot eliminate human fallibility, we can act to moderate and limit the risks.human factors is about understanding human limitations and designing the workplace and the equipment we use to allow for variability in humans and human performance.

·         Knowing how fatigue, stress, poor communication and inadequate knowledge and skill affect health professionals is important because it helps us understand predisposing characteristics that may be associated with adverse events and errors.

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HUMAN FACTORS AND MEDICAL ERRORS

·         Errors can occur during reception, processing, and interpretation of information

·         Humans inferior to machines: unpredictable, unreliable, limited memory, lower speed of information processing, distractible,

·         Humans superior to machines:  creative, self-aware, imaginative and flexible in their thinking

·         Humans can misperceive situations leading to errors

·         Human factors that predispose to errors:  illness, medication, stress,alcohol, fatigue, emotion

THINGS TO DO TO AVOID ERRORS

·         Do not rely on memory, write it down read instructions before action

·         Make things visible

·         Review and simplify processes

·         Standardize common processes and procedures

·         Routinely use checklists

·         Decrease reliance on vigilance: do not assume you will realize the error

SUMMARY: WHAT IS NEEDED

·         Understanding the interaction and interrelationships between humans and the tools and machines they use.

·         Understanding the inevitability of error and the range of human capabilities and responses in any

·         given situation is essential to knowing how application of human factors engineering principles

·         Can improve health care.

SMALL GROUP EXERCISES

Working in groups of 5-6 students develop checklists for avoiding errors in the following procedures

1.      Taking blood, cross matching, and transfusing

2.      Preparing an intravenous infusion with three drugs in powder form and administering the drug

3.      A skin operation involving removing a leg vein and using it to graft a diseased coronary artery

4.      Cannulation of the femoral artery

CASE STUDY No 1: Sandra, a 28-year-old woman, goes to see her obstetrician complaining of a three-day history of foul-smelling vaginal discharge. Sandra gave birth to a baby boy 10 days earlier. She required anesthesiology during the delivery process. The obstetrician suspects a urine infection and prescribes a five-day course of antibiotics.

·         Sandra returns to see the obstetrician a week later with the same symptoms. She has completed the course of antibiotics. Vaginal examination reveals tenderness at the episiotomy site and some swelling. The obstetrician goes through Sandra’s case notes in detail, looking particularly at the notes relating to the delivery and at the swab count. The count has been documented in the case notes, and verified by a second nurse. A further course of antibiotics is prescribed.

·         As the symptoms persist, Sandra decides to seek a second opinion and goes to see a different obstetrician. The second obstetrician admits her for an examination under anesthesia and dilation and curettage (D&C). The obstetrician telephones the first obstetrician of finding a swab left behind during packing of the episiotomy wound and to advise him to inform his professional indemnity insurer.

·         Reference: Case from the WHO Patient Safety Curriculum Guide for Medical Schools expert consensus group. Supplied by Ranjit De Alwis, International Medical University, Kuala Lumpur, Malaysia

CASE STUDY No 2:

·         Suzanne’s medical history included four caesarean sections in a 10-year period. The second and third operations were held at hospital B and the fourth at hospital C.

·         Two months after her fourth caesarean, Suzanne presented to hospital C suffering from severe anal pain. A doctor performed an anal dilation under general anesthesia and retrieved a surgical retractor from the rectum that was 15 cm long by 2 cm wide, with curved ends. It was of a type commonly used by New South Wales hospitals and the engraved initials indicated it came from hospital B. The doctor thought that the retractor had been left inside Suzanne after one of her caesareans and it had worked its way gradually through the peritoneum into the rectum.

·         During her fourth caesarean, the surgeon noted the presence of gross adhesions, or scarring, to the peritoneum; whereas, no scarring had been seen by the doctor who had performed the third caesarean two years earlier.

·         While it is not known for certain what had occurred, the instrument was most likely to have been left inside Suzanne during her third caesarean and remained there for more than two years.