patient safety - Human factors

Question 1

Rasmussen classified human performance into what 3 levels?

in oder of increasing levels of familiarity with the task …

Answer 1

1. knowledge -based - novel situations in which actions must be planned, using conscious analytic processes and stored knowledge
2. rule-based: familiar problems are addressed by application of stored rules
3. skill based: stored patterns of pre-programmed instruction

*with increasing expertise, performance moves from knowledge-based toward skill-based

Question 2

what are the types of errors based on Rasmussen’s 3 levels of performance

• knowledge-based mistakes: actions which are intended but do not achieve the intended outcome due to knowledge deficits
• Rule-based mistakes: actions that matach intentions but do not achieve thier intended outcome due to incorrect application of a rule or inadequacy of th eplan
• Skill-based errors: slips and lapses- when the action made is not what was intended

Question 3

what percent of doctors feel the workload is too heavy?

Answer 3

> 60%

Question 4

what are the predictors of conflicts in the ICU?

Answer 4

• >40 hrs week worked
• > 15 ICU beds
• caring for dying patients within last week
• symptom control not ensured jointly by physicians and nurses
• no routine unit-level meetings

Question 5

does rudeness impact on the performance of medical teams?

Answer 5

• diagnostic and procedural performance scores were lower for members of teams exposed to rudenss than to members of control teams

Question 6

describe the SHEL model of human factors

Answer 6

Software - procedures/protocol/training

Hardware - machines, medical instruments

Environment - operating theater - wards, etc

Liveware - human factors like doctors, nurses, and other health professionals

Question 7

what are some lessons from other industries that we can use in the healthcare industry?

Answer 7

• respect human limits and design jobs for safety
• avoid reliance on memory
• use constraints, forcing function, and natural mappings
• simplify and standardise whenever possible
• promote effective team functioning
• encourage reporting of errors and near-misses
• improve information access
• include the patient in the design of safe processes
• anticipate the unplanned
• plan for failure and design for recovery

Question 9

Describe how stress within healthcare professional teams affects patient safety

Answer 9

60% of doctors feel workload is too heavy

half have had workload increases in the past year

• leads to burnout and substance abuse, relationship difficulties, depression, suicide
• when working greater than 24 hour shifts =

increased risk of burnout, needle stick injuries, road traffic accidents or near misses, attention lapses, and serious medical errors