U2 PoP And Human Eror Theory Flashcards
What benefits does applying a human factors approach to the workplace have for patients and staff?
- Makes it easier to do the right thing
- improve patient care
What types of dispensing errors can occur?
- Dose/item error - wrong item selected or assembled
- labelling error
- Issue error - order issued to wrong patient or not at all
- documentation error - incorrect documentation of issue
What is meant by ‘unprevented error’?
Exposure of a patient to potential harm, whether or not harm results
E.g. patient receiving incorrect meds from a pharmacy
What is meant by ‘prevented error’?
Situation that could have led to harm had it not been stopped
What are the four most commonly reported errors in community pharmacy?
- wrong dose/strength (30%)
- wrong medicine (28%)
- wrong formulation
- wrong quantity
What are people factors that undermine safe dispensing?
- fatigue
- stress
- unaware of risks
What are task related factors that undermine safe dispensing?
- too many tasks at one time
- vague information
- governed by impractical SOP
What are physical environment factors that undermine safe dispensing?
- cramped or poor layout
- too hot or cold
- loud
What factors related to tools and technology undermine safe dispensing?
- are to access equipment
- unreliable tech
- easy to misinterpret info
What factors regarding organisational structure can undermine safe dispensing?
- unclear responsibilities
- more focus on productivity than accuracy
What five assurances contribute most to safe dispensing?
- Well trained and motivated staff
- Tasks are designed to be carried out easily
- Comfortable and supportive environment
- Tools are easy to access and use
- Organisational structure fosters teamwork and information sharing
