Impact of automated dispensing cabinets on dispensing errors, interruptions and pillbox preparation time

AIM

This work aimed to evaluate the impact of automated dispensing cabinets on the dispensing error rate, the number of interruptions, and pillbox preparation times.

METHODS

A prospective observational study was conducted across 16 wards in two departments (internal medicine and surgery) of a large teaching hospital. The study compared eight wards using automated dispensing cabinets (ADCs) and eight using a traditional ward stock (TWS) method. A disguised observation technique was used to compare occurrences of dispensing errors and interruptions and pillbox preparation times. The proportion of errors was calculated by dividing the number of doses with one or more errors by the total number of opportunities for error. Wards participating in the 'More time for patients' project-a Lean Management approach-were compared with those not participating. The potential severity of intercepted errors was assessed.

RESULTS

Our observations recorded 2924 opportunities for error in the preparation of 570 pillboxes by 132 nurses. We measured a significantly lower overall error rate (1.0% vs 5.0%, p=0.0001), significantly fewer interruptions per hour (3.2 vs 5.7, p=0.008), and a significantly faster mean preparation time per drug (32 s vs 40 s, p=0.0017) among ADC wards than among TWS wards, respectively. We observed a significantly lower overall error rate (1.4% vs 4.4%, p=0.0268) and a non-significantly lower number of interruptions per hour (3.8 vs 5.1, p=0.0802) among wards participating in the 'More time for patients' project.

CONCLUSIONS

A high dispensing-error rate was observed among wards using TWS methods. Wards using ADCs connected to computerised physician order entry and installed in a dedicated room had fewer dispensing errors and interruptions and their nurses prepared pillboxes faster. Wards participating in a Lean Management project had lower error rates than wards not using this approach.

Using risk analysis to ensure patients' medication safety during hospital relocations and evacuations

OBJECTIVES

To ensure patient safety and the preparedness of medication processes during hospital relocations and evacuations by using Failure Modes, Effects, and Criticality Analysis (FMECA).

METHODS

The relocation of six regional hospitals to a single building, resulting in 400 beds being moved, could be compared with an emergency evacuation. An FMECA was performed on the hospital group's internal medicine and intensive care units (IMU and ICU), examining how medication processes would be affected by a hospital relocation or evacuation.

RESULTS

We identified 59 hospital relocation and 68 evacuation failure modes. Failure modes were ranked based on their criticality index (CI; range 1-810). The higher the CI, the greater the patient-related risk. Average initial IMU and ICU hospital relocation CI scores were 160 (range 105-294) and 201 (range 125-343), respectively, subsequently reduced to 32 (-80%) and 49 (-76%) after mitigation measures. Average initial IMU and ICU evacuation CI scores were 319 (range 245-504) and 592 (range 441-810), respectively, subsequently reduced to 194 (-39%) and 282 (-52%). Most mitigation measures (17/22), such as for example checklists, could be implemented in both situations. Due to their unpredictable nature, five measures were specific to evacuation situations.

CONCLUSIONS

This study highlights the value of using an FMECA on medication processes to anticipate potential negative impacts on patient safety during hospital relocations or evacuations. Preparation for a hospital relocation can provide useful knowledge and an opportunity to test mitigation measures that might prove useful in evacuations.

Assessment of Noise Exposure and Its Characteristics in the Intensive Care Unit of a Tertiary Hospital

Noise generated in the intensive care unit (ICU) adversely affects both critically ill patients and medical staff. Recently, several attempts have been made to reduce ICU noise levels, but reliable and effective solutions remain elusive. This study aimed to provide evidence on noise distributions in the ICU to protect patient health. For one week, we measured noise levels in isolated rooms, open units, and nursing stations in medical, surgical, and pediatric ICUs, respectively. We additionally analyzed the noise generated by medical equipment that is frequently used in ICUs. The median (interquartile range) noise exposure level (dBA) of all ICU units was 54.4 dB (51.1–57.5) over 24 h. The highest noise exposure was noted in the surgical ICU’s daytime open unit at 57.6 dB (55.0–61.1). Various ICU medical devices continuously generated low-frequency noise. Mechanical noise levels ranged from a minimum of 41 dB to a maximum of 91 dB. It was also confirmed that patient-monitoring devices generated loud, high-frequency noise at 85 dB. ICU noise levels were much higher than expected. Noise reduction that focuses on behavior modification of medical staff has limited potential; instead, structural improvements should be considered to reduce the transmission of noise.

Where is the patient's chair? Differences in general practitioner consultation room layouts - an exploratory questionnaire

Background: Consultation room design varies from country to country. The layout of a general practitioner’s (GP’s) consulting room may influence the physician’s or patient’s experience. The aim of this study is to explore and investigate the layout of GP’s consulting rooms around the world and to describe any significant differences.

Methods: Between 3rd July and 2nd August 2018, an internet-based questionnaire on Google Docs was distributed by email, social media and WhatsApp platforms to several worldwide rural medicine groups.  Analysis of an internet-based questionnaire to explore possible layouts of consultation rooms within practices was performed. The questionnaire was designed with three distinct sections: first, a GP demographic profile including gender, year of graduation from medical school, country of graduation, and type of practice (private or public); second, questions relating to the office layout; third, a section for questionnaire feedback.  

Results: 502 responses to the questionnaire were received; 65.3% women and 34.7% men.  The most common layout in Europe and America was where the physician and the patient were separated by a desk. The layout where the physician and the patient had a 90º angle facing each other was the most commonly used layout in Asia-Pacific and Africa. For GPs who graduated before 1990 and between 1990-2010, the layout where the table was between the patient and physician was preferred. However, physicians graduating after 2010 preferred a layout with the physician and the patient with a 90º angle facing each other.

Conclusion: The position of the GP’s desk differs between and within countries as well as the gender of the physician and year of graduation. Next steps should focus on gathering an even greater breadth of GP input, as well as comparing and contrasting those to the preferences of our patients and communities.

Legibility of floor plans and wayfinding satisfaction of residents in Care and Attention homes in Hong Kong

OBJECTIVE

Focusing on Hong Kong Care and Attention homes which provide residential care, meals, personal care and limited nursing care for older people, this study aimed to understand the impact of floor plans' legibility (layout and complexity) on residents' wayfinding satisfaction and self-reported health status.

METHODS

A questionnaire survey was conducted in nine Care and Attention homes. Space syntax, a well-established method, was used to evaluate the legibility of their floor plans via calculating the integration value.

RESULTS

Familiarity with Care and Attention homes did not influence the residents' satisfaction with wayfinding. The integration value had a significant impact on residents' satisfaction with wayfinding. No relationship was observed between integration value and self-reported health status.

CONCLUSION

Increasing complexity in floor plans appears to negatively affect residents' wayfinding satisfaction. These data suggest that circulation patterns should be improved for better wayfinding.

A Multicomponent Intervention to Encourage Stair Use in Municipal Buildings

PURPOSE

Evaluate the incremental impact of environmental stairwell enhancements on stair usage in addition to prompts.

DESIGN

Phased, nonrandomized, quasi-experimental intervention.

SETTING

Two 6-story and one 8-story municipal government office buildings-each with 2 stairwells.

PARTICIPANTS

Approximately 2800 municipal employees and 1000 daily visitors.

INTERVENTION

All stairwells received door wraps and point-of-decision and wayfinding prompts. Environmental enhancements were installed in 1 stairwell in each of the 2 buildings: wall paint, upgraded stair treads and handrails, artwork, light-emitting diode (LED) lighting, fire-rated glass doors, and removal of security locks on at least the ground floor.

MEASURES

Staff surveys and focus groups, electronic and direct measures of stair and elevator use occurred at baseline and over 3 years of phased implementation and follow-up.

ANALYSIS

Change in the proportion of vertical movement by stairs using χ² analysis.

RESULTS

The prompts were associated with a significant increase in stair use (odds ratio [OR] = 1.36; 95% confidence interval [CI]: 1.31-1.41), with an average absolute increase of 3.2%. Environmental enhancements were associated with an additional significant increase in stair use (OR = 1.31; 95% CI: 1.25-1.37) beyond prompts alone with an average absolute increase of a further 3.5% that was sustained for 1 year. The initial increases in stair use with prompts alone were not sustained.

CONCLUSION

Implementing environmental stairwell enhancements in office buildings increased stair usage in a sustained manner beyond that achieved by prompts alone.

The effectiveness of environment assessment tools to guide refurbishment of Australian residential aged care facilities: A systematic review

OBJECTIVE

To determine applicability of environment assessment tools in guiding minor refurbishments of Australian residential aged care facilities.

METHOD

Studies conducted in residential aged care settings using assessment tools which address the physical environment were eligible for inclusion in a systematic review. Given these studies are limited, tools which have not yet been utilised in research settings were also included. Tools were analysed using a critical appraisal screen.

RESULTS

Forty-three publications met the inclusion criteria. Ten environment assessment tools were identified, of which four addressed all seven minor refurbishment domains of lighting, colour and contrast, sound, flooring, furniture, signage and way finding. Only one had undergone reliability and validity testing.

CONCLUSION

There are four tools which may be suitable to use for minor refurbishment of Australian residential aged care facilities. Data on their reliability, validity and quality are limited.

Development of an Easy-to-Use Tool for the Assessment of Emergency Department Physical Design

Physical design of the emergency department (ED) has an important effect on its role and function. To date, no guidelines have been introduced to set the standards for the construction of EDs in Iran. In this study, we aim to devise an easy-to-use tool based on the available literature and expert opinion for the quick and effective assessment of EDs in regards to their physical design. For this purpose, based on current literature on emergency design, a comprehensive checklist was developed. Then, this checklist was analyzed by a panel consisting of heads of three major EDs and contradicting items were decided. 178 crude items were derived from available literature. The Items were categorized in to three major domains of Physical space, Equipment, and Accessibility. The final checklist approved by the panel consisted of 163 items categorized into six domains. Each item was phrased as a "Yes or No" question for ease of analysis, meaning that the criterion is either met or not.