Work - Volume 33, issue 2

Article Type: Other

DOI: 10.3233/WOR-2009-0859

Citation: Work, vol. 33, no. 2, pp. 133-133, 2009

Authors: Dieckmann, P. | Rall, M. | Østergaard, D.

Article Type: Research Article

Abstract: We describe how simulation and incident reporting can be used in combination to make the interaction between people, (medical) technology and organisation safer for patients and users. We provide the background rationale for our conceptual ideas and apply the concepts to the analysis of an actual incident report. Simulation can serve as a laboratory to analyse such cases and to create relevant and effective training scenarios based on such analyses. We will describe a methodological framework …for analysing simulation scenarios in a way that allows discovering and discussing mismatches between conceptual models of the device design and mental models users hold about the device and its use. We further describe how incident reporting systems can be used as one source of data to conduct the necessary needs analyses – both for training and further needs for closer analysis of specific devices or some of their special features or modes during usability analyses. Show more

DOI: 10.3233/WOR-2009-0860

Citation: Work, vol. 33, no. 2, pp. 135-143, 2009

Authors: Koneczny, Sonja

Article Type: Research Article

Abstract: Ergonomics is still not fully implemented in the design of operation rooms (ORs). The OR staff has to deal with various ergonomic deficiencies which may be associated with potential hazards for the patient and/or the OR team. Three surveys were conducted among German OR staff at major conferences. Two of them dealt with the working conditions in the OR and were conducted among surgeons and OR nurses. The third survey queried OR nurses about the electrical safety in the …OR. In addition, a specially developed checklist was used to evaluate the work place OR in five German OR units and the staff of these OR units were queried with questionnaires adapted from the surveys. For this article a few of the deficiencies found in the ORs were chosen to serve as examples for the plethora of results gathered. Findings showed that there was a high potential for ergonomic improvement and therefore an increase in safety and comfort. Many of these deficiencies may be eased by simple means such as the reduction of the number of different devices and mandatory training in the use of the devices since device operation is one of the main causes leading to potential hazards in the OR. Other deficiencies, such as the cable routing in the OR, require more extensive intervention and/or the implementation of new techniques, for example the "wireless" OR. All these deficiencies demonstrate the need for better implementation of ergonomics into the OR and for individual solutions, as there is no such thing as an 'one-size-fits-all' solution for OR units. Show more

Keywords: Operating room, OR, architecture, checklist, survey, hazards, cables, devices

DOI: 10.3233/WOR-2009-0861

Citation: Work, vol. 33, no. 2, pp. 145-164, 2009

Authors: Matern, Ulrich

Article Type: Research Article

Abstract: The importance of minimally invasive surgery (MIS) has constantly increased in the last 20 years. Laparoscopic removal of the gallbladder has become the gold standard with advantages for patients. However, in laparoscopy, the surgeon loses direct contact with the surgical site. Rather than seeing the entire surgical field including adjacent organs, the surgeon's vision is restricted by an optic and camera system. Pictures of the surgical site in the abdomen are presented on a monitor. Hand …eye coordination is decreasing because the operating team is not able to position the monitor at an ergonomically preferable position given that operation tables, constructed for open surgery where surgeons use short instruments, are too high for laparoscopic procedures where surgeons use long-shafted instruments. Additionally the degrees of freedom for camera movements and the instruments are limited, tactile feedback given in open surgery is lost. The typical design of instrument handles leads to pressure areas and nerve lesions. All these aspects force the surgeon into unnatural and uncomfortable body postures that can affect the outcome of the operation. An ideal posture for laparoscopic surgeons is described and ergonomic requirements for an optimal height of operation tables, monitor positions and man-machine interfaces are discussed. Show more

Keywords: Surgery, ergonomics, human factors, posture, instruments

DOI: 10.3233/WOR-2009-0862

Citation: Work, vol. 33, no. 2, pp. 165-168, 2009

Authors: Vredenburgh, Alison G. | Zackowitz, Ilene B.

Article Type: Research Article

Abstract: Adverse drug events (ADE) are defined as any medication error with significant potential to harm a patient [13]. Often times, ADE occur due to inadequate or ineffective systems of labeling. These ADE often result in mistakes in prescription adherence (compliance) with the prescription instructions. These mistakes are costly and can be deadly. Potential problems with drug labeling can occur in both in-patient and out-patient environments. This paper discusses some of the key issues to consider in …drug labeling and its impact on patient safety. Show more

Keywords: Medication, adverse reaction, prescriptions, warnings, adverse drug event (ADE), patient safety

DOI: 10.3233/WOR-2009-0863

Citation: Work, vol. 33, no. 2, pp. 169-174, 2009

Authors: Hignett, Sue | Griffiths, Paula

Article Type: Research Article

Abstract: As part of a larger research project the patient pathway was mapped for an emergency admission to identify the manual handling major risks. Focus group interviews were held with 25 key stakeholders from the acute, community and ambulance healthcare sectors and social services at 3 venues across the United Kingdom (UK). A detailed qualitative iterative analysis used 'cause and effect' or fishbone (Ishikawa) diagrams to identify key issues. Five themes emerged as generic risks throughout the …bariatric patient pathway, these were: patient factors including body shape, mobility, pain, co-operation, privacy, comfort and dignity; building (or vehicle) space and design, including space, clearance, floor surface, and safe working load of floor; equipment (manual handling and clinical) and furniture, including fit, maximum weight capacity, availability, suitability, compatibility, size, and effort to move; communication both within and between organisations; and organisational and staff issues, including policies, culture and staff availability and training. It was concluded that buildings, vehicles and equipment need to be designed to 'fit' a range of bariatric shapes and sizes so that bariatric patients could be accommodated in safety and comfort, and with minimal loss of dignity. Show more

Keywords: Patient pathway, risk management, moving and handling

DOI: 10.3233/WOR-2009-0864

Citation: Work, vol. 33, no. 2, pp. 175-180, 2009

Authors: Hill, III, James J. | Slade, Martin D. | Russi, Mark B.

Article Type: Research Article

Abstract: Objective: Principal components analysis (PCA) was used to explore the relationship between anthropometric measurements, job strain and work organization factors and the prevalence of musculoskeletal symptoms/occupational injuries in medical sonographers. Methods: A cross-sectional survey of twenty-six female sonographers at a tertiary medical center completed a standardized symptom questionnaire and underwent anthropometric measurement. First aid events and OSHA reportable injuries were abstracted from employee health records. Results: 96% of …subjects reported some type of musculoskeletal symptoms within the past year, with shoulders (73%), low back (69%) and wrist/hand symptoms (54%) reported most often. PCA identified seven domains among the predictive variables: physical size, job strain, time on job, abdominal girth, work pace/variability, movement during study, and time spent standing. The magnitude and direction of effect for predicting musculoskeletal symptoms varied by symptom location. Abdominal girth was consistently associated with increased likelihood of reporting symptoms. Conclusion: Sonographers work in a high demand/low control environment. Future studies of sonographers may need to include measures of both physical size and job strain. Reducing risk factors for one anatomical location may increase the risk at another location in this population. Show more

DOI: 10.3233/WOR-2009-0865

Citation: Work, vol. 33, no. 2, pp. 181-189, 2009

Authors: Nilsson, Kerstin | Hertting, Anna | Petterson, Inga-Lill

Article Type: Research Article

Abstract: Background: This study focuses on employees' experience of occupational health in a radiology department within a Swedish university hospital during years of continual reorganisations. This department's stable personal health trends in terms of self-rated mental health and sick-leave rates diverged from the general trends of deteriorating working conditions in the hospital. Aim: The aim was to identify dimensions of working conditions as positive determinants contributing to occupational health in a …department of radiology undergoing continual reorganisations. Method: Open-ended interviews with twelve employees were transcribed and analyzed using content-analysis. Result: The employees experienced their new stimulating working tasks and a supporting organizational climate as important contributors to the healthy work condition. Conclusion: The positive effects of handling new technical challenges and the positive organisational climate, which were characterized by mutual trust, as well as work-confidence and respect for each others' competence, seem to function as buffering factors, balancing the negative effects of parallel downsizing and restructuring processes. Show more

Keywords: Work environment, occupational health, employee, digitalization, work-pride, work-confidence, organisational reorganisation

DOI: 10.3233/WOR-2009-0866

Citation: Work, vol. 33, no. 2, pp. 191-200, 2009

Authors: Or, Calvin K.L. | Valdez, Rupa S. | Casper, Gail R. | Carayon, Pascale | Burke, Laura J. | Brennan, Patricia Flatley | Karsh, Ben-Tzion

Article Type: Research Article

Abstract: Sicker patients with greater care needs are being discharged to their homes to assume responsibility for their own care with fewer nurses available to aid them. This situation brings with it a host of human factors and ergonomic (HFE) concerns, both for the home care nurse and the home dwelling patient, that can affect quality of care and patient safety. Many of these concerns are related to the critical home care tasks of information access, communication, …and patient self-monitoring and self-management. Currently, a variety of health information technologies (HITs) are being promoted as possible solutions to those problems, but those same technologies bring with them a new set of HFE concerns. This paper reviews the HFE considerations for information access, communication, and patients self-monitoring and self-management, discusses how HIT can potentially mitigate current problems, and explains how the design and implementation of HIT itself requires careful HFE attention. Show more

Keywords: Health information technology, home care, human factors, work system

DOI: 10.3233/WOR-2009-0867

Citation: Work, vol. 33, no. 2, pp. 201-209, 2009

Authors: Smith, Thomas J. | Schoenbeck, Kathleen | Clayton, Sandra

Article Type: Research Article

Abstract: This study collected staff responses to an occupancy quality survey before, and 6 and 22 months after, St. Paul Children's Hospitals and Clinics (CHC) replaced an open bay (OB) with a private room (PR) neonatal intensive care unit (NICU) design. Staff interview responses and task activity observations also were collected. The goal was to assess how this change would influence staff perceptions and performance. As a result of the transition from the OB to the PR …environment: (1) rankings of overall physical environment, patient care, job, technology, and off-the-job quality significantly improved; but (2) rankings of patient care team interaction quality significantly declined. Results for the 22-month PR survey indicate essentially no meaningful changes in rankings of occupancy quality from the 6-month survey, suggesting no consolidation of quality gains in the intervening 16-month period. Written comments pertaining to private room NICU design issues by survey respondents, targeting problems with unit operations, may explain this finding. Collectively, the findings suggest that NICU operational management was not effectively modified to deal with the new design, and that an OB to PR NICU transition requires a systems approach to macroergonomic challenges imposed by the new design. Show more

Keywords: Health care environments, macroergonomics, occupancy quality, perceptual response survey, task analysis

DOI: 10.3233/WOR-2009-0868

Citation: Work, vol. 33, no. 2, pp. 211-227, 2009