Enda Fallon

Human reliability assessment of a critical nursing task in a radiotherapy treatment process.

Radiotherapy treatment, like many other fields of medicine, has changed significantly in the last decade with the introduction of more advanced technology and automation. This change has often resulted in aspects of the system which cannot be automated due to technological feasibility and local implementation constraints. This has resulted in a requirement for significant human interaction. This combination of human operations and automation has introduced new error pathways. Traditionally, recommendations to improve the safety of such systems are typically made after the analysis of an adverse event or a significant series of incidents. In contrast, adopting a proactive approach to safety would enable prior identification of potential errors and the specification of appropriate defences against them, thus avoiding costs associated with adverse outcomes. In this paper, a modified version of the proactive Human Reliability Assessment (HRA) method Human Error Assessment and Reduction Technique (HEART) was used to analyse a critical nursing task within a modern radiotherapy system. The modified technique used a participative team approach to complete the assessment in contrast to the normal approach, which uses a single expert assessor. The HEART technique quantifies the likelihood of unreliability of a task and ranks the conditions which most affect the successful completion of that task. HEART has been proposed as a potentially useful HRA tool for applications in healthcare, but such applications have not previously been formally documented. As a result of the modified HEART analysis reported in this paper, remedial measures were identified which were both cost effective and easy to implement.

School children's use of computers and teachers' education in computer ergonomics

A national survey to investigate the education of teachers in computer-related ergonomics was carried out by postal questionnaire. The use of computers by primary school children (age 4–12 years) was also investigated. Data were collected from a random sample of 25% (n = 830) of primary schools in the Republic of Ireland. Questionnaires (n = 1863) were returned from 416 schools giving a response rate of 50.1%. Almost all schools (99.7%) had computers for childrens use. The computers were most often (69.8%) used in the classroom. The majority (56.3%) of children worked in pairs. Most teachers (89.6%) had received computer training, but few (17.6%) had received ergonomics information during the training. Respondents were not satisfied with their current knowledge of ergonomics. Over 90% stated that they would like to receive further information by printed format or during a training course, rather than by computer (web or CD-ROM).

Learning from Risk Assessment in Radiotherapy

The lessons learned from completing a risk assessment of a radiotherapy information system in a public hospital are presented. A systems engineering perspective with respect to the risk assessment was adopted. Standard engineering tools modified for application in healthcare environments were applied, e.g. HFMEATM. It was found that there was a complete absence of the application of systems engineering at the development stage of the radiotherapy system, however aspects of quality systems, i.e. process improvement, were present at the operating stage. Team work played a significant role in the successful operation of the system. However, in contrast to most engineering systems, team composition was highly heterogeneous as roles were clearly defined by professional qualification. There were strong boundaries between the radiotherapy team and other teams in the hospital. This was reflected by their lack of concern regarding the availability of patient information beyond their own department.

Risk Assessment in Radiotherapy - Lessons from Systems Engineering

Radiotherapy is a highly structured discipline in health care with well defined processes and patient flows. Errors in radiotherapy have been well documented and are widely publicised. In this paper a systems engineering perspec- tive with respect to the risk assessment of a radiation oncology management system is reported with the aim to study any lessons which could be learned from this approach. The system is the Siemens/IMPAC LANTIS™ system which was intro- duced in Galway University Hospitals in 2005. This system was the first fully electronic radiotherapy management system in Ireland, which allowed the introduction of paper- and film-less radiotherapy. A full risk assessment of the system was con- ducted using standard engineering tools modified for applica- tion in healthcare environments, e.g. HFMEA™. It was found that there was a complete absence of the application of systems engineering at the specification and implementation stage of the radiotherapy system, however aspects of quality systems, i.e. process improvement, were present at the operating stage. Team work played a significant role in the successful operation of the system. However, in contrast to most engineering sys- tems, team composition was highly heterogeneous as roles were clearly defined by professional qualification. There were strong boundaries between the radiotherapy team and other teams in the hospital. This was reflected by their lack of con- cern regarding the availability of patient information beyond their own department.

Functional safety of health information technology.

In an effort to improve patient safety and reduce adverse events, there has been a rapid growth in the utilisation of health information technology (HIT). However, little work has examined the safety of the HIT systems themselves, the methods used in their development or the potential errors they may introduce into existing systems. This article introduces the conventional safety-related systems development standard IEC 61508 to the medical domain. It is proposed that the techniques used in conventional safety-related systems development should be utilised by regulation bodies, healthcare organisations and HIT developers to provide an assurance of safety for HIT systems. In adopting the IEC 61508 methodology for HIT development and integration, inherent problems in the new systems can be identified and corrected during their development. Also, IEC 61508 should be used to develop a healthcare-specific standard to allow stakeholders to provide an assurance of a system’s safety.

Defining User Needs for a New Sepsis Risk Decision Support System in Neonatal ICU Settings Through Ethnography: User Interviews and Participatory Design

The diagnosis of late onset sepsis in neonates is complex and therefore usually late, resulting in increased risks. The Digi-NewB project proposes a novel solution to this problem, by designing a non-invasive Decision Support System (DSS) which will use vital signs, images and sounds to measure the risk of sepsis in the preterm infant and therefore support clinicians in diagnosis. The introduction of any new system to a neonatal intensive care unit (NICU) environment presents a challenge for designers who must account for a technology laden environment and a demanding work-load for clinicians. To define the user needs and therefore build the first use cases for such a system, a multi-method approach was adopted and is described in this paper. This approach consisted of a period of ethnography, eleven semi-structured interviews and the application of a prototyping exercise based on the principles of participatory design.

Prototyping a User Interface for a New Sepsis Risk Decision Support System Using Participatory Design

Digi-NewB is a system currently being developed to monitor and predict the risk of sepsis in infants within a Neonatal Intensive Care Unit (NICU) setting. More than 300,000 preterm infants are hospitalized each year in a European care unit. Sepsis diagnosis is complex and therefore usually late, resulting in an increased risk. In this paper, we present on our experience with applying a participatory design based prototyping method to create user interface (UI) concepts for the Digi-Newb system and then testing the prototypes with end-users. Prototype making within the participatory design framework was found to be an effective method to rapidly develop potential design solutions, utilizing the experience of the end-user as a design partner.

State of the Art and Future Trends in the Usability of Patient Monitors

According to the recent literature, approximately 250,000 deaths occur annually in U.S. hospitals resulting from medical error, making it the 3rd leading cause of death. One of the most commonly used devices in hospitals is the Patient Monitor (PM), a device which constantly monitors the vital signs of the patient. This paper reports on a review of the scientific literature on the usability of PMs in critical care. A detailed analysis of the data reveals that: (i) PMs are undergoing a slow, but continuous process of evolution with new advances focusing on enhancing the interaction between the caregivers and the PM, (ii) the usability of PMs is beginning to receive particular attention as usability is now considered to be strongly associated with patient safety. The data from this study will be used to carry out further investigations into the usability of PMs and to inform the design of future PMs.

Investigation of the Human Factors, Usability and User Experience of Patient Monitors used in a Hospital Setting

According to the recent literature, approximately 250,000 deaths occur annually in U.S. hospitals resulting from medical error, making it the 3rd leading cause of death. One of the most commonly used devices in hospitals is the Patient Monitor (PM), a device which constantly monitors the vital signs of the patient. In this study, nurses and physicians who regularly interact with patient monitors were surveyed on their perceptions of the usability of the PMs they use on a regular basis. Results indicate that clinicians appeared to be mostly satisfied with the general usability of the monitors, particularly in terms of the information being presented and how it is presented. However, participants pointed out problems with the menu navigation during moments of high stress and the high frequency of false alarms. Also, participants expressed the desire to see additional information displayed on screen.

The Analysis of Project Delay Factors Using the Double Roof House of Quality

One of the biggest engineering concerns in the Middle East is the major delays in infrastructural projects which impact on both their quality and cost. A significant number of projects do not finish on time, are subject to cost overruns and are not completed to the specified quality. The Kingdom of Saudi Arabia (KSA) claims losses of the order of