Kraig L. Schell

Using enhanced text to facilitate recognition of drug names: Evidence from two experimental studies

Two studies examined the effects of enhanced text on immediate recognition of drug names. Study 1 sampled 102 college students using a between-subjects design, while Study 2 sampled 11 practicing pharmacists and technicians using a within-subjects Latin square design. Both studies utilized a computer-based sequential recognition task where a prime word was shown with various text enhancements, followed by a mask and then a target word. Participants decided whether the target word was the same as the prime word. Stimuli were organized so that 120 trials were matches and 120 trials were mismatches, randomly sequenced for each participant. Results showed an effect of orthographic similarity, where high-similarity name mismatches were missed more often. This effect was independent of the type of text enhancement used and response bias. Case-based enhancements also increased errors of commission (false alarms) significantly. Discussion includes the practical relevance of the data and future directions for research.

IMPROVING ACCURACY IN SIMULATED PHARMACY ASSEMBLY TASKS USING WORKSPACE INTERVENTIONS TO ENHANCE THE COGNITIVE ENVIRONMENT

In this study, the error-reducing effectiveness of two work-environment interventions was examined in a simulated pharmacy task. 110 participants worked for 3 to 4 hours filling approximately 110 orders for simulated drugs in a laboratory-based, controlled environment. One group of participants used a monitor-mounted copy strip to enhance data entry, and another group used the copy strips as well as labeled product sleeves on stock bottles to enhance product selection. Results indicated that participants who worked using copy strips as well as participants who worked using both copy strips and product sleeves were more accurate in their order-filling performance than participants in the control condition. However, participants in the copy strip and the copy strip/sleeve conditions did not differ from one another in accuracy. Further research ideas and potential explanations of these data are discussed.

Quality Control Pharmacy Tasks: Big Five Personality Model and Accuracy of Error Detection

The relationships between extraversion, conscientiousness, neuroticism, and performance were examined in the context of an error detection task completed under stable and shifting workload conditions. 114 participants checked two sets of 40 fictitious prescriptions for errors. Errors were inserted at rates varying from 26% to 38%. Workload was manipulated by altering the amount of time allowed to complete each set. The stable workload group had 45 min. per set, the workload upshift group had 60 min. for the first set and 30 min. for the second set. Performance was measured using hit rates and false alarms. Analysis indicated that extraversion and conscientiousness were correlated with hit rates, but only in the stable workload condition. Results are discussed and research directions are considered.

Signal probability effects on error detection performance in a quality control task.

This study was designed to examine the influence of signal probability on detection accuracy in a quality control task patterned after the checking of prescriptions in a pharmacy. Signal probability was defined as the ratio of erroneous scripts to correct scripts. 91 participants were either exposed to signal probabilities ranging from 26 to 30% (“low probability”) or 34 to 38% (“high probability”) while checking two sets of 40 simulated scripts for accuracy. Wrong item, wrong number, and wrong label information errors were possible, and performance was measured in terms of sensitivity (percentage of errors detected) and specificity (percentage of correct orders accepted) Analysis indicated that sensitivity was significantly worse for participants in the high signal probability condition, but specificity was not significantly different between signal probability conditions. Connections to existing theory and future directions for research are discussed.

Extending effects of salience and payoffs on stimulus discrimination: an experimental simulation of prescription checking.

This study applied specific aspects of signal detection theory (target salience and decision payoffs) to examine the associations among measured attention and accuracy on a stimulus discrimination task patterned after prescription checking. 85 participants completed the d2 Test of Attention and were assigned to either a control condition with general task instructions or a payoff condition with points accumulated or lost based on ultimate performance. Participants checked simulated product order forms for clerical errors for 40 min. The stimulus set included errors that varied with respect to their ease of detection or salience. Analysis indicated that measured attention was related to performance accuracy and speed as expected. Also decision payoffs significantly increased accuracy on the discrimination task regardless of target salience and discrimination accuracy decreased as the salience of the stimulus mismatches decreased. Implications for real-world applications of signal detection theory to tasks such as prescription checking are explored.

Self-Regulation, Engagement, Motivation, and Performance in a Simulated Quality Control Task

This study examined how self-regulation and task-related motivation were related to the accuracy of error detection and task engagement in a simulated quality control task that mimicked prescription-checking behavior in a pharmacy. Ninety-one participants completed measures of self-regulation, task engagement, and task-related motivation and then checked 80 simulated scripts with inserted error ratios ranging from 26% to 38%. Motivation and task engagement were assessed at the beginning of the task, the midpoint of the task, and after the task was over. Performance was measured in terms of sensitivity (error detections) and specificity (false alarm responses). Results indicated that motivation was correlated with higher sensitivity, while self-regulation was correlated with lower specificity. Higher mid-task motivation and higher self-regulation were also predictive of greater task engagement at the midpoint of the task only. Results are discussed and future research directions are proposed.

Reducing Medical Error and Improving Patient Safety: A Methodology for Studying Pharmaceutical Error in Teams

It has been noted that as many as 98,000 Americans die in hospitals each year as a consequence of medical error. In comparison to even the lowest estimated figures of medical error occurrence, it is believed that the number of deaths due to preventable events is still greater than deaths due to motor vehicle accidents, breast cancer, or AIDS. Of those errors committed, one type that occurs all too frequently, are those related to the dispensation of medications. Consequently, efforts are currently underway to develop methods for the study of this class of medical error. The current paper describes one such methodology and its use thus far for the study of individual performance, as well as recommending a research agenda that would be useful for investigating pharmaceutical error in the context of a team task performance situation.