Micro- and macroergonomic changes in mental workload and medication safety following the implementation of new health IT

Health information technology (IT) is a promising way to achieve safer medication management in the delivery of healthcare. However, human factors/ergonomics dictates that in order to make the complex, cognitive work of healthcare delivery safer, health IT must properly support human cognition. This means, for example, that new health IT must reduce, not increase, workload during safety-critical tasks. The present study was the first to quantitatively assess the short- and long-term impact of bar coded medication administration (BCMA) IT on nurses' mental workload as well as on perceived medication safety. One-hundred seventy registered nurses across 3 dissimilar clinical units at an academic, freestanding pediatric hospital in the Midwest US participated in surveys administered before, 3 months after, and 12 months after the hospital implemented BCMA. Nurses rated their external mental workload (interruptions, divided attention, being rushed) and internal mental workload (concentration, mental effort) during medication administration tasks as well as the likelihood of each of three medication safety events: medication administration errors, medication errors on the clinical unit, and clinical unit-level adverse drug events. Clinical unit differences were assessed. Findings generally confirmed the hypothesis that external but not internal mental workload was associated with the perceived likelihood of a medication safety event. Comparisons of mental workload from pre- to post-BCMA revealed statistically significant changes in the critical care unit only. Medication safety appeared to improve over the long term in the hematology/oncology unit only. In the critical care and medical/surgical units, medication safety exhibited short-term improvements that were eliminated over time. Changes in mental workload and medication safety, two classically microergonomic constructs, were deeply embedded in macroergonomic phenomena. These included the fit between the BCMA system and the nature of nursing work, the process of BCMA implementation, and BCMA interactions with concurrent changes occurring in the hospital. Findings raise questions about achieving sustainable performance improvement with health IT as well as the balance between micro- and macroergonomic approaches to studying technology change.Relevance to industryDesigners must consider how technology changes cognitive work, including mental workload. Hospitals and other implementers of technology must ensure that new technology fits its users, their tasks, and the context of use, which may entail tailoring implementation, for example, to specific clinical units. Evaluators must look over time to assess both changes in cognitive work and implementation issues. Healthcare practitioners must also recognize that new technology means a complex transformation to an already complex sociotechnical system, which calls for a macroergonomic approach to design and analysis.     

基于循证设计理念的医院急诊医学科服务效率研究——以北京朝阳医院为例

循证设计是西方医疗建筑中逐渐兴起的、以实证研究为基础的设计理论和方法,基于循证设计的指导思想将很有可能成为未来医院设计的主体。本文运用循证设计的基本原理和方法,对北京朝阳医院急诊科调研结果进行分析,总结其设计优点与不足,提出影响医院急诊科使用效率的几个方面的内容,期望为医院急诊科设计者提供一些参考。     

建成环境对老年人健康的影响:认识基础与方法探讨

良好的环境有益于居民的身心健康,对于长时间逗留在居住环境里的老年人而言意义尤其重大。针对衰老带来的一系列健康问题,规划设计应关注建成环境对老年人个体活动机能的支持与补偿,发掘环境要素在促进健康行为、发挥康复作用等方面的潜力。由于建成环境和人群健康分属于两个影响因素众多的开放系统,现阶段,作为新兴研究领域的相关探索在认识基础和研究方法等方面尚存在一系列亟待解决的问题。为此,本文提出以环境压力模型和积极生活生态模型作为理论基础,以循证策略作为研究方法,以中介效应作为分析手段开展研究工作,旨在为健康视野下老年宜居环境的探索提供理论基础和研究框架。     

A simulation-based embedded probe technique for human-computer interaction evaluation

There is growing interest in developing video-based methods to evaluate the usefulness and usability of computerised tools in healthcare. In this paper, we propose a human-computer interaction evaluation method that protects the confidentiality of patient information and reduces litigation risks for participants by embedding and analysing performance on probes in complex scenarios with high face validity in a simulated setting. We describe the application of the method to a series of three studies of bar code medication administration (BCMA) software, used to reduce medication errors in the Veterans Administration.     

BCLA CLEAR - Evidence-based contact lens practice

Evidence-based contact lens practice involves finding, appraising and applying research findings as the basis for patient management decisions. These decisions should be informed by the strength of the research study designs that address the question, as well as by the experience of the practitioner and the preferences and environment of the patient. This reports reviews and summarises the published research evidence that is available to inform soft and rigid contact lens history and symptoms taking, anterior eye health examination (including the optimised use of ophthalmic dyes, grading scales, imaging techniques and lid eversion), considerations for contact lens selection (including the ocular surface measurements required to select the most appropriate lens parameter, lens modality and material selection), evaluation of lens fit, prescribing (teaching self-application and removal, adaptation, care regimen and cleaning instructions, as well as minimising risks of lens wear through encouraging compliance) and an aftercare routine.     

Research synthesis in software engineering: A tertiary study

Context

Comparing and contrasting evidence from multiple studies is necessary to build knowledge and reach conclusions about the empirical support for a phenomenon. Therefore, research synthesis is at the center of the scientific enterprise in the software engineering discipline.

Objective

The objective of this article is to contribute to a better understanding of the challenges in synthesizing software engineering research and their implications for the progress of research and practice.

Method

A tertiary study of journal articles and full proceedings papers from the inception of evidence-based software engineering was performed to assess the types and methods of research synthesis in systematic reviews in software engineering.

Results

As many as half of the 49 reviews included in the study did not contain any synthesis. Of the studies that did contain synthesis, two thirds performed a narrative or a thematic synthesis. Only a few studies adequately demonstrated a robust, academic approach to research synthesis.

Conclusion

We concluded that, despite the focus on systematic reviews, there is limited attention paid to research synthesis in software engineering. This trend needs to change and a repertoire of synthesis methods needs to be an integral part of systematic reviews to increase their significance and utility for research and practice.     

美国联邦政府自然资源时空数据治理的顶层设计与启示 增刊

美国自20世纪90年代开展数字政府建设以来针对政府信息化和循证决策管理发布了大量法律法规、官方文件，形成了非常健全的政府数据治理顶层设计。在总体要求下，美国联邦政府、内政部、商务部等也针对自然资源相关时空数据治理提出了政府管理架构改革、设立数据治理委员会、开展数据管理评估等改革行动。为此，重点梳理了自然资源领域时空数据治理的顶层设计和循证决策框架下开展数据治理的实践推进情况，并分析了美国经验对我国未来开展自然资源时空信息数据治理的启示。     

Applying hierarchical task analysis to medication administration errors

Medication use in hospitals is a complex process and is dependent on the successful interaction of health professionals functioning within different disciplines. Errors can occur at any one of the five main stages of prescribing, documenting, dispensing or preparation, administering and monitoring. The responsibility for the error is often placed on the nurse, as she or he is the last person in the drug administration chain whilst more pressing underlying causal factors remain unresolved. This paper demonstrates how hierarchical task analysis can be used to model drug administration and then uses the systematic human error reduction and prediction approach to predict which errors are likely to occur. The paper also puts forward design solutions to mitigate these errors.