Download Lighting conditions and medical errors

7
HOSPITAL
PATIENT SAFETY DESIGN
Dr. ADIB A YAHYA, MARS
9 JUNI 2017
STATE – OF – THE - ART
PATIENT SAFETY
despite all the known power of modern
medicine to cure and ameliorate illness,
hospitals were not safe places for healing.
Instead, they were places fraught with risk
of patient harm
4
Historically hospitals were
not the safest places
4
“TO ERR IS HUMAN” CORRIGAN, KOHN AND DONALDSON
US ACADEMY OF SCIENCES / INSTITUTE OF MEDICINE,
2000
• 1984 New York -2.9% of admissions suffered an adverse event, 58% of
which were preventable
• 1992 Colorado and Utah - 3.7% of admissions suffered an adverse event,
53% of which were avoidable
• Over 33.6Mn US hospital admissions pa between 44,000 and
98,000 avoidable deaths occur
8th most frequent cause of death
ahead of AIDS (16,516 deaths pa),
breast cancer (42,297 deaths pa) and
motor car accidents (43,458 deaths pa)
• Total cost to the US economy of avoidable deaths due to
healthcare error $17 - $29 Bn pa
HRRI.Healthcare Risk Resources International
To Err is Human:
Building a Safer Health System
(1999/2000)
IOM Study of Medical Errors
Organisational &
Corporate Culture
Contributary Factors
Influencing
Clinical Practice
Management
Decisions/
Organisational
Processes
Error
Producing
Conditions
Error
Violation
Producing
Conditions
Violation
Latent Failures
(“BLUNT END”)
1.
PATIENT
2.
TASK AND
TECHNOLOGY
3.
INDIVIDUAL
4.
TEAM
5.
WORK
ENVIRONMENT
Planning,
Designing ,
Policy-making,
Communicating
Defence
Barriers
Task
Active Failures
( “sharp end “ )
•Emergency
•Diagnose
•Pemeriksaan
•Pengobatan
•Perawatan
-Procedure
-Professionali
sm
-Team
-Individual
-Environment
-Equipment
Adapted from Reason (revised)
Thought leaders in health care offered persuasive arguments
that errors could be reduced by redesigning systems and
processes using human factors principles.
These could reduce mistakes through design features,
including standardization, simplification, and the use of
constraints (which is a design characteristic that makes error
impossible)
Initially, perhaps, blunt-end factors were typically thought of as
organizational policies and processes that shaped the behavior
of individuals at the sharp end-point of service
PENGERTIAN
Patient safety (WHO/Europe | Patient safety)
The simplest definition of patient safety is the prevention of errors and
adverse effects to patients associated with health care.
Keselamatan Pasien Rumah Sakit – KPRS
• Suatu sistem dimana
RS membuat asuhan pasien lebih aman.
(KKP-RS PERSI 2005)
Key Concepts
Human fallibility / “ to err is human “
Anatomy of error / incident types
System approach
“ Just Culture “ / no blaming culture
Organizational Learning by reporting
10
The role of hospital design
in
patient safety
“We shape our buildings and afterwards our buildings shape us.”
-WINSTON CHURCHILL, MAY 10, 1941
Hospital design refers to the physical environment that
includes :
- the indoor environment (e.g. noise, air quality and
lighting),
- the interior design (e.g. furniture, fixtures and materials)
and
- the configuration (e.g. relative locations and
adjacencies of spaces) of a hospital.
Factors Influencing the Built Environment
With human factors in mind, there are several aspects of the built environment that
should be considered.
The following design elements were identified as critical in ensuring patient safety and
quality care, based on the six quality aims of the Institute of Medicine’s report,
Crossing the Quality Chasm: A New Health System for the 21st Century:
• Patient-centeredness, including
- using variable-acuity rooms and single-bed rooms
- ensuring sufficient space to accommodate family members
- enabling access to health care information
- having clearly marked signs to navigate the hospital
• Safety, including
- applying the design and improving the availability of assistive devices to avert
patient falls
- using ventilation and filtration systems to control and prevent the spread of
infections
- using surfaces that can be easily decontaminated
- facilitating hand washing with the availability of sinks and alcohol hand rubs
- preventing patient and provider injury
- addressing the sensitivities associated with the interdependencies of care, including
work spaces and work processes
• Effectiveness, including
- use of lighting to enable visual performance
- use of natural lighting
- controlling the effects of noise
• Efficiency, including
- standardizing room layout, location of supplies and medical equipment
- minimizing potential safety threats and improving patient satisfaction by
minimizing patient transfers with variable-acuity rooms
• Timeliness, by
- ensuring rapid response to patient needs
- eliminating inefficiencies in the processes of care delivery
- facilitating the clinical work of nurses
• Equity, by
- ensuring the size, layout, and functions of the structure meet the diverse
care needs of patients
According to the model of system accidents
proposed by Reason, research has shown
that Hospital design may :
- directly impact safety in hospitals.
- indirectly impact safety by triggering
adverse events that cause harm to
patients and staff.
- impact safety in hospitals by working as a
barrier to harmful events.
Adverse events in hospitals are related to both active and latent
failures.
- Active failures are unsafe acts (slips, lapses, fumbles, mistakes
and procedural violations) committed by the individuals in direct
contact with the patient.
- latent failures create local conditions that in specific situations may
lead to active failures.
Latent failures may become embedded within systems as a result of
wrong decisions made by designers, builders, procedure writers and
top level management .
Direct impacts on patient safety
Aspects of hospital design such as air quality, lighting, patient room design
and other interior design elements can directly impact safety outcomes
such as nosocomial infections, patient falls and medical errors.
Air quality and nosocomial infections
Single bedrooms and nosocomial infections
Lighting conditions and patient outcomes
Lighting conditions and medical errors
Noise in hospitals and patient outcomes
Hospital design and patient falls
Impact of the environment
on staff working conditions
A poorly designed physical environment creates latent
conditions such as staff stress, fatigue, annoyance, burnout
and lack of handwashing compliance that may potentially
lead to adverse events in hospitals.
Noise in hospitals and staff outcomes
Variable acuity patient rooms and transfers
Unit layout and staff effectiveness
Accessibility to handwashing stations and handwashing
compliance
Environmental barriers/defenses
to healthcare accidents
The environment potentially acts as a defense to adverse events by
providing opportunities for staff and families to prevent accidents
before they occur.
Visibility to patients
Presence of family
Organisational &
Corporate Culture
Management
Decisions/
Organisational
Processes
Contributary Factors
Influencing
Clinical Practice
Defence
Barriers
Task
Error
Producing
Conditions
Error
Violation
Producing
Conditions
Violation
Active Failures
( “sharp end “ )
Latent Failures
(“BLUNT END”)
Impact of the environment
on staff working conditions :
Direct impacts on patient safety :
Noise in hospitals and staff
outcomes
Variable acuity patient rooms and
transfers
Unit layout and staff effectiveness
Accessibility to handwashing
stations and handwashing
compliance
Air quality and nosocomial infections
Single bedrooms and nosocomial
infections
Lighting conditions and patient
outcomes
Lighting conditions and medical errors
Noise in hospitals and patient
outcomes
Hospital design and patient falls
•Emergency
•Diagnose
•Pemeriksaan
•Pengobatan
•Perawatan
Environmental
barriers/defense
- Visibility to patients
- Presence of family
Adapted from Reason (revised)
Direct impacts on patient safety
Air quality and nosocomial infections
Airborne infections are spread when dust and pathogens are released during
hospital construction and are caused by contamination and malfunction of
hospital ventilation systems .
fungal load in the air may be linked to humidity, temperature and construction
activity .
High-efficiency particulate air (HEPA) filters can be highly effective in preventing
airborne infections in hospitals .
Air contamination is least in laminar airflow rooms with HEPA filters, and this
approach is recommended for such areas as operating-room suites and
ultraclean rooms for immunocompromised patients.
Lower rates of surgical site infections in the newer operating rooms with laminar
flow ventilation systems and automatically closing doors
Single bedrooms and nosocomial infections
single-bed patient rooms with high-quality HEPA filters and with
negative or positive pressure ventilation are more effective
in preventing air-borne pathogens.
multibed rooms are more difficult to decontaminate and have more
surfaces that act as a reservoir for pathogens.
On the basis of the study findings, the 2006 American Institute of
Architects Guidelines for Design and Construction of
Healthcare Facilities has adopted the single bed room as the
standard for all new construction in the United States
Single rooms now required in new hospitals in 40+
U.S. states
“In new construction, the maximum number of
beds per room shall be one . .”
2006 Guidelines for Design and Construction of
Health Care Facilities (section 3.1.1.1, p. 40)
Published by:
The Facility Guidelines Institute
American Institute of Architects U.S. Department of Health and
Human Services
Lighting conditions and patient outcomes
different psychological and physiological effects of lighting in hospitals,
some of which may be directly related to patient safety. For example,
‘ICU psychosis’ in adult patients can be partly attributed to bright or
constant lighting conditions in ICUs that lack night/day cues.
A similar phenomenon has been described among children in pediatric
ICUs .
the mortality rate may be higher in dull patient rooms,
poor lighting conditions may negatively impact physiological
developments among infants .
studies suggest that lighting conditions should be considered more
carefully in the design of patient care areas of a hospital.
Lighting conditions and medical errors
Performance on visual tasks gets better as light levels increase .
errors in dispensing medications in a high volume outpatient pharmacy
were significantly lower at an illumination level of 146 foot-candles (2.6%)
as opposed to the baseline level of 45 foot candles (3.8%).
58% of all medication errors among hospital workers occurred during the
first quarter of the year when daylight hours were less.
importance of appropriate lighting levels for complex tasks requiring
excellent vision