Designs to reduce common medical errors

By Smitha Mundasad
BBC News


Surgeons and designers have worked together to build a new type of hospital bed space that they hope will reduce common medical errors.

"Amazingly enough, one in 10 patients who go into hospital in the UK suffer some kind of unintended harm," says Prof Myerson, principal investigator.

Visitors at the Royal College of Surgeons can see equipment designed to make surgical wards safer.

The Designing Out Medical Error (DOME) exhibition runs until 4 February 2011.

Clinicians, engineers, designers, psychologists, and business experts worked on the three-year-long project, taking advice from the construction, mining and shipping industries too.

The first step was to spend several hundred hours observing everyday process in three hospitals.

"The majority of errors happen on surgical wards. In spite of being highly frequent, it is an area that is missed in research," says George Hanna, professor of surgical sciences and DOME lead clinician.

Surveying staff and patients they identified five areas where errors were most likely to be made.

Preventing infections from spreading between patients, cleaning hands properly, giving out medication, handing-over information between staff on different shifts and the monitoring of vital signs were key areas of concern.

'You don't have to run'

The team put together five different interventions to reduce the chance of mistakes occurring during these everyday processes, and tested them in clinical environments.

The CareCentre, an all-in-one unit to be placed at the end of the bed, is designed to reduce how much time nurses spend walking around wards to collect all the equipment they need, says Jonathan West, Helen Hamlyn Centre for Design, Royal College of Art.

The unit has space for drugs that are traditionally kept in a separate locker by the patient's bedside, a flat surface to allow nurses to chart their observations and a dedicated area to store gloves and aprons to help prevent the spread of infection.

"If I am performing a procedure on a patient and I get my gloves and apron dirty I would have to leave the patient halfway through to dispose of them and get a new set whereas with the CareCentre I can easily use the bin, which functions without the need for touch," said Oliver Anderson, a clinical research fellow, who worked on the project.

"Everything is there so you don't have to run, wasting time, so I really, really liked it," said Anna Mccaffrey, deputy ward sister.

A new vital signs trolley used to measure blood pressure, pulse, rate of breathing and temperature, stands next to the bed. The Velcro normally present on the blood pressure cuff has replaced by magnets in an attempt to reduce the chance of bugs taking root.

The touch screen computer replaces paper charts, storing the vital signs of all patients on the ward.

At a touch of a button. a nurse can review all the observations over the last few hours. This allows trends to be spotted quickly.

The system includes an early warning system, alerting nurses to the observations of patients who may be seriously unwell.

'Complicated business'

The researchers met people in the mining, chemical, shipping and construction industries to find out how they handled risky processes.

"We noticed on construction sites there are very clear signs encouraging workers to use personal protective equipment, so we used that clear graphic style and applied it to the bed space," said Mr West.

Their new sign for hand-hygiene is printed on a mirror so that movement near the bedside prompts people to look up and see the sign.

Some of their new designs are undergoing clinical trials at Imperial College and others, such as the all-in-one bedside unit, are now in production.

"Safety is a very complicated business. It requires thinking about the clinical environment, how people behave, about the equipment and the technology.

"The DOME project is about the contribution of design and designers can make to improving the safety of health care," says Prof Charles Vincent, DOME lead psychologist.

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