Nurses’ perception of how physical environment affects medication errors in acute care settings

Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada.
Applied nursing research: ANR (Impact Factor: 0.73). 11/2011; 24(4):229-37. DOI: 10.1016/j.apnr.2009.08.005
Source: PubMed


The work that nurses perform in hospital environments is physically and psychologically intense, with the potential for burnout and stress. This issue is compounded by crowded and poorly designed work spaces in nursing units that can contribute to medical mistakes, including medication errors. This article is based on a study that examined the nurses' perception of how the physical environment in hospitals affects medication errors. Literature suggests that reduction of staff stress can be achieved through physical environmental considerations, such as improved air quality, acoustics, and lighting. However, there is no empirical study specifically exploring the relationship between aspects of the physical environment and medication errors. In this study, a cross-sectional survey was conducted with nursing staff (N = 84) in four hospitals in the Pacific Northwest region of the United States. The survey included questions on nursing unit design, medication room configurations, perceived incidence of errors, and adverse events. Respondents noted several physical environmental factors that are potentially problematic in the nursing station area and can lead to medication, documentation, and other types of nursing errors. These factors include inadequate space in charting and documentation area, lengthy walking distances to patient rooms, insufficient patient surveillance opportunity/lack of visibility to all parts of the nursing unit, small size of the medication room, inappropriate organization of medical supplies, high noise levels in nursing unit, poor lighting, and lack of privacy in the nursing stations. As administrators in acute care facilities consider strategies for organizational and staff interventions to reduce medication errors, it is important to consider physical environmental factors to have a comprehensive understanding of the issue.

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    • "Health professionals are concerned about this issue and identified noise as a barrier to work performance (Gurses and Carayon, 2009; Sampaio Neto et al., 2010). In fact, noise may induce extra-auditory effects in professionals, including burnout, stress, and fatigue, which results in errors (Mahmood et al., 2011). "
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    ABSTRACT: Evidence indicates that exposure to high levels of noise adversely affects human health, and these effects are dependent upon various factors. In hospitals, there are many sources of noise, and high levels exert an impact on patients and staff, increasing both recovery time and stress, respectively. The goal of this pilot study was to develop, implement, and evaluate the effectiveness of a training program (TP) on noise reduction in a neonatal intensive care unit (NICU) by comparing the noise levels before and after the implementation of the program. In total, 79 health professionals participated in the study. The measurements of sound pressure levels took into account the layout of the unit and locations of the main sources of noise. General results indicated that LAeq levels before implementation of the training program were often excessive, ranging from 48.7 ± 2.94 dBA to 71.7 ± 4.74 dBA, exceeding international guidelines. Similarly, following implementation of the training program, noise levels remained unchanged (54.5 ± 0.49 dBA to 63.9 ± 4.37 dBA), despite a decrease in some locations. There was no significant difference before and after the implementation of TP. However, a significant difference was found for Lp,Cpeak, before and after training staff, suggesting greater care by health care professionals performing their tasks. Even recognizing that a TP is quite important to change behaviors, this needs to be considered in a broader context to effectively control noise in the NICU.
    Journal of Toxicology and Environmental Health Part A 07/2015; 78(13-14):897-903. DOI:10.1080/15287394.2015.1051204 · 2.35 Impact Factor
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    • "Most hospital designs are complex and possess an abundance of interrelated functions that must accommodate the constant movement of people, equipment and supplies throughout its structure (Haron, Hamid, and Talib 2012). Poorly designed and crowded hospital work spaces are common and may cause fatigue, stress and burnout and compromise patient safety by disrupting the staff's work performance, quality of care and lead to an increased number of medication errors (Gluck 2007; Chaudhury, Mahmood, and Valente 2009; Aiken et al. 2011; Mahmood, Chaudhury, and Valente 2011). Design modifications at later stages of a hospital building's lifecycle are expensive and difficult to achieve (Mourshed and Zhao 2012). "
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    ABSTRACT: This article presents a literature review of the challenges and possibilities for Lean design in modern health-care facilities. Many of today's health-care facilities are in dire need of renovation since limited financial resources among health-care demand improved work process efficiency, safety and employee well-being. Lean philosophy has been successfully implemented into hospitals with up-and-running hospital processes, but has not been thoroughly tested as a design methodology. The principles of Lean do not contradict with user-centric, participatory or ergonomic design approaches and thus the possibilities of using Lean as a complementary design methodology to the aforementioned approaches are discussed in this article. Lean fundamentals are also useful when dealing with change management issues. Lean offers a fundamentally solid ideology and a wide range of tools – many of which seem fitting to solve several urgent design problems in today's health-care design.
    Intelligent Buildings International 06/2014; 6(3). DOI:10.1080/17508975.2014.901904
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    • "There are few studies that consider the impact of noise on the critically ill patient and the staff that care for them, but the noise levels commonly generated in an ICU have been related to sleep disruption and to delayed patient recovery [11] [12] [13]. Staff wellbeing may be similarly affected [14], including their ability to care for patient [15]. There are however guideline limits for rooms where patients are being observed or treated, set by the World Health Organisation (WHO) [16] (35 dB L Aeq,day and 30 dB L Aeq,night , with a 10 dB differential limit) and the American Environmental Protection Agency [17] (45 dB L Aeq,day and 35 dB L Aeq,night ). "
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    ABSTRACT: Intensive Care Units (ICUs) can be immensely noisy places, where high noise levels may have deleterious effects on patients, visitors and staff alike. Many studies have identified sound levels exceeding World Health Organisation’s recommendations, although very few measured for more than 24 h or concurrently in multiple locations, as normally done in outdoor studies. In order to assess the feasibility of installing a continuous monitoring system in the indoor environment of an 18 bedded general intensive care, a MEMS-based microphone was used to monitor the noise levels for 7 days. Results showed minimal variation between night and day, but changes in sound level could be correlated with regularly occurring activities. The impact of microphone-holding structure on the measurements and the possibility of inferring patient and visitor’ exposure from a fixed measurement position are also discussed. Laboratory analysis, confirmed by in situ testing, identified ideal microphone positioning, and led to a correction of −1 dB for the sound pressure level measured at the microphone to obtain the level experienced by the patient.
    Applied Acoustics 05/2014; 79:124–130. DOI:10.1016/j.apacoust.2013.12.018 · 1.02 Impact Factor
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