Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 320

Increasingly, design and technology are being used to great effect to improve patient safety as healthcare learns from the principles of human factors and ergonomics that are well‐engrained in other safety‐critical industries. These disciplines are concerned with the interaction between humans and the systems in which they work, including perception, cognition, human performance, interaction with technology, teamwork, and organizational behaviour. Design of hospital equipment used to be carried out by people at a relative distance from end users, with feedback occurring only at a late stage or when accidents occurred. Now there tends to be a much more integrated approach, with a substantial and growing literature around evidence‐based design. This has led to numerous practical benefits, such as the redesign of labelling and packaging of medications and anaesthetic and emergency equipment, and in designing hospital environments to reduce the incidence of hospital‐acquired infections.¹

The same principles and ideas can be effective in reducing the incidence of geriatric syndromes in older people in the hospital. For example, there is a growing amount of work on the role that design of the hospital environment can play in preventing falls and delirium in terms of ensuring adequate lighting, noise reduction, orientation boards, suitable hospital beds, appropriate flooring, and signage.

Advances in technology can reduce errors by improving communication, providing reminders, making knowledge more readily accessible, prompting for key information, assisting with calculations, monitoring and checking in real time, and providing decision support⁵⁹. There are many examples of how technology has helped to counteract the cognitive errors that humans can be prone to make, such as the use of barcodes in blood transfusions. Technology can also enhance the human qualities of judgement and decision‐making, such as with computerized decision support with systems for diagnosis, reminder systems for prevention, systems for disease management, and systems for supporting prescribing and drug dosing.⁶⁰ Any organisation needs a framework for safety measurement and monitoring, as described by The Health Foundation.⁶¹ Five dimensions of such a framework include assessment of past harms, reliability, sensitivity to operations, anticipation and preparedness, and integration and learning.