Human Factors Engineering, Bar Coding Medication Administration, and Nursing: An Interview with Drs. Richard Holden and Laurie L. Novak
Buerhaus, Peter I., Nursing Economics
FOLLOWING THE PUBLICATION of the landmark Institute of Medicine report "To Err is Human" more than a decade ago, hospitals have undertaken many initiatives to improve the quality and safety of patient care. Studies have provid- ed evidence of an association between nurses and the quality Richard Holden and safety of care, and have developed, tested, and refined a number of quality and safety indicators sensitive to nursing. Some of these indicators have been adopted by prominent quali- ty monitoring organizations (the Joint Commission and the Nation- al Quality Forum), by research funding agencies (Agency for Healthcare Research & Quality), and by private and public sector payers, including Medicare. Efforts to improve quality and safety will continue as hospitals and other care delivery organizations face changes in payment systems that increasingly link payment to measurable and comparable qual- ity and safety outcomes.
Much of what has been learned about the causes of errors and lapses in quality, as well as how to reduce their risk, is attrib- utable to the application of Hu- man Factors to study complex health care delivery systems. To learn more about Human Factors and why it can be helpful to nurse executives, managers, and nurses, I turn to two experts in the field. Richard J. Holden, PhD, assistant professor of medicine, Vanderbilt University School of Medicine, is a Human Factors engineer and psy- chologist with 12 years of extensive experience con- ducting applied research in health care (Dr. Holden worked with the late health care Human Factors pio- neer Bentzi Karsh on his 5-year, federally funded study, "Bar Coding and Patient and Employee Safety"). In his studies, Dr. Holden has investigated nursing workload, how nurses adapt and solve opera- tional problems, and nurses' perceptions, acceptance, and use of health information technologies, among many other topics. Laurie L. Novak, PhD, MHSA, is assistant professor of biomedical informatics at the Vanderbilt University School of Medicine. Dr. Novak earned a PhD in medical and organizational anthro- pology and a master's degree in health services man- agement and policy. Her research has examined the impact of technology design and implementation on clinical work practices. Currently, she is investigating medication management practices of nurses, pharma- cists, and patients and new technology development.
Interacting with the Work System
Peter Buerhaus (PB): Please explain Human Factors engineering.
Richard Holden (RH): Human Factors, also called ergonomics, is concerned with how people interact with the elements of their work system. As a science and practice, our discipline seeks to apply Human Factors knowledge, theories, and methods to improve the design of work systems. The field of Human Factors uses a systems approach and as the name "Human Factors" implies, we place the person or people at the center of that system. We try to design the surrounding work system elements - tools, tech- nologies, organizations, tasks, and environments - to accommodate people to improve both their perform- ance and well-being.
Laurie Novak (LN): When new technologies are implemented, all of the elements of the work system can be affected, potentially creating new levers for improvement of the overall system. Organizational Human Factors, or macro-ergonomics, offers a useful perspective when a complex work system is per- turbed by new technology. For example, implement- ing bar code medication administration technology can result in direct and indirect impacts on the entire system of inpatient care.
The Impact of BCMA
PB: Bar coding is designed to benefit the patient, the organization, and the provider. What do we know about bar coding and medication administration?
LN: Bar code medication administration (BCMA) refers to a technology that is intended to ensure the five rights of medication administration: the right patient, right medication, right dose, right time, and right mode of administration. …