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- All Subjects: medicine
- Creators: Cooke, Nancy J.
Description
The objective of this project was to evaluate human factors based cognitive aids on endoscope reprocessing. The project stems from recent failures in reprocessing (cleaning) endoscopes, contributing to the spread of harmful bacterial and viral agents between patients. Three themes were found to represent a majority of problems: 1) lack of visibility (parts and tools were difficult to identify), 2) high memory demands, and 3) insufficient user feedback. In an effort to improve completion rate and eliminate error, cognitive aids were designed utilizing human factors principles that would replace existing manufacturer visual aids. Then, a usability test was conducted, which compared the endoscope reprocessing performance of novices using the standard manufacturer-provided visual aids and the new cognitive aids. Participants successfully completed 87.1% of the reprocessing procedure in the experimental condition with the use of the cognitive aids, compared to 46.3% in the control condition using only existing support materials. Twenty-five of sixty subtasks showed significant improvement in completion rates. When given a cognitive aid designed with human factors principles, participants were able to more successfully complete the reprocessing task. This resulted in an endoscope that was more likely to be safe for patient use.
ContributorsJolly, Jonathan D (Author) / Branaghan, Russell J (Thesis advisor) / Cooke, Nancy J. (Committee member) / Sanchez, Christopher (Committee member) / Arizona State University (Publisher)
Created2011
Description
Medical errors are now estimated to be the third leading cause of death in the United States (Makary & Daniel, 2016). Look-alike, sound- alike prescription drug mix-ups contribute to this figure. The US Food and Drug Administration (FDA) and Institute for Safe Medication Practices (ISMP) have recommended the use of Tall Man lettering since 2008, in which dissimilar portions of confusable drug names pairs are capitalized in order to make them more distinguishable. Research on the efficacy of Tall Man lettering in differentiating confusable drug name pairs has been inconclusive and it is imperative to investigate potential efficacy further considering the clinical implications (Lambert, Schroeder & Galanter, 2015). The present study aimed to add to the body of research on Tall Man lettering while also investigating another possibility for the mechanism behind Tall Man’s efficacy, if it in fact exists. Studies indicate that the first letter in a word offers an advantage over other positions, resulting in more accurate and faster recognition (Adelman, Marquis & Sabatos-DeVito, 2010; Scaltritti & Balota, 2013). The present study used a 2x3 repeated measures design to analyze the effect of position on Tall Man lettering efficacy. Participants were shown a prime drug, followed by a brief mask, and then either the same drug name or its confusable pair and asked to identify whether they were the same or different. All participants completed both lowercase and Tall Man conditions. Overall performance measured by accuracy and reaction time revealed lowercase to be more effective than Tall Man. With regard to the position of Tall Man letters, a first position advantage was seen both in accuracy and reaction time. A first position advantage was seen in the lowercase condition as well, suggesting the location of the differing portion of the word matters more than the format used. These findings add to the body of inconclusive research on the efficacy of Tall Man lettering in drug name confusion. Considering its impact on patient safety, more research should be conducted to definitively answer the question as to whether or not Tall Man should be used in practice.
ContributorsKnobloch, Ashley (Author) / Branaghan, Russell (Thesis advisor) / Cooke, Nancy J. (Committee member) / Gray, Robert (Committee member) / Arizona State University (Publisher)
Created2017
Description
The American Heart Association (AHA) estimates that there are approximately 200,000 in-hospital cardiac arrests (IHCA) annually with low rates of survival to discharge at about 22%. Training programs for cardiac arrest teams, also termed code teams, have been recommended by the Institute of Medicine (IOM) and in the AHA's consensus statement to help improve these dismal survival rates. Historically, training programs in the medical field are procedural in nature and done at the individual level, despite the fact that healthcare providers frequently work in teams. The rigidity of procedural training can cause habituation and lead to poor team performance if the situation does not match the original training circumstances. Despite the need for team training, factors such as logistics, time, personnel coordination, and financial constraints often hinder resuscitation team training. This research was a three-step process of: 1) development of a metric specific for the evaluation of code team performance, 2) development of a communication model that targeted communication and leadership during a code blue resuscitation, and 3) training and evaluation of the code team leader using the communication model. This research forms a basis to accomplish a broad vision of improving outcomes of IHCA events by applying conceptual and methodological strategies learned from collaborative and inter-disciplinary science of teams.
ContributorsHinski, Sandra T. (Author) / Cooke, Nancy J. (Thesis advisor) / Roscoe, Rod (Committee member) / Bekki, Jennifer (Committee member) / Arizona State University (Publisher)
Created2017
Description
ABSTRACT
Billions of dollars are spent annually on urine specimen collection and analysis as they are critical clinical components vital to human health. The mid-stream clean catch (MSCC) process is the gold standard of ambulatory urine specimen collection for clinical diagnosis of urinary tract infections (UTI). The MSCC process is over 60 years old and is plagued by ridiculously high specimen contamination rates. The MSCC has resisted numerous attempts aimed at improving it.
The purpose of this study was to determine if utilizing the concepts of Human Systems Engineering (HSE) could improve the urine specimen collection process. HSE concepts were not only targeted toward the problems, they were also used in the quest to develop effective solutions. Results obtained demonstrate that HSE concepts, when applied to urine specimen collection, can and do make a difference in terms of specimen quality and patient satisfaction. One low cost easily implemented targeted HSE-informed intervention effort resulted in a specimen contamination rate reduction of 16.6%.
A second targeted HSE-informed intervention involving the redesign of the specimen cup, its instruction set, and additional sign placement made it three times less likely for participants to provide a contaminated MSCC sample. The redesigned specimen cup automatically captures and isolates an initial void sample from an MSCC sample, both derived from one continuously provided patient specimen. Clinical utility comes in the form of improved MSCC specimen quality and a separated initial void available for analysis using Nucleic Acid Amplification Testing (NAAT) or other test protocols. Capturing and isolating both an initial void and an MSCC at the same time allows for a more complete diagnostic workup utilizing a higher quality MSCC without requiring the patient to follow two different protocols to urinate into two different specimen cups.
The redesigned specimen cup also provides for automatic overflow prevention, incorporates a new ergonomic grip, and a saddle adapter that provides affordances for both women and men in terms of urine capture and the reduced likelihood of urinating on one’s self.
ContributorsWallace, David (Author) / Gutzwiller, Robert S (Thesis advisor) / Branaghan, Russell J (Committee member) / Cooke, Nancy J (Committee member) / Hall, Rick (Committee member) / Arizona State University (Publisher)
Created2021