95 research outputs found
Preventing acute kidney injury: a qualitative study exploring 'sick' day rules implementation in primary care
No full textThe political economy of trade and growth: an analytical interpretation of sir James Steuart's inquiry
Full text linkSir James Steuart (1713-80) has been unduly neglected by the majority of historians of economic thought. This study aims at casting a new light upon his original thought to provide a basis for the revaluation of his contribution to the development of economic discipline. The present interpretation of his Inquiry (1767) reveals that his political economy contains not only fresh new ideas and path-breaking thinking for his time but also most major ingredients of modem economics. Firmly based on the recognition of the interdependence of economic sectors and social classes, he clearly grasped the circular system of production, distribution and consumption in the exchange economy. He discerned between the 'profit upon alienation' and the 'real value' of commodities in their current price' determined in the markets. He emphasized the 'balance of work and demand', secured by the 'double competition' among the sellers and buyers of commodities, for the efficient allocation of economic resources. On these foundations, Steuart established his theory of output, employment and population in terms of the notion of 'effectual demand'. His economic analysis culminates in his discussions of economic growth and foreign trade. He linked the limitations of the former to the benefits of the latter. Meanwhile, refuting his predecessors' quantity theory, Steuart presented what might be called the production-consumption theory of money, according to which money is not neutral to the determination of the level of output in an exchange economy. His theory of international money also takes on modernity, as it adopts an absorption approach to the balance of payments. Steuart's monetary analysis comes complete with his argument for government's active finance. The state interventionism underlying the whole of Steuart's political economy is seen as its logical conclusion, rather than a mere assumption. Thus, it is suggested that the ultimate message of his Inquiry is neither laissez faire nor centa-al planning
A naturalistic decision-making perspective on anaesthetists' rule-related behaviour
Full text linkAs a widely recognised feature of work activity, procedural violations have been of considerable interest to human factors specialists, and several models have been proposed to aid in understanding their occurrence. A common feature of these models is that they depict violations as being, to a greater or lesser extent, intentional; therefore, rule-related behaviour could be reconceptualised as an exercise in decision-making. In this paper, we examine anaesthetists' use of rules from the perspective of naturalistic decision-making. Doing so suggests that their rule-related behaviour is a product of the extent to which following a rule is consistent with other principles that guide their decision-making. Observational and interview data from 23 consultant anaesthetists indicated the presence of three such principles: "doing the right thing"; "doing what works in the circumstances"; and "using one's skills and expertise". Hence, rule-related behaviour in this setting is better understood as a form of situated action than as the following or breaking of rules per se. We discuss the implications of this view for understanding why violations occur, and how to address them. © 2014 Springer-Verlag London
Looking Behind Patient Safety Culture: Organisational Dynamics, Job Characteristics and the Work Domain
No full textPerceptual control and feedback control in the analysis of complex tasks:
No full text© 2014, Copyright Taylor & Francis Group, LLC.Despite its extensive and successful use in the human factors specialist's work, there remain challenges for the development of task analysis. One such challenge is posed by the need to capture the features of the dynamic, complex tasks that take place in modern socio-technical systems. In this paper, we discuss the theoretical and practical implications of using perceptual control theory (PCT) as a theoretical grounding for task analysis. In particular, we describe the ability of PCT to combine the notion of perceptual control (which is similar to the assumptions underlying ecological design) with that of feedback control (which is fundamental to some traditional task analysis approaches). We describe some of the current PCT-based task analysis methods before introducing a new method that aims to integrate PCT concepts into hierarchical task analysis. Finally, we demonstrate how this method might be applied to a real-world dynamic control task
Community pharmacists' decision-making patterns in clinical prescription checking: A simulation-based study
No full textBackgroundCommunity pharmacists (CPs) make a significant number of decisions on the clinical appropriateness of prescriptions daily to ensure safe and effective use of medications, in a process known as “clinical checking”. The process is complex and is affected by multiple factors in practice. This study aimed to investigate the cognitive processes involved in clinical prescription checking by CPs.MethodThis qualitative study employed a purposive sampling technique to recruit a diverse sample from the population of CPs in England. Engaging in Zoom interviews, participants clinically checked three simulated prescriptions, providing concurrent verbal accounts of their thoughts. The participants' commentaries during the task were audio-recorded, transcribed verbatim, and underwent deductive thematic analysis based on Klein's recognition-primed decision-making (RPD) model.ResultsTwelve CPs from diverse backgrounds and varied working conditions were recruited and completed the online checking task. Making decisions on the clinical appropriateness of prescriptions appeared to be a multi-staged procedure whereby several levels of concerns exist, and pharmacists vary in their ability to recognise and resolve those concerns. CPs behaved in a manner similar to that described by the RPD model; they mostly engaged in pattern-recognition during clinical checking, but adopted a more analytical approach when they recognised an atypical situation. Participants showed more consistency when processing cues and expectancies; however, their subsequent actions exhibited substantial variability, coupled with a degree of hesitancy.ConclusionClinical checking of prescriptions is a multifaceted process in which pharmacists employ a blend of pattern recognition and analytical thinking when making decisions. The process differs notably among pharmacists, underscoring the need to understand the factors driving these variations and any hesitancy in decision- making, as well as their potential impact on patient safety
Clinical checking in practice: qualitative perspectives from community pharmacists
No full textObjectives Community pharmacists (CPs) are the last healthcare professional to check the clinical appropriateness of prescribed medicines prior to being dispensed to patients. This process is known as “clinical checking” and is intended to ensure the prescribed medications are safe and effective. This study aims to explore how CPs carry out clinical checking in practice, and the main factors affecting their clinical decisions. Method: The study was qualitative in nature, and data were collected by means of semi-structured interviews. The interview questions aimed to explore how CPs carry out clinical checking in practice. A purposive sampling strategy was employed to recruit a sample representative of CPs in England. Interview transcripts were subjected to thematic template analysis. Key findings:Twelve CPs of various professional backgrounds participated in the interviews. The analysis yielded three overarching themes, namely: pharmacists’ perception of the clinical checking process; clinical checking as a naturalistic decision-making process; and barriers to effective clinical checking. Interviewees described being faced with a trade-off between examining each prescription thoroughly and maintaining the throughput of prescriptions, due to the highly pressurised environment they work within. A number of factors inform this trade-off: (1) assuming the safety of repeat medicines; (2) lacking access to sufficient clinical information (3) working under challenging circumstances (such as a lack of resources).Conclusion: Clinical checking is a complex, variable and experience driven process which is heavily influenced by the surrounding environment and information accessibility. Further research should investigate the cognitive process involved in clinical checking and explore the practicalities and potential benefits of the recommendations identified in this study
Predicting dispensing errors in community pharmacies: an application of the Systematic Human Error Reduction and Prediction Approach
Full text linkIntroduction The objective of this study was to use a prospective error analysis method to examine the process of dispensing medication in community pharmacy settings and identify remedial solutions to avoid potential errors, categorising them as strong, intermediate, or weak based on an established patient safety action hierarchy tool. Method Focus group discussions and non-participant observations were undertaken to develop a Hierarchical Task Analysis (HTA), and subsequent focus group discussions applied the Systematic Human Error Reduction and Prediction Approach (SHERPA) focusing on the task of dispensing medication in community pharmacies. Remedial measures identified through the SHERPA analysis were then categorised as strong, intermediate, or weak based on the Veteran Affairs National Centre for Patient Safety action hierarchy. Non-participant observations were conducted at 3 pharmacies, totalling 12 hours, based in England. Additionally, 7 community pharmacists, with experience ranging from 8 to 38 years, participated in a total of 4 focus groups, each lasting between 57 to 85 minutes, with one focus group discussing the HTA and three applying SHERPA. A HTA was produced consisting of 10 sub-tasks, with further levels of sub-tasks within each of them. Results Overall, 88 potential errors were identified, with a total of 35 remedial solutions proposed to avoid these errors in practice. Sixteen (46%) of these remedial measures were categorised as weak, 14 (40%) as intermediate and 5 (14%) as strong according to the Veteran Affairs National Centre for Patient Safety action hierarchy. Sub-tasks with the most potential errors were identified, which included ‘producing medication labels’ and ‘final checking of medicines’. The most common type of error determined from the SHERPA analysis related to omitting a check during the dispensing process which accounted for 19 potential errors. Discussion This work applies both HTA and SHERPA for the first time to the task of dispensing medication in community pharmacies, detailing the complexity of the task and highlighting potential errors and remedial measures specific to this task. Future research should examine the effectiveness of the proposed remedial solutions to improve patient safety.</p
Extending hierarchical task analysis to identify cognitive demands and information design requirements
No full textWhile hierarchical task analysis (HTA) is well established as a general task analysis method, there appears a need to make more explicit both the cognitive elements of a task and design requirements that arise from an analysis. One way of achieving this is to make use of extensions to the standard HTA. The aim of the current study is to evaluate the use of two such extensions - the sub-goal template (SGT) and the skills-rules-knowledge (SRK) framework - to analyse the cognitive activity that takes place during the planning and delivery of anaesthesia. In quantitative terms, the two methods were found to have relatively poor inter-rater reliability; however, qualitative evidence suggests that the two methods were nevertheless of value in generating insights about anaesthetists' information handling and cognitive performance. Implications for the use of an extended HTA to analyse work systems are discussed. © 2010 Elsevier Ltd and The Ergonomics Society
Understanding the attitudes of hospital pharmacists to reporting medication incidents: A qualitative study
No full textBackground: The attitudes of doctors, nurses, and midwives to reporting errors in health care have been extensively studied, but there is very limited literature considering pharmacists' attitudes to medication error reporting schemes, in particular in hospitals. Objectives: To explore and understand the attitudes of hospital pharmacists to reporting medication incidents. Methods: Focus groups were conducted with a total of 17 hospital pharmacists from 4 purposively sampled hospitals in the North West of England. The recordings of the focus groups were transcribed verbatim and subject to thematic analysis using a framework analysis approach. Results: Pharmacists agreed that the high prevalence of medication errors, especially prescribing errors of omission, has led to an acceptance of not using hospital reporting systems. There were different personal thresholds for reporting medication errors but pharmacists agreed that the severity of any patient harm was the primary reporting driver. Hospital pharmacists had specific anxieties about the effects of reporting on interprofessional working relationships with doctors and nurses, but felt more confident to report if they had previously witnessed positive feedback and system change following an error. Existing reporting forms were considered too cumbersome and time consuming to complete, as pharmacists felt the need to find and record every possible detail. Conclusions: Hospital pharmacists understood the importance of reporting medication incidents, but because of the high number of errors they encounter do not report them as often as may be expected. The decision to report was a complex process that depended on the severity of patient harm, anxieties about harming interprofessional relationships, prior experience of the outcomes from reporting, and the perceived effort required to use reporting forms. © 2013 Elsevier Inc
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