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Human factors is the study of: (A) Interactions among humans (B) Interactions between humans and machines (C) Interactions between humans and the environment (D) All of the above โโD - Human factors is an established science that uses many disciplines to understand how people perform under different circumstances. This engineering discipline deals with the interface of people, equipment, and the environment. Which of the following is an example of unconscious processing by the brain? (A) Optical illusions (B) Skipping a step on a checklist to save time (C) Mistaking one drug for another because of look-alike packages (D) A and C โโD - Optical illusions and mistakes involving look-alike drugs and names reflect unconscious processing by the human brain. Unconscious processing is a fundamental part of
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human cognition that can lead to human error even when people are trying their best. Safe systems take these known characteristics of human cognition into account to help people do things the right way. When attempting to decrease the risk of error, it's important to use human factors principles because: (A) If you understand the factors that cause people to make mistakes, you can hire safer providers. (B) If you understand human factors principles, you can ensure your system is perfectly safe. (C) If you understand the factors that affect human performance on critical tasks, you can design a safer system. (D) If you understand human factors principles, you can always justify using the latest technology at the bedside. โโC - Understanding how factors that affect human performance (such as fatigue, stress, and poor lighting) affect work and detract from one's ability to execute a safety-critical task (such as administering a medication, filling a prescription, or writing an order) can help you design processes and systems in ways that make them safer. Which of the following types of errors is associated with controlled thinking?
Which of the following is a basic strategy for minimizing the opportunity for error in a process? (A) Reducing reliance on technology (B) Standardizing how the process is completed (C) Trying harder to perform the process correctly (D) A and C โโB - The science of human factors has helped us identify many design principles that can help prevent errors; standardizing processes is one such principle. Although we shouldn't be overly reliant on technology, technology can often be used to help prevent errors. Simply trying harder is not an effective error-prevention tactic. Which of the following statements about redundancies within processes is always true? (A) They are needlessly inefficient. (B) They remove the opportunity for error. (C) They require two people to do the work of one. (D) None of the above โโD - None of these statements is always true. In high-risk situations โ such as the medication administration process โ you may need redundancy to ensure safety. Although a typical redundancy involves one person checking the work of another, you can also
use technology to "double check." It's important to keep in mind that it is possible for two people to make the same mistake and double checks can still allow the opportunity for error. Use the following scenario to answer questions 3-5: Your hospital is implementing an electronic health record (EHR) and is teaching all staff how to use it. As you go through the EHR training, you notice that it takes five clicks to bring up the vital signs for a patient. In the past, when you wanted to see a patient's vital signs, you could simply look at the sheet of paper clipped onto the end of the bed. Which of the following likely needs to be improved about the new process to review vital signs? (A) It needs to be simplified. (B) It needs to be standardized. (C) It needs redundancies added. (D) It needs to avoid reliance on memory. โโA - A process that has a lot of steps โ some of which seem unnecessary โ is a prime target for simplification. This is especially true for commonly used processes, such as reviewing and recording vital signs.
(D) A and B โโA - Forcing functions make it impossible to skip a task. Just as you cannot put a car into reverse unless your foot is on the brake, you cannot complete this particular admission order in this EHR unless you address the prevention of blood clots. This is not an example of simplification, as it actually adds a step. At the same time, it's not repeating a step, so it's not an example of redundancy. Use the following scenario to answer question 1: You're working in an outpatient clinic that recently started using an electronic health record (EHR). You are entering a prescription for an antibiotic into the EHR to treat Mrs. Jones's urinary tract infection. As you enter the order, a warning screen pops up saying that she has chronic kidney disease, and the medication dose should be adjusted based upon her last recorded creatinine level (a measure of kidney function). However, you know that Mrs. Jones's most recent creatinine level โ recorded at a different clinic and therefore not available in your EHR โ came back normal. When you attempt to move past the warning, the system will not allow you to proceed. Which of the following concepts does this scenario demonstrate? (A) Technology can introduce unintended problems. (B) Technology should facilitate how you do your work, not dictate it.
(C) Human beings must still be very present when interacting with technology to ensure its proper and effective use. (D) All of the above โโD - All of the above is the best answer. In this case, the computer has information, but not all of the information. The system does not seem to allow for the fact that there will sometimes be additional information that caregivers must take into account. Instead, it tries to force caregivers to follow rigid rules. Remember: Human beings must still be very present when interacting with technology to ensure its proper and effective use. As a caregiver, which of the following common health IT issues would you be in the best position to help solve? (A) Incomplete data entries into the computer (B) Delays due to connectivity issues (C) Out-of-date software (D) None of the above โโA - The best answer is incomplete data entries into the computer, which is a human-computer issue (as opposed to a computer issue). User feedback from caregivers is critical to improve the interfaces between computers and humans. Which of the following is the best example of using technology to improve safety and prevent errors?
(C) Encouraging users to find workarounds (D) All of the above โโB - Once designed, actual users should test technology in real-world situations. If users don't test the technology, then the possibility of introducing a faulty system goes up, which additional training would not address. Workarounds can lead to serious error; you should view them as a symptom of a poorly designed or overly complex system. You're caring for a patient with diabetes who was admitted to your hospital with an elevated blood glucose level. She is on an insulin pump that is programmed to deliver one unit of insulin per hour through her intravenous (IV) line. How does this technology help make her care safer? (A) The pump eliminates the need for providers to be involved in her care. (B) The pump eliminates the possibility of a medication error. (C) The pump helps automate a complex care process. (D) All of the above โโC - The pump automates the complex process of precisely administering insulin at regular intervals, helping make care safer for the patient. However, there's the chance the pump could malfunction, and providers dictate dosing decisions, so errors could still occur. Providers must always be present to ensure proper and effective use of technology. Which of the following statements about bar-cording systems is true?
(A) They typically offer few benefits and merely promote workarounds. (B) They can completely prevent medication errors. (C) They can help providers keeps track of laboratory specimens, identify medications and medical equipment, and identify patients. (D) B and C โโC - Bar-coding systems can help identify medications and match them to the correct patient, as well be used to label and track laboratory specimens, identify medical equipment, and identify patients. Despite these significant benefits, bar-coding systems have potential flaws, and can promote workarounds if not designed properly. Effective ways for addressing defects in the human-technology interface include: (A) Involving the user in the design of the technology (B) Testing the technology under real-life conditions (C) Reducing the cost of the technology (D) A and B โโD - When developing or trying out a new technology, it's essential to test the technology in the environment in which it will be used. It's also essential to involve those who will use the technology in its design. In the absence of these steps, it's possible that serious design problems will surface later โ in a way that could hurt patients. Attending to cost will not improve the interface between technology and the humans who will use it.
You're caring for a patient with diabetes who was admitted to your hospital with an elevated blood glucose level. She is on an insulin pump that is programmed to deliver one unit of insulin per hour through her intravenous (IV) line. Which of the following is a risk of this technology? (A) The pump is dictating rather than facilitating your work. (B) The pump could malfunction. (C) There is no risk associated with the pump. (D) A and B โโB - Although the pump helps facilitate your work by automating the process of delivering a precise amount of insulin at regular intervals, there is always some chance it could malfunction. Remember, human beings must still be very present when interacting with technology to ensure its proper and effective use.
