The dome project

Published: 14 November 2012

Make it better: designing out medical error

Susan Pirie reports on a Hunterian meeting she attended where an inspiring project was exhibited

The dome project involved a collaboration of health care designers, clinicians, psychologists and business experts. The project team worked together to establish an evidence base for the design of equipment and products which improve patient safety in surgical wards.

Funded by the Engineering and Physical Sciences Research Council, the aim of the project is to improve patient safety through design. The team considered workflows and practices on surgical wards in order to identify current problems and encourage new design solutions.

While there are evolving practices in health care, ward design remains very much as it has been for decades.

Patient care involves a varied and wide range of integrated activities and yet the standard design of the work area and equipment does little to ensure ease of these activities.

The project team have identified a wide range of issues and five specific activities which were considered to be highest risk. These were:

A brief summary of how the project has addressed these identified issues is below.

Infection control

There are many occasions when basic items such as gloves, aprons and hand gel are not easily available.

The solution which the project team came up with was to provide a care station at the end of every bed. The care station incorporates a documentation holder, hand gel dispenser, flat surface for writing, storage pocket for wipes, medication locker, bin and an apron and gloves dispenser. The model on show at the exhibition appeared to be a vast improvement on the current systems in hospital wards.

Hand hygiene

The design team has identified that there are a wide range of individual signs for the need for effective hand hygiene.
The team has established a uniform symbol to indicate areas and times at which hand hygiene should be observed. This unified approach mirrors successful campaigns for consistence in other industries, such as the construction industry.

Medication

The team observed the numerous interruptions that can occur during medication rounds, and how such interruptions can increase the risk of error in this activity.

The solution devised is to have drugs dispensed in a different style of blister pack which incorporates a spoon and patient-friendly information, including the drug name and dose.

During each medicine round, the nurse will dispense medication from a blister pack individual to the patient and place it in their tray. It will be obvious what medication have been dispensed and crucially, any medication the patient may not have taken.

Vital signs

The design team has identified that there are occasions when vital signs are not recorded at appropriate times and that there is a wide margin for error in documenting observations.

The current design of vital signs trolleys also has the potential to contribute to the spread of infection. This is due to the length and number of cables on each trolley.

The solution was to improve the cable design on the trolley, and to provide a prompt for each nurse undertaking observations. In addition, the device automatically records the information in a chart format, this reducing the risk of documentation errors.

Handover

There has been an increase of nursing and medical handovers in recent years as the impact of the European Working Time Directive has resulted in changed shift pattern for junior doctors. The team observed that handovers are often undertaken in staff rooms which are poorly designed and subject to frequent interruptions as others use the room during handover. 

The team has designed a multifunction staff room which can also act as a handover area, with clear signage to indicate that a handover is taking place.

The exhibition and discussions at the Hunterian meeting I attended identified a wide range of issues and actual and potential solutions. Further information is available at www.domeproject.org.uk