Effect of fatigue, workload, and environment on patient safety in the pediatric intensive care unit
Effect of fatigue, workload, and environment on patient safety in the pediatric intensive care unit
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DOI：
10.1097/01.pcc.0000257735.49562.8f
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发表时间：
2007-03-01
影响因子：
4.1
通讯作者：
Montgomery, Vicki L.
中科院分区：
文献类型：
--
作者：
Montgomery, Vicki L.
导言。儿科重症监护病房患者的护理发生在一个不可预测的、技术丰富的环境中，该环境依赖于需要持续沟通的高技能提供者-所有这些功能都为潜在的错误提供了环境。这篇综述考察了人为错误和睡眠生理学的基本原理，并评估了疲惫的医护人员和工作量对医疗错误的潜在影响的证据。从人的因素工程学的角度来看，儿科重症监护病房的设置是一个高度复杂的环境，在这种环境中，疲劳和过度的工作量可能会提供可能导致差错发生的潜在“漏洞”。大量证据表明，睡眠不足会损害医疗和手术表现，并可以通过时间安排干预来改善。护理疲劳和工作量已经记录了增加重症监护病房差错、感染和成本的影响。特定的环境因素，如分心和沟通障碍，也与更大的错误相关。结论：疲劳、过多的工作量和儿科重症监护病房的环境会对儿科重症监护病房的医生和护士的工作表现产生不利影响。证据的重要性表明，这些因素有可能导致儿科重症监护病房的医疗差错。
Introduction. Pediatric intensive care unit patient care occurs in an unpredictable, technology-rich environment that is dependent on highly skilled providers who need constant communication-all features providing the setting for potential error. This review examines basic principles of human error and sleep physiology and evaluates the evidence for potential effects of fatigued healthcare workers and workload on medical error.Body. The pediatric intensive care unit setting, examined from a human factors engineering standpoint, is a highly complex environment in which fatigue and excessive workload can provide potential "holes" that may allow errors to occur. A large body of evidence is examined that suggests sleep deprivation can impair medical and surgical performance and can be improved with scheduling intervention. Nursing fatigue and workload have documented effects on increasing intensive care unit error, infections, and cost. Specific environmental factors such as distractions and communication barriers are also associated with greater error.Conclusion: Fatigue, excessive workload, and the pediatric intensive care unit environment can adversely affect the performance of physicians and nurses working in the pediatric intensive care unit. The weight of the evidence suggests that these factors have the potential to contribute to medical error in the pediatric intensive care unit.