HUMAN FACTORS TO DESIGN SAFE PEDIATRIC SEDATION SYSTEMS

描述：(由申请者提供)目标：测试人为因素范式 提高易发生事故的医疗保健领域的有效性和安全性。 测试领域将是儿科程序性镇静--治疗 儿童用药引起的程序相关的疼痛和压力。 具体目标：1)确定儿科程序性镇静护理系统的危害； 2)儿科程序镇静实践中的失败模式；3) 创新错误预防、错误恢复和容错策略 儿科镇静护理系统。 研究设计：1)模拟两个与镇静相关的事件 有可能造成严重伤害或死亡。场景将可以使用 儿科模拟器(Ped-SIM TM，医学教育技术公司)。气道口 梗阻和中枢性呼吸暂停是两种镇静事件 嵌入到典型的镇静环境中。2)研究四个方面的表现 麻醉学])管理一个没有事件的场景，一个有事件的场景 呼吸道阻塞和1例中枢性呼吸暂停。模拟案例将 使用标准的日程安排系统进行分配，护理将被录像。3) 视频分析，以识别与以下各项相关的危险和漏洞 儿科镇静剂。将使用视频和口头数据来执行一项工作 分析以定义运营商、环境、技术和 患者要求在管理镇静时确定儿科镇静的特征 相关的呼吸事件。定性方法(协议分析、流程 追踪和危险分析)和半定量方法(该措施 操作条件、响应时间、准确率、模拟器缺氧 PaO2&lt；27秒)将采用分析。4)工程安全进入 镇静护理系统。我们的目标是迭代地设计出小说《最佳》 镇静护理的实践不仅要防止错误，而且要创造 中确定的系统级别的容错和错误恢复 步骤1-3将是设计工作的重点。

DESCRIPTION: (provided by applicant)Goal: Test a Human Factors paradigm to improve efficacy and safety in medical care domains that are accident-prone. The test domain will be pediatric procedural sedation--the treatment of procedure related pain and stress with medication in children. Specific Aims: 1) identify pediatric procedural sedation care system hazards; 2) model modes of failure in the practice of pediatric procedural sedation; 3) innovate error prevention, error recovery and error tolerance strategies for pediatric sedation care systems. Research Design: 1) Simulate two sedation associated events that carry the potential for serious injury or death. Scenarios will be reproducible using a pediatric simulator (Ped-sim TM, Medical Education Technologies, Inc.). Airway obstruction and central apnea are the two sedation events that will be embedded into typical sedation contexts. 2) Study the performance of four Anesthesiology) managing one scenario without an event, one scenario with airway obstruction and one scenario with central apnea. Simulated cases will be assigned using standard scheduling systems and care will be videotaped. 3) Video analysis to identify hazards and vulnerabilities associated with pediatric sedation. Video and verbal data will be used to perform a work analysis in order to define the operators, environment, technology, and patient demands that characterize pediatric sedation when managing sedation associated respiratory events. Qualitative methods (protocol analysis, process tracing and hazards analysis) and semi-quantitative methods (that measure operative conditions, response times, accuracy rates, simulator hypoxia of PaO2 < 27 in seconds) of analysis will be employed. 4) Engineering safety into sedation care systems. The goal is to iteratively design novel "best practices for sedation care that not only prevent error, but also create error tolerance and error recovery at the system level Hazards identified in steps 1-3 will be the focal point of design efforts.