HUMAN FACTORS TO DESIGN SAFE PEDIATRIC SEDATION SYSTEMS

描述：（由申请人提供）目标：测试人为因素范例， 提高事故多发医疗领域的效率和安全性。 测试领域将是儿科手术镇静-治疗 手术相关的疼痛和压力与儿童药物治疗。 具体目标：1）识别儿科手术镇静护理系统危害; 2)儿科手术镇静实践中的失败模式模型; 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）模拟两个镇静相关事件， 严重伤害或死亡的可能性。情景将使用 儿科模拟器（Ped-sim TM，Medical Education Technologies，Inc.）。气道 阻塞和中枢性呼吸暂停是两个镇静事件， 嵌入到典型的镇静环境中。2)研究四个性能 麻醉学）管理一个无事件场景，一个有事件场景 呼吸道阻塞和一种中枢性呼吸暂停。模拟案件将 使用标准的时间安排系统进行分配，护理将被录像。第三章 视频分析，以识别与以下方面相关的危险和漏洞： 小儿镇静剂视频和口头数据将用于执行一项工作 分析，以确定运营商、环境、技术和 在管理镇静时表征儿科镇静的患者需求 相关呼吸事件。定性方法（方案分析、过程 追踪和危险分析）和半定量方法（测量 手术条件，响应时间，准确率，模拟器缺氧， PaO 2 < 27秒）。4)工程安全进 镇静护理系统我们的目标是反复设计新颖的“最佳 镇静护理的实践，不仅可以防止错误，而且还可以创建 系统级的容错和错误恢复 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.