Abstract

Many medical errors that involve drug infusion devices are related to classic interface problems. Although manufacturers are becoming increasingly aware of human factors design considerations, many devices that are currently on the market are still sub-optimal for human use. This places significant responsibility for device selection on institutional purchasing groups. Theories of naturalistic decision-making point to many potential strengths and pitfalls of group decision-making processes that may affect the final outcome. This paper describes a retrospective analysis of decision-making process for infusion pump selection in a large hospital and focuses on factors related to patient safety. Through a series of detailed interviews and a study of relevant documentation we characterized the nature of the decision-making, patterns of communication, and the roles of different participants. Findings show that although the process involves a number of different professional groups and committees, the information flow among them is restricted. This results in inadequate representation of critical device usability considerations in the decision-making process. While all participants view device safety as an important consideration in the selection process, administrators (who are the final decision-makers) tend to equate safety with technical accuracy and reliability, paying less attention to the role of human factors in safe device use. Findings suggest that collaborative communication technology and automated evidence-based guidelines could provide support to institutional decision-making, ensuring that the process is efficient, effective, and ultimately safe for the patients.

Author Keywords: Patient safety; Institutional decision-making; Human factors design

Article Outline

1. Introduction

2. Medical errors and human factors design

3. Strengths and pitfalls of individual and group decision-making

4. Search for appropriate methodology

5. Methodological design

5.1. Overview of the setting

5.2. Instrumentation

5.3. Interview with participants

5.4. Review of action documentation

6. Analysis

7. Characterization of the decision-making process

7.1. Participating groups

7.2. Flow of information during the process

7.3. Device selection process

7.3.1. Process as recalled by the participants

7.3.2. The process as reflected in the minutes of Committee for Technology meetings

7.4. Clinical evaluation of the pumps

7.5. Factors that influenced the process

8. Conclusions

Acknowledgements

Appendix A. Participant interview instrument

Appendix B. Excerpt from a coded protocol with a core group’s administrator

Appendix C. Participant 7 (Core group’s administrator), statements assigned to Core Group’s Interactions with Clinicians and Users coding category

References