This section reviews the evidence on the design of work processes and workspaces, including the inherent risks to patient safety involved in certain nursing work processes, reduced patient safety due to inefficient nursing work processes, and the effect of the physical design of workspaces on both safety and efficiency. The final section examines how work processes and workspaces can be designed to enhance the safety and efficiency of the direct care provided by nursing staff to patients.

Inherent Risks to Patient Safety in Some Nursing Work Processes

Flaws in work or equipment design, equipment failures, and unanticipated interactions in work processes are recognized threats to safety in a many industries, including health care (Hyman, 1994; Senders, 1994). Medication administration and handwashing are two common nursing activities well documented as involving threats to patient safety.

Medication Administration

Medication administration is a high-frequency activity performed by nurses in every setting of care. It also is associated with great risks to patients. More than 770,000 people annually are estimated to suffer injury or death in hospitals as a result of adverse drug events (ADEs) (Kaushal and Bates, 2001). One study of preventable ADEs in hospitals found that 34 percent of such events occurred in connection with administering the drug (a nursing role), as opposed to ordering, transcribing, or dispensing of the drug (Bates et al., 1995). A 6-month study of all ADEs in two tertiary care hospitals found that 38 percent had resulted from administration by nursing staff (Pepper, 1995). The administration of medications is a complex process involving selecting the correct drug, dose, route, patient, and time, while also remaining alert to prescribing or dispensing errors. Consequently, errors in medication administration are enabled and caused by many factors.

Causes of medication administration errors The increasing numbers of new drugs available for administration are frequently cited as a factor in medication errors (O’Shea, 1999). With increased numbers of drugs for administration comes a concomitant increase in nurses’ responsibilities for knowledge of drug action, side effects, and correct dosage. Yet studies have documented that lack of knowledge about medications is a persistent problem—and a cause of ADEs. A systems analysis of ADEs occurring in 11 medical and surgical units in two tertiary care hospitals over a 6-month period found that lack of knowledge about the drug was the most common

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