“Patient centered care needs to include careful consideration of the caregiver work environment.” – Brent Whiteley, Vice-President, Parkin Architects
Medication errors constitute one of the most common types of preventable adverse events leading to patient harm and fatalities in healthcare facilities today. According to the Canadian Patient Safety Institute, drug- and fluid-related incidents are the second most common type of adverse healthcare events in Canada.
These errors can occur anywhere along the healthcare process, from initial prescription ordering, dispensing and administration, to the updating of medication records. A combination of social, cognitive, organizational/systems, and environmental factors all contribute to the potential for human error, including worker fatigue, workspace layout, lighting, climate control, and noise levels.
Human error is inevitable, but research over the past 20 years indicates that the design of a healthcare facility’s physical environment can have a significant impact on patient safety and staff performance. By assessing latent environmental conditions that led to human error, designers can develop solutions using evidence-based design principles to deliver more focused and efficient work and patient spaces that support staff and, ultimately, reduce potentially harmful mistakes.
Environmental factors and design solutions
Frequent interruptions have been correlated with an increased risk of medication errors, as noted in The Effect of Environmental Design on Reducing Nursing and Medication Errors in Acute Care Settings, published by the Center for Health Design. High noise levels—compounded by pagers, alarms, and equipment noise—also lead to increased stress and distraction. These distractions are amplified by a lack of private space when tasks that require uninterrupted concentration, such as charting and medication dosing, are being executed.
To address these issues, Care Desk areas should be planned to provide a variety of work zones that offer greater privacy for tasks that require more focus. Dedicated charting and medication prep area, offering suitable privacy and acoustic control, help to alleviate interruptions and distractions. Other elements, such as rubber flooring, acoustic tile ceiling, and acoustic panels, provide better sound control to support focus when needed.
These work areas, however, must accomplish a delicate balance by providing enough privacy while maintaining a minimum level of direct observation to surrounding patient care areas. Solutions such as using higher glazed screens in areas to create private work zones, and providing smaller satellite charting stations away from the central nurse station and closer to patient care areas, can help achieve that balance.
Lighting and ventilation
Illumination levels that are either too low or too intense can make reading labels difficult and increase the risk of misreading dosing instructions. Inappropriate lighting used with reflective surfaces such as stainless steel can also cause eye strain due to glare.
Providing appropriate task lighting reduces eye strain and allows staff to read labels and charts clearly. Evenly placed general lighting is necessary at Care Desks and in Medication rooms. Luminaires need to be located to avoid casting shadows onto work surfaces or causing glare.
Poor temperature control and ventilation can contribute further to worker fatigue, especially in facilities with older mechanical systems. Spaces that were not designed for occupancy, and have been repurposed as charting or medication rooms, may need to be updated to provide proper ventilation, lighting, and noise control.
The design process should include a thorough assessment of existing mechanical systems and upgrades required in order to meet current ventilation standards, and to account for additional heat loads from equipment. A commissioning stage is also instrumental in ensuring that the design parameters are achieved following construction.
Automated drug dispensers have been proven to reduce the frequency of medication errors. Planning of medication rooms should incorporate countertop or full-size drug dispensing systems, with room to provide future auxiliary units. Bar-coded medications could even be linked to patients’ medical wristbands so that timing and dosing can be tracked automatically.
Multi-patient rooms, especially if they do not feature a standard layout throughout the facility, can also increase distraction and lead to improper doses of medications being administered, or even medication being given to the wrong patient. Single-patient rooms that are acuity adaptable, designed to meet a patient’s changing care needs, mean that patients do not need to be transferred to other rooms, allowing them to stay within the same nursing unit. Single-patient rooms also provide staff with enough space to carry out caregiver tasks, there are fewer distractions from visitors, and the instances of administering medications to the wrong patient are reduced.
The Effect of Environmental Design on Reducing Nursing and Medication Errors in Acute Care Settings, published by the Center for Health Design (https://www.healthdesign.org/chd/research/effect-environmental-design-reducing-nursing-and-medication-errors-acute-care-settings)