OPSC Patient Safety Minute | Tools for Oregon Facilities: A Human Factors Matrix & Podcast

When reviewing reports that Oregon facilities submit through the Patient Safety Reporting Program (PSRP), we often see human factors as a common theme. When human factors principles are applied during a root cause analysis, they can help your team identify strong strategies to improve patient safety.

How Human Factors Can Help

Combining Human Factors Engineering with an adverse event investigation helps identify system‑level causes rather than placing blame on individuals (which can be detrimental to learning and improvement!). This approach supports the development of new strategies and prevention methods that help providers and staff perform standard procedures safely and follow established policies. 

For example, in one report submitted to PSRP, a patient experienced a transfusion reaction after receiving blood in the emergency department. The event analysis identified several system-level factors (including a skill-based human factor) that played a role in the event. Their analysis looked at the equipment, policies, and procedures in the blood bank, as well as the design of the physical space. They were able to standardize equipment and simplify overly complicated procedures. But perhaps most significantly, they were able to modify the physical space to reduce interruptions and distractions.

Legal Disclaimer:

EIN Presswire provides this news content "as is" without warranty of any kind. We do not accept any responsibility or liability for the accuracy, content, images, videos, licenses, completeness, legality, or reliability of the information contained in this article. If you have any complaints or copyright issues related to this article, kindly contact the author above.