Standardisation has been shown to be an effective mechanism for reducing human error in complex processes or situations. Conversely, the lack of it can increase risk and make human error more likely and in some cases inevitable.

In order to inform the Department of Health’s Human Factors Reference Group, we conducted a rapid on-line survey asking CHFG supporters about the top priority areas which in their view, if standardised, would make a positive contribution to improving patient safety as well as making their work easier and more effective overall.

A textual and content analysis was conducted to produce “categories” of priorities.

Respondents[1]

The majority of respondents:

  • describe their primary role as ‘Medical’ (73%) with the next largest group being ‘Patient Safety / Improvement Specialist’ (7%)
  • describe themselves as working for / within NHS Acute Providers  (79%)
  • are based in England (85%) with an even spread across regions. The next largest groups are from Scotland and Wales both at nearly 6% of respondents.

 Summary of Standardisation priorities

In summary, three main priorities stood out in the analysis:

1. Protocols – this relates to all comments associated with what might otherwise be called “standard operating procedures” for a range of specific clinical circumstances.

Category examples include standardisation of:

  • Consent processes
  • Protocol-driven management of a wide range of clinical presentations and interventions – specific mentions included sepsis, trauma management, chemotherapy, difficult airways, commencement of surgery
  • Screening procedures
  • Management of deteriorating patients including vital signs measurement and montioring, escalation protocols etc.

A significant number of comments also related to standardisation of the documentation associated with these protocols.

2.  Medicines handling – this relates to all comments associated with prescription, storage and administration of medicines but excludes drug labelling which has been treated as a separate category. (NB If combined this would elevate “Medicines” to first position)

Category examples include standardisation of:

  • Drug / Fluids / Anticoagulation / Insulin chart layouts
  • Intravenous drug doses and concentrations including prefilled labelled syringes
  • Drug infusions for use in Critical Care / Theatres / Emergency Care
  • Drug cupboards, packaging, ampoules
  • National prescription chart
  • Electronic prescribing – avoiding incorrect prescriptions, drug interactions and incorrect administration.

3.     Equipment – this relates to all comments associated with commonly used monitoring, treatment and other specialist equipment.

Category examples include standardisation of:

  • Pumps & Infusion devices
  • Monitoring equipment
  • Difficult Airway Trolley – NOTE this piece of equipment also had its own category as it had 8 mentions in the respondents’ number 1 priority for standardisation, and 18 in total across all five priority listings
  • Equipment packs for CVC insertion
  • Operating tables.

 Comments

A number of caveats should be considered when examining the results of this survey.

  •  Medically qualified practitioners working in surgical and/or anaesthetics practice were very strongly represented in the sample
  • Respondents offered more than fifty additional free text comments. Within these responses there was a wide variation in how the term “standardisation” was being used
  • A significant number of respondents suggest “whole NHS” implementation approaches and treat the NHS as a single organisation rather than a federation of semi-independent bodies with their own systems of governance and control.

 


[1] A total of 321 surveys were started. 143 surveys were started and partially completed. 169 were fully completed.