Improving Shared Situation Awareness for High-risk Therapies in Hospitalized Children

BACKGROUND: High-risk therapies (HRTs), including medications and medical devices, are an important driver of preventable harm in children’s hospitals. To facilitate shared situation awareness (SA) and thus targeted harm prevention, we aimed to increase the percentage of electronic health record (EHR) alerts with the correct descriptor of an HRT from 11% to 100% on a high-acuity hospital unit over a 6-month period. METHODS: The interdisciplinary team defined an HRT as a medication or device with a significant risk for harm that required heightened awareness. Our aim for interventions was to (1) educate staff on a new HRT algorithm; (2) develop a comprehensive table of HRTs, risks, and mitigation plans; (3) develop bedside signs for patients receiving HRTs; and (4) restructure unit huddles. Qualitative interviews with families, nurses, and medical teams were used to assess shared SA and inform the development and adaptation of interventions. The primary outcome metric was the percentage of EHR alerts for an HRT that contained a correct descriptor of the therapy for use by the care team and institutional safety leaders. RESULTS: The percentage of EHR alerts with a correct HRT descriptor increased from an average of 11% to 96%, with special cause variation noted on a statistical process control chart. Using qualitative interview data, we identified critical awareness gaps, including establishing a shared mental model between nursing staff and the medical team as well as engagement of families at the bedside to monitor for complications. CONCLUSIONS: Explicit, structured processes and huddles can increase HRT SA among the care team, patient, and family.

Empirical Study of Shared Situation Awareness between Active and Passive Group-view Displays

The purpose of this study is to develop an active group-view display and evaluate the effectiveness of the prototype to cope with team errors in terms of shared situation awareness. The results of this research provide effective countermeasures that can be used to cope with team errors from the perspective of team communication and contextual situation sharing. To develop the active group-view display, we first investigated hazardous factors that could cause team error based on the team error process; we determined countermeasures to cope with these hazardous factors, validated the countermeasures by scenario-based analysis, developed an active group-view display that adds the function of interaction among operators in nuclear facilities and, finally, validated the effectiveness of the active display in terms of team situational awareness. Based on the team error process, we determined hazardous factors for team error that may occur in the process of using the group-view display. To prevent these hazardous factors, brainstorming with experienced operators is used to establish four countermeasures and three barriers against team error. A laser writing device with the function of pointing and marking information through gestures to the group-view display is proposed. An effectiveness test of team communication and decision making using the active group-view display device is performed using SACRI. The results of the test show a significant difference between active and passive displays. This study suggests that an improved interface using an active group-view display device can be utilized as a countermeasure against team errors. In order to cope with human errors that may occur in a digital control room, it is necessary to prepare countermeasures through systematic analysis of various interfaces such as computer-based procedures, digitalized alarm indicators, and mimic-based displays in nuclear power plants.