Desarrollo

In addition  to the  task  observations  and  analysis,  further  ergonomics system  factors  were 

analysed. This identified a significant number of areas of concern that could directly or indirectly 

compromise the performance of the home with respect to medication administration. These areas 

are listed below.  

1.  Task Interruptions 

• Staffing levels influenced interruptions  • Other duties required during round 

o Manager/assistant manager doing round 

o Nurse with responsibility for care staff supervision  • Training often low or absent 

• Very few interruptions relevant to completion of the drug round (e.g. feedback on a 

residents reaction to earlier medication etc) 

• Wide variation between homes, normally due to either difference in staffing levels and 

‘other’ duties, or in the level of attention required by residents between care types (i.e. 

nursing, residential, dementia etc) 

2.  Physical ergonomics of the trolley design  • Lack of space on top surface 

• Poor posture when lifting MDS out of interior  • Poor manoeuvrability 

• Lack of storage ‘pockets’ to aid in organising non‐MDS medication 

• Top surface often too high for comfortable use/entry on MAR chart and sorting of MDS 

cards 

• Often observed trolley being kept in one location during the round, not moved to resident  • In some cases mainly used just for secure storage, not portability 

3.  Physical ergonomics of building design  • Inadequate lighting for task 

• Narrow corridors  • Poor ventilation  • Little natural light 

• Inadequate elevators for trolley 

• Emergency call systems poorly designed  • Contrast with some purpose built homes  4.  General 

• Need to secure medication in trolley between residents was time consuming, awkward to 

complete and distracting to the primary task 

• Variation in how water was supplied to residents with medication (e.g. on trolley, already 

in rooms etc) 

5.  Discontinued items 

• Observations suggested that this was not a widespread problem (this contrasted with the 

analysis of errors in the CHUMS project) 

• In many cases there were no discontinued items 

• Not often viewed as a problem by care home or pharmacy staff  • Design improvements could be made to reduce impact further 

• Most pharmacies had procedures in place to reduce or eliminate the issue 

• Scope  to  enhance  existing  procedures  further  through  software  re‐design  and 

communication procedures  6.  Communication 

• Normally reported by both pharmacies and care homes as reasonably good  • Main mechanisms used are FAX and telephone 

• Possible  weakness  in  the  procedures  and  mechanisms  available  for  care  homes  to 

communicate with pharmacy 

• Variation in the use of the MAR chart to feed back data on next drug cycle requirements  • Some homes did not see prescriptions prior to dispensing by pharmacy 

• Both pharmacy and care home staff would like to see the scope for more visits by 

pharmacists and GPs to care home 

• Patient medical and medication information could be more comprehensive/suitable for 

tasks at both the pharmacy and care home 

To further appreciate their implications, a table (Table 7.1) has been constructed that includes 

suggestions regarding the consequences of each issue and also possible actions to resolve each. It 

must be stressed that these are suggestions that might be explored and tested rather than being 

‘answers’ to the problems raised. (Note: It was not possible within this study to provide and test 

solutions to the problems encountered.)   

Table 7.1: Ergonomics systems problems, consequences and actions  Ergonomics

systems problems, consequences and actionsCategory 

Observation Consequences Suggested action

Staffing levels

Insufficient staff available to deal with unexpected events during the drug round

Improve staffing levels. Two staff to conduct busy drug rounds

Other duties

required during drug round

Interruption of primary task to complete other duties (e.g. answering telephone or door. Dealing with staff management issues)

Review staff duties during a drug round. Temporary switching of duties during the critical time. Staffing issues

Training often low or absent

Drug round staff unable to identify mistakes or required changes in medication. Unable to recognise physical

symptoms either resulting from or requiring medication Address training priorities specific to conducting a drug round. Ensure knowledge of common medications including their purpose and possible side-effects.

Lack of space on top surface

Difficulty in organising MAR charts and MDS systems. Spillages during drinking water

dispensing. Limited room for measuring out liquid medication

Trolley re-design

MDS location inside drug trolley

Poor posture required to either remove or return MDS file to the drug trolley

Re-design trolley interior to permit better location of MDS files. Review design of MDS file to facilitate better match with trolley interior

Poor

manoeuvrability

Trolley left further away from resident to avoid the problem. Potential

posture problems while pushing/pulling

Re-design of trolley wheels. Consider recent developments in trolley design in other sectors (e.g. retail) Lack of storage

‘pockets for non- MDS medication

Medicines stored in old margarine tubs, or loose in the trolley door

Re-design trolley interior to

accommodate non- MDS medicines. Better use of door cavities Trolley design

Top surface often too high for comfortable use

Potential for mis- reading/completing of MAR chart, or mistakes in selecting correct MDS for resident

Use ergonomics standards to assess working height suitable for standing task. Re- design trolley to suit

Category Observation Consequences Suggested action

Trolley design

Kept in one location during drug round. Not moved to residents

Trolley is being used as secure storage rather than a mobile facility

Consider use of a ‘drug room’ in

particular homes. This allows better space for storage, filing, drinks etc.

Inadequate lighting for task

Inaccurate measurement of liquid dosages. Small increase in potential for mistakes on MAR or selecting MDS

Conduct lighting surveys in care homes. Consider localised task lighting, possibly integrated in trolley design

Narrow corridors

Leaving trolley further from resident.

Interference with other procedures in the home (e.g. residents moving around home. Staff movement)

Design input to new home builds. Establish standards for building conversions. Design narrower trolley

Inadequate elevators for drug trolleys

Potential physical injury while manoeuvring trolley into elevator. Trolley left on ground floor

Establish criteria for lift design in new and converted buildings. Study into trolley dimensions to suit existing lifts Building design

Emergency call systems poorly designed

Distracting noise during drug round

Check volume and pitch against hearing characteristics of staff. Use of more visual signals

Variation in how water is supplied for residents during drug round

If transported with trolley, often resulted in spillages and used valuable space on the trolley top

Consider supplying fresh water to

residents just prior to the drug round. This is already practiced at some homes

General observations

Residents not able or unwilling to take

medication at the time of the drug round

Doses can be missed and not discovered until the next round

Supply a checklist on the drug trolley that can act as a reminder to staff on completion of the round. Each resident could be ticked off when ALL medication has been given. This would also be an aid when the drug round has to be interrupted

Category Observation Consequences Suggested action

Ad-hoc prescriptions are faxed to the pharmacy for dispensing

Homes often have no feedback to acknowledge that the prescription has been received. Time is wasted in contacting pharmacy to confirm

Introduce a procedure whereby faxes in either direction are confirmed immediately via a return fax or telephone call Often no formal way for

the home to feedback information to the

pharmacy on changes in medication since the last cycle

Can result in items being included on the MAR chart that are no longer required. Wasted time for pharmacy in checking with the care home to clarify missing

prescriptions

Some homes already have a feedback form associated with each sheet of the MAR chart. This could be recommended across all homes.

Communication

In some cases when a GP prescribes

medication during a typical 28 day drug cycle, the home will obtain the medication from a local pharmacy and not the one used for the whole cycle. Information on these events is often not fed back to the main pharmacy

This results in the main pharmacy not having a comprehensive record of medication for particular residents. In isolated cases it could mean that the expertise of the pharmacy could be wasted in relation to possible interactions between medicines.

Introduce a procedure to ensure that any ad- hoc medication during the 28 day cycle is reported back to the main pharmacy for their records