The rate of injury and death inadvertently caused by medical treatment is too high and exacts enormous human and financial costs. Each year in Britain and the United States alone, hundreds of thousands of patients are injured, ten of thousands are killed and billions of dollars are spent on additional health care due to iatrogenic harm. Health care organisations remain predominately human-centred in their approach to safety-that is, methods of avoiding error rely primarily on the resolve and vigilance of individual clinicians to avoid bad outcomes. However, this approach is becoming increasingly inadequate in the face of the steadily rising complexity of modern health care and the increasing number of procedures carried out each year. In other high-reliability organisations such as aviation and nuclear power generation, safety results not from the sheer effort of “operators”, but from in-depth analysis of problems and the removal and redesign of dangerous aspects of systems-the so-called systems approach. Here I present an evaluation of the integrated drug administration system (IDAS) as an example of the systems approach, intended to reorganise the way in which anaesthetists give drugs to improve performance and facilitate safe practice. The problem of drug error in anaesthesia is an important subset of iatrogenic harm in medicine. From the prospective study of 10806 conventional anaesthetics I define the rate of drug error in anaesthesia as one error in every 133 anaesthetics conducted-a rate five times higher than anything previously reported. In addition, anaesthetists rated the risk of harming a patient through drug error in the course of their career as high. I discuss the principles of safe system design, the psychology of error, and advanced systems safety concepts with respect to the design of the IDAS and the future of safety in medicine. In clinical use, the IDAS saved time before and during anaesthesia, and was rated by anaesthetists as significantly safer and more useable than conventional methods of drug administration. This work supports the hypothesis that error in anaesthesia can be reduced through the systematic analysis of its causes and the implementation of appropriate countermeasure strategies. / Subscription resource available via Digital Dissertations only.

The rate of injury and death inadvertently caused by medical treatment is too high and exacts enormous human and financial costs. Each year in Britain and the United States alone, hundreds of thousands of patients are injured, ten of thousands are killed and billions of dollars are spent on additional health care due to iatrogenic harm. Health care organisations remain predominately human-centred in their approach to safety-that is, methods of avoiding error rely primarily on the resolve and vigilance of individual clinicians to avoid bad outcomes. However, this approach is becoming increasingly inadequate in the face of the steadily rising complexity of modern health care and the increasing number of procedures carried out each year. In other high-reliability organisations such as aviation and nuclear power generation, safety results not from the sheer effort of “operators”, but from in-depth analysis of problems and the removal and redesign of dangerous aspects of systems-the so-called systems approach. Here I present an evaluation of the integrated drug administration system (IDAS) as an example of the systems approach, intended to reorganise the way in which anaesthetists give drugs to improve performance and facilitate safe practice. The problem of drug error in anaesthesia is an important subset of iatrogenic harm in medicine. From the prospective study of 10806 conventional anaesthetics I define the rate of drug error in anaesthesia as one error in every 133 anaesthetics conducted-a rate five times higher than anything previously reported. In addition, anaesthetists rated the risk of harming a patient through drug error in the course of their career as high. I discuss the principles of safe system design, the psychology of error, and advanced systems safety concepts with respect to the design of the IDAS and the future of safety in medicine. In clinical use, the IDAS saved time before and during anaesthesia, and was rated by anaesthetists as significantly safer and more useable than conventional methods of drug administration. This work supports the hypothesis that error in anaesthesia can be reduced through the systematic analysis of its causes and the implementation of appropriate countermeasure strategies. / Subscription resource available via Digital Dissertations only.

Fatigue in the minerals industry of Western Australia is a greatly under-recognised issue that has serious potential consequences for shift workers at work and at home. A review of fatigue literature demonstrates the elusive nature of fatigue. It is something that most people have probably experienced at some time in their lives. It is a diffuse sensation that is accompanied by feelings of lethargy and a lack of interest in any activity. A general sensation of weariness is a major symptom of fatigue. Fatigue cannot be measured directly and subjective estimates have to be relied upon. Potentially life threatening consequences can result when shift workers perform under the influence of fatigue. Fatigue and sleepiness have the power to kill if not treated with the respect they deserve. A cross-sectional survey of five underground mines was conducted to obtain a better understanding of their fatigue risk management strategies and the views of managers and shift workers on their sleep and shift schedules. Four mines provided information on their fatigue risk management procedures. Ten underground mining crews comprising 147 shift workers provided their views by an anonymous survey questionnaire administered at each mine at the start of shift. Shift worker sleep at the five mines compared well with mines in Tasmania, New South Wales and Queensland. However, it was found that frequently waking earlier than intended was the most widely reported sleep concern for shift workers on day shift, night shift and days off. Falling asleep while on day shift and on night shift demonstrates that fatigue is an issue that can occur on day shift as well as night shift. Fatigue is not an issue that is confined to night shift. Mine fitness for work procedures focused primarily on: shift schedules, hours of work and drug and alcohol issues. The level of detail provided on fatigue risk management was considered to be less than adequate when compared with the three previous issues and fatigue risk management documentation sourced from the minerals industry and the transport industry. The survey data and fitness for work procedures provided by four mines suggests that considerably more work needs to be done to recognise and address sleep quantity and quality, as well as sleepiness and fatigue experienced by shift workers while on shift and at home on rest days. There is a serious need for the Western Australian minerals industry to recognise the vital importance of sleep to shift workers during their shift schedule and rest days. There needs to be a concerted and on-going campaign by the industry to raise and maintain the awareness of sleep as a key element in fitness for duty.

The rate of injury and death inadvertently caused by medical treatment is too high and exacts enormous human and financial costs. Each year in Britain and the United States alone, hundreds of thousands of patients are injured, ten of thousands are killed and billions of dollars are spent on additional health care due to iatrogenic harm. Health care organisations remain predominately human-centred in their approach to safety-that is, methods of avoiding error rely primarily on the resolve and vigilance of individual clinicians to avoid bad outcomes. However, this approach is becoming increasingly inadequate in the face of the steadily rising complexity of modern health care and the increasing number of procedures carried out each year. In other high-reliability organisations such as aviation and nuclear power generation, safety results not from the sheer effort of “operators”, but from in-depth analysis of problems and the removal and redesign of dangerous aspects of systems-the so-called systems approach. Here I present an evaluation of the integrated drug administration system (IDAS) as an example of the systems approach, intended to reorganise the way in which anaesthetists give drugs to improve performance and facilitate safe practice. The problem of drug error in anaesthesia is an important subset of iatrogenic harm in medicine. From the prospective study of 10806 conventional anaesthetics I define the rate of drug error in anaesthesia as one error in every 133 anaesthetics conducted-a rate five times higher than anything previously reported. In addition, anaesthetists rated the risk of harming a patient through drug error in the course of their career as high. I discuss the principles of safe system design, the psychology of error, and advanced systems safety concepts with respect to the design of the IDAS and the future of safety in medicine. In clinical use, the IDAS saved time before and during anaesthesia, and was rated by anaesthetists as significantly safer and more useable than conventional methods of drug administration. This work supports the hypothesis that error in anaesthesia can be reduced through the systematic analysis of its causes and the implementation of appropriate countermeasure strategies. / Subscription resource available via Digital Dissertations only.

The rate of injury and death inadvertently caused by medical treatment is too high and exacts enormous human and financial costs. Each year in Britain and the United States alone, hundreds of thousands of patients are injured, ten of thousands are killed and billions of dollars are spent on additional health care due to iatrogenic harm. Health care organisations remain predominately human-centred in their approach to safety-that is, methods of avoiding error rely primarily on the resolve and vigilance of individual clinicians to avoid bad outcomes. However, this approach is becoming increasingly inadequate in the face of the steadily rising complexity of modern health care and the increasing number of procedures carried out each year. In other high-reliability organisations such as aviation and nuclear power generation, safety results not from the sheer effort of “operators”, but from in-depth analysis of problems and the removal and redesign of dangerous aspects of systems-the so-called systems approach. Here I present an evaluation of the integrated drug administration system (IDAS) as an example of the systems approach, intended to reorganise the way in which anaesthetists give drugs to improve performance and facilitate safe practice. The problem of drug error in anaesthesia is an important subset of iatrogenic harm in medicine. From the prospective study of 10806 conventional anaesthetics I define the rate of drug error in anaesthesia as one error in every 133 anaesthetics conducted-a rate five times higher than anything previously reported. In addition, anaesthetists rated the risk of harming a patient through drug error in the course of their career as high. I discuss the principles of safe system design, the psychology of error, and advanced systems safety concepts with respect to the design of the IDAS and the future of safety in medicine. In clinical use, the IDAS saved time before and during anaesthesia, and was rated by anaesthetists as significantly safer and more useable than conventional methods of drug administration. This work supports the hypothesis that error in anaesthesia can be reduced through the systematic analysis of its causes and the implementation of appropriate countermeasure strategies. / Subscription resource available via Digital Dissertations only.

Thesis (Ph.D.)--University of California, San Francisco, 2007. / Source: Dissertation Abstracts International, Volume: 68-10, Section: B, page: 6588. Adviser: Julia Faucett.

Thesis (Ph.D.)--University of California, San Francisco, 2007. / Source: Dissertation Abstracts International, Volume: 68-02, Section: B, page: 0889. Adviser: William Holzemer.

Thesis (Ph.D.)--Indiana University, School of Health, Physical Education and Recreation, 2008. / Title from home page (viewed on Jul 28, 2009). Source: Dissertation Abstracts International, Volume: 69-12, Section: B, page: 7425. Adviser: Dong-Chul Seo.

Thesis (Ph.D.)--University of California, San Francisco, 2008. / Source: Dissertation Abstracts International, Volume: 69-12, Section: B, page: 7413. Adviser: Mary C. White.

Thesis (Ph.D.)--Wake Forest University, 2007. / (UMI)AAI3294400. Source: Dissertation Abstracts International, Volume: 68-12, Section: B, page: 7973. Adviser: Michael Aschner.