Role satisfaction among community volunteers working in mass COVID-19 vaccination clinics, Waterloo Region, Canada.

INTRODUCTION: Unpaid community volunteers are a vital public health resource in times of crisis. In response to the COVID-19 pandemic, community volunteers were mobilized to support mass vaccination efforts in many countries. To have this group's continued engagement, it is essential to understand the community volunteer experience, including the opportunities and challenges they encounter and how these contribute to their role satisfaction. This qualitative study investigated the factors contributing to community volunteers' role satisfaction at COVID-19 mass vaccination clinics in the Region of Waterloo, Canada. METHODS: Qualitative data were analyzed from 20 volunteers (aged 48-79 years) who had worked at one of four COVID-19 vaccination clinics in the Region of Waterloo, Canada. Data were analyzed thematically using an inductive coding process followed by an iterative process of grouping and identifying linkages and relationships within the themes. RESULTS: Four interrelated themes were developed from the inductive analysis process. The theme of community volunteers feeling valued or disesteemed in their role depends on the interaction between the three themes of role description, role preparation, and clinic context. CONCLUSIONS: For volunteers in crises such as the COVID-19 pandemic, volunteer role satisfaction depends on how their contributions are valued, the clarity of their role descriptions, volunteer-specific training, and the sentiments of volunteers and staff within the clinic context. Greater role satisfaction can help with retention as volunteers become more resilient and adaptable to the complex dynamic circumstances of a crisis response. Activities such as training and materials development for role preparations should be explicitly planned and well-resourced, even in crisis/pandemic situations. Building clinic managers' or supervisors' skills in communication during crisis/pandemic situations and the skills for the creation of team cohesion are critical investment areas.

Prescribers' perspectives on including reason for use information on prescriptions and medication labels: a qualitative thematic analysis.

BACKGROUND: The indication for prescribing a particular medication, or its reason for use (RFU) is a crucial piece of information for all those involved in the circle of care. Research has shown that sharing RFU information with physicians, pharmacists and patients improves patient safety and patient adherence, however RFU is rarely added on prescriptions by prescribers or on medication labels for patients to reference. METHODS: Qualitative interviews were conducted with 20 prescribers in Southern Ontario, Canada, to learn prescribers' current attitudes on the addition of RFU on prescriptions and medication labels. A trained interviewer used a semi-structured interview guide for each interview. The interviews explored how the sharing of RFU information would impact prescribers' workflows and practices. Interviews were recorded, transcribed and thematically coded. RESULTS: The analysis yielded four main themes: Current Practice, Future Practice, Changing Culture, and Collaboration. Most of the prescribers interviewed do not currently add RFU to prescriptions. Prescribers were open to sharing RFU with colleagues via a regional database but wanted the ability to provide context for the prescribed medication within the system. Many prescribers were wary of the impact of adding RFU on their workflow but felt it could save time by avoiding clarifying questions from pharmacists. Increased interprofessional collaboration, increased patient understanding of prescribed medications, avoiding guesswork when determining indications and decreased misinterpretation regarding RFU were cited by most prescribers as benefits to including RFU information. CONCLUSIONS: Prescribers were generally open to sharing RFU and clearly identified the benefits to pharmacists and patients if added. Critically, they also identified benefits to their own practices. These results can be used to guide the implementation of future initiatives to promote the sharing of RFU in healthcare teams.

Who provides care for people dying of cancer? A comparison of a rural and metropolitan cohort in a South Australian bereaved population study.

OBJECTIVE: To examine and compare urban and rural palliative care service availability and patterns of care from randomised, population-based surveys of caregivers of people at the end of life. DESIGN, SETTING & PARTICIPANTS: Survey responses on the death of 'someone close' from 23,588 interviews of South Australians conducted between 2001 and 2007 are analysed. INTERVENTIONS: A randomised population survey. MAIN OUTCOME MEASURES: Explored palliative care service availability, caregiving provided, and characteristics of the deceased and their caregivers. RESULTS: There was no difference in reported rates of accessing specialist palliative care services between rural and urban respondents (in unadjusted and adjusted analyses) nor did the proportion of people for whom cancer was their life-limiting illness. There was greater reliance on friends than first degree relatives in hands-on care provided at the end of life in rural settings. The rates of reported need for more support did not differ between urban and rural respondents for caregivers of people at the end of life. CONCLUSION: Use of palliative care services was similar for rural and urban caregivers for someone close at the end of life with similar levels of met and unmet needs.

Using team cognitive work analysis to reveal healthcare team interactions in a birthing unit.

Cognitive work analysis (CWA) as an analytical approach for examining complex sociotechnical systems has shown success in modelling the work of single operators. The CWA approach incorporates social and team interactions, but a more explicit analysis of team aspects can reveal more information for systems design. In this paper, Team CWA is explored to understand teamwork within a birthing unit at a hospital. Team CWA models are derived from theories and models of teamwork and leverage the existing CWA approaches to analyse team interactions. Team CWA is explained and contrasted with prior approaches to CWA. Team CWA does not replace CWA, but supplements traditional CWA to more easily reveal team information. As a result, Team CWA may be a useful approach to enhance CWA in complex environments where effective teamwork is required. PRACTITIONER SUMMARY: This paper looks at ways of analysing cognitive work in healthcare teams. Team Cognitive Work Analysis, when used to supplement traditional Cognitive Work Analysis, revealed more team information than traditional Cognitive Work Analysis. Team Cognitive Work Analysis should be considered when studying teams.

Capturing Home Care Information Management and Communication Processes Among Caregivers of Older Adults: Qualitative Study to Inform Technology Design.

BACKGROUND: The demand for complex home care is increasing with the growing aging population and the ongoing COVID-19 pandemic. Family and hired caregivers play a critical role in providing care for individuals with complex home care needs. However, there are significant gaps in research informing the design of complex home care technologies that consider the experiences of family and hired caregivers collectively. OBJECTIVE: The objective of this study was to explore the health documentation and communication experiences of family and hired caregivers to inform the design and adoption of new technologies for complex home care. METHODS: The research involved semistructured interviews with 15 caregivers, including family and hired caregivers, each of whom was caring for an older adult with complex medical needs in their home in Ontario, Canada. Due to COVID-19-related protection measures, the interviews were conducted via Teams (Microsoft Corp). The interview guide was informed by the cognitive work analysis framework, and the interview was conducted using storytelling principles of narrative medicine to enhance knowledge. Inductive thematic analysis was used to code the data and develop themes. RESULTS: Three main themes were developed. The first theme described how participants were continually updating the caregiver team, which captured how health information, including their communication motivations and intentions, was shared among family and hired caregiver participants. The subthemes included binder-based health documentation, digital health documentation, and communication practices beyond the binder. The second theme described how participants were learning to improve care and decision-making, which captured how they acted on information from various sources to provide care. The subthemes included developing expertise as a family caregiver and tailoring expertise as a hired caregiver. The third theme described how participants experienced conflicts within caregiver teams, which captured the different struggles arising from, and the causes of, breakdowns in communication and coordination between family and hired caregiver participants. The subthemes included 2-way communication and trusting the caregiver team. CONCLUSIONS: This study highlights the health information communication and coordination challenges and experiences that family and hired caregivers face in complex home care settings for older adults. Given the challenges of this work domain, there is an opportunity for appropriate digital technology design to improve complex home care. When designing complex home care technologies, it will be critical to include the overlapping and disparate perspectives of family and hired caregivers collectively providing home care for older adults with complex needs to support all caregivers in their vital roles.

Uncovering an invisible network of direct caregivers at the end of life: a population study.

BACKGROUND: Most palliative care research about caregivers relies on reports from spouses or adult children. Some recent clinical reports have noted the assistance provided by other family members and friends. AIM: This population study aims to define the people who actually provide care at the end of life. SETTING/PARTICIPANTS: A South Australian study conducted an annual randomized health population survey (n=23,706) over a 7 year period. A sample was obtained of self-identifying people who had someone close to them die and 'expected' death in the last 5 years (n=7915). Data were standardised to population norms for gender, 10-year age group, socioeconomic status, and region of residence. RESULTS: People of all ages indicated they provided 'hands on' care at the end of life. Extended family members (not first degree relatives) and friends accounted for more than half (n=1133/2028; 55.9%) of identified hands-on caregivers. These people came from the entire age range of the adult community. The period of time for which care was provided was shorter for this group of caregivers. People with extended family or friends providing care, were much more likely to be supported to die at home compared to having a spousal carer. CONCLUSION: This substantial network of caregivers who are mainly invisible to the health team provide the majority of care. Hospice and palliative care services need to create specific ways of identifying and engaging this cohort in order to ensure they are receiving adequate support in the role. Relying on 'next-of-kin' status in research will not identify them.

A repeat alcohol septal ablation procedure for hypertrophic obstructive cardiomyopathy where the first septal branch arose from the intermediate (ramus) artery.

Septal reduction therapy (via alcohol septal ablation or surgical myomectomy) is indicated in patients with hypertrophic obstructive cardiomyopathy (HOCM) who have NYHA class III/IV symptoms despite maximal medical therapy. In 90% of patients with HOCM the target septal artery arises from the LAD or diagonal artery. In the remaining 10% of cases it may arise from the ramus, proximal circumflex, or posterolateral or posterior descending branches of the RCA. We present a case where alcohol septal ablation was initially performed on the first septal branch arising from the left anterior descending artery. Left ventricular outflow tract (LVOT) obstruction with symptoms recurred. Upon repeat angiography, a large septal branch in fact arose from the proximal intermediate (ramus) artery. Alcohol ablation of this branch achieved a sustained response. This case highlights that correctly identifying the most suitable septal perforating artery, in addition to myocardial contrast echocardiography, may improve response rates and overall outcomes for patients with hypertrophic obstructive cardiomyopathy.

Multi-Disciplinary Design and Implementation of a Mass Vaccination Clinic Mobile Application to Support Decision-Making.

Mass vaccination clinics are complex systems that combine professionals who do not typically work together. Coordinating vaccine preparation and patient intake is critically important to maintain patient flow equilibrium, requiring continuous communication and shared decision-making to reduce vaccine waste. OBJECTIVES: (1) To develop a mobile application (app) that can address the information needs of vaccination clinic stakeholders for end-of-day doses decision-making in mass immunization settings; and (2) to understand usability and clinical implementation among multi-disciplinary users. METHODS: Contextual inquiry guided 71.5 hours of observations to inform design characteristics. Rapid iterative testing and evaluation were performed to validate and improve the design. Usability and integration were evaluated through observations, interviews, and the system usability scale. RESULTS: Designing the app required consolidating contextual factors to support information and workload needs. Twenty-four participants used the app at four clinics who reported its effectiveness in reducing stress and improving communication efficiency and satisfaction. They also discussed positive workflow changes and design recommendations to improve its usefulness. The average system usability score was 87 (n = 22). DISCUSSION: There is significant potential for mobile apps to improve workflow efficiencies for information sharing and decision-making in vaccination clinics when designed for established cultures and usability, thereby providing frontline workers with greater time to focus on patient care and immunization needs. However, designing and implementing digital systems for dynamic settings is challenging when healthcare teams constantly adapt to evolving complexities. System-level barriers to adoption require further investigation. Future research should explore the implementation of the app within global contexts.

Caregiver Expectations of Interfacing With Voice Assistants to Support Complex Home Care: Mixed Methods Study.

BACKGROUND: Providing care in home environments is complex, and often the pressure is on caregivers to document information and ensure care continuity. Digital information management and communication technologies may support care coordination among caregivers. However, they have yet to be adopted in this context, partly because of issues with supporting long-term disease progression and caregiver anxiety. Voice assistant (VA) technology is a promising method for interfacing with digital health information that may aid in multiple aspects of being a caregiver, thereby influencing adoption. Understanding the expectations for VAs to support caregivers is fundamental to inform the practical development of this technology. OBJECTIVE: This study explored caregivers' perspectives on using VA technology to support caregiving and inform the design of future digital technologies in complex home care. METHODS: This study was part of a larger study of caregivers across North America on the design of digital health technologies to support health communication and information management in complex home care. Caregivers included parents, guardians, and hired caregivers such as personal support workers and home care nurses. Video interviews were conducted with caregivers to capture their mental models on the potential application of VAs in complex home care and were theoretically analyzed using the technology acceptance model. Interviews were followed up with Likert-scale questions exploring perspectives on other VA applications beyond participants' initial perceptions. RESULTS: Data were collected from 22 caregivers, and 3 themes were identified: caregivers' perceived usefulness of VAs in supporting documentation, care coordination, and person-centered care; caregivers' perceived ease of use in navigating information efficiently (they also had usability concerns with this interaction method); and caregivers' concerns, excitement, expected costs, and previous experience with VAs that influenced their attitudes toward use. From the Likert-scale questions, most participants (21/22, 95%) agreed that VAs should support prompted information recording and retrieval, and all participants (22/22, 100%) agreed that they should provide reminders. They also agreed that VAs should support them in an emergency (18/22, 82%)-but only for calling emergency services-and guide caregivers through tasks (21/22, 95%). However, participants were less agreeable on VAs expressing a personality (14/22, 64%)-concerned they would manipulate caregivers' perceptions-and listening ambiently to remind caregivers about their documentation (16/22, 73%). They were much less agreeable about VAs providing unprompted assistance on caregiving tasks (9/22, 41%). CONCLUSIONS: The interviews and Likert-scale results point toward the potential for VAs to support family caregivers and hired caregivers by easing their information management and health communication at home. However, beyond information interaction, the potential impact of VA personality traits on caregivers' perceptions of the care situation and the passive collection of audio data to improve user experience through context-specific interactions are critical design considerations that should be further examined.

Exploring the Experiences of Family Caregivers of Children With Special Health Care Needs to Inform the Design of Digital Health Systems: Formative Qualitative Study.

BACKGROUND: Family caregivers of children with special health care needs (CSHCN) are responsible for managing and communicating information regarding their child's health in their homes. Although family caregivers currently capture information through nondigital methods, digital health care applications are a promising solution for supporting the standardization of information management in complex home care across their child's health care team. However, family caregivers continue to use paper-based methods where the adoption of digital health care tools is low. With the rise in home care for children with complex health care needs, it is important to understand the caregiving work domain to inform the design of technologies that support child safety in the home. OBJECTIVE: The aim of this study is to explore how family caregivers navigate information management and communication in complex home care for CSHCN. METHODS: This research is part of a broader study to explore caregivers' perspectives on integrating and designing digital health care tools for complex home care. The broader study included interviews and surveys about designing a voice user interface to support home care. This formative study explored semistructured interview data with family caregivers of CSHCN about their home care situations. Inductive thematic analysis was used to analyze the information management and communication processes. RESULTS: We collected data from 7 family caregivers in North America and identified 5 themes. First, family caregivers were continuously learning to provide care. They were also updating the caregiver team on their child's status and teaching caregivers about their care situation. As caregiving teams grew, they found themselves working on communicating with their children's educators. Beyond the scope of managing their child's health information, family caregivers also navigated bureaucratic processes for their child's home care. CONCLUSIONS: Family caregivers' experiences of caring for CSHCN differ contextually and evolve as their child's condition changes and they grow toward adulthood. Family caregivers recorded information using paper-based tools, which did not sufficiently support information management. They also experienced significant pressure in summarizing information and coordinating 2-way communication about the details of their child's health with caregivers. The design of digital health care systems and tools for complex home care may improve care coordination if they provide an intuitive method for information interaction and significant utility by delivering situation-specific insights and adapting to unique and dynamic home care environments. Although these findings provide a foundational understanding, there is an opportunity for further research to generalize the findings.

Understanding Human Factors Challenges on the Front Lines of Mass COVID-19 Vaccination Clinics: Human Systems Modeling Study.

BACKGROUND: Implementing mass vaccination clinics for COVID-19 immunization has been a successful public health activity worldwide. However, this tightly coupled system has many logistical challenges, leading to increased workplace stress, as evidenced throughout the pandemic. The complexities of mass vaccination clinics that combine multidisciplinary teams working within nonclinical environments are yet to be understood through a human systems perspective. OBJECTIVE: This study aimed to holistically model mass COVID-19 vaccination clinics in the Region of Waterloo, Ontario, Canada, to understand the challenges centered around frontline workers and to inform clinic design and technological recommendations that can minimize the systemic inefficiencies that contribute to workplace stress. METHODS: An ethnographic approach was guided by contextual inquiry to gather data on work as done in these ad-hoc immunization settings. Observation data were clarified by speaking with clinic staff, and the research team discussed the observation data regularly throughout the data collection period. Data were analyzed by combining aspects of the contextual design framework and cognitive work analysis, and building workplace models that can identify the stress points and interconnections within mass vaccination clinic flow, developed artifacts, culture, physical layouts, and decision-making. RESULTS: Observations were conducted at 6 mass COVID-19 vaccination clinics over 4 weeks in 2021. The workflow model depicted challenges with maintaining situational awareness about client intake and vaccine preparation among decision-makers. The artifacts model visualized how separately developed tools for the vaccine lead and clinic lead may support cognitive tasks through data synthesis. However, their effectiveness depends on sharing accurate and timely data. The cultural model indicated that perspectives on how to effectively achieve mass immunization might impact workplace stress with changes to responsibilities. This depends on the aggressive or relaxed approach toward minimizing vaccine waste while adapting to changing policies, regulations, and vaccine scarcity. The physical model suggested that the co-location of workstations may influence decision-making coordination. Finally, the decision ladder described the decision-making steps for managing end-of-day doses, highlighting challenges with data uncertainty and ways to support expertise. CONCLUSIONS: Modeling mass COVID-19 vaccination clinics from a human systems perspective identified 2 high-level opportunities for improving the inefficiencies within this health care delivery system. First, clinics may become more resilient to unexpected changes in client intake or vaccine preparation using strategies and artifacts that standardize data gathering and synthesis, thereby reducing uncertainties for end-of-day dose decision-making. Second, improving data sharing among staff by co-locating their workstations and implementing collaborative artifacts that support a collective understanding of the state of the clinic may reduce system complexity by improving shared situational awareness. Future research should examine how the developed models apply to immunization settings beyond the Region of Waterloo and evaluate the impact of the recommendations on workflow coordination, stress, and decision-making.

Automated digital technologies for supporting sepsis prediction in children: a scoping review protocol.

INTRODUCTION: While there have been several literature reviews on the performance of digital sepsis prediction technologies and clinical decision-support algorithms for adults, there remains a knowledge gap in examining the development of automated technologies for sepsis prediction in children. This scoping review will critically analyse the current evidence on the design and performance of automated digital technologies to predict paediatric sepsis, to advance their development and integration within clinical settings. METHODS AND ANALYSIS: This scoping review will follow Arksey and O'Malley's framework, conducted between February and December 2022. We will further develop the protocol using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. We plan to search the following databases: Association of Computing Machinery (ACM) Digital Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Google Scholar, Institute of Electric and Electronic Engineers (IEEE), PubMed, Scopus and Web of Science. Studies will be included on children >90 days postnatal to <21 years old, predicted to have or be at risk of developing sepsis by a digitalised model or algorithm designed for a clinical setting. Two independent reviewers will complete the abstract and full-text screening and the data extraction. Thematic analysis will be used to develop overarching concepts and present the narrative findings with quantitative results and descriptive statistics displayed in data tables. ETHICS AND DISSEMINATION: Ethics approval for this scoping review study of the available literature is not required. We anticipate that the scoping review will identify the current evidence and design characteristics of digital prediction technologies for the timely and accurate prediction of paediatric sepsis and factors influencing clinical integration. We plan to disseminate the preliminary findings from this review at national and international research conferences in global and digital health, gathering critical feedback from multidisciplinary stakeholders. SCOPING REVIEW REGISTRATION: https://osf.io/veqha/?view_only=f560d4892d7c459ea4cff6dcdfacb086.

What is the role of friends when contributing care at the end of life? Findings from an Australian population study.

PURPOSE: To examine the role of friends as caregivers of people with terminal illness. METHOD: Piloted questions were included in the 2001-2007 random face-to-face annual health surveys of 23588 South Australians on the death of a loved one, caregiving provided, and characteristics of the caregiver and deceased individual. The survey was representative of the population by age, gender, and region of residence. Analyses focused on friends of the deceased loved one, providing daily or intermittent 'hands on' care. Logistic regression assessed predictors of home death. RESULTS: Daily 'hands on' carers were much more likely to be female and aged between 55 and 64; there was also a younger (12 months. Home deaths were more frequent (32%, p=0.014) when friends were carers, and the rate of palliative care use was higher than when family/others provided care (70 vs 61%). Regression analyses confirmed friends as caregivers as a predictor of home death (OR 1.73: 95%, CI 1.15-2.87). CONCLUSION: Friends contribute their caregiving: A cohort of younger caregivers may reflect changing social mores as the extended family shrinks and people turn to friendship networks for care and support at the end of life.

Occurrence detection and selection procedures in healthcare facilities: a comparison across Canada and Brazil.

Healthcare institutions face high levels of risk on a daily basis. Efforts have been made to address these risks and turn this complex environment into a safer environment for patients, staff, and visitors. However, healthcare institutions need more advanced risk management tools to achieve the safety levels currently seen in other industries. One of these potential tools is occurrence investigation systems. In order to be investigated, occurrences must be detected and selected for investigation, since not all institutions have enough resources to investigate all occurrences. A survey was conducted in healthcare institutions in Canada and Brazil to evaluate currently used risk management tools, the difficulties faced, and the possibilities for improvement. The findings include detectability difficulties, lack of resources, lack of support, and insufficient staff involvement.

Situation awareness and risk management understanding the notification issues.

Healthcare institutions are known to be risky environments that still lag behind other industries in the development and application of risk management tools. Awareness of risk is an important aspect of a risk management program. People depend on high awareness to take precautions to manage risk. The Situation Awareness framework describes how a person perceives elements of the environment, comprehends and projects its actions into the future, and analyzes the cognitive process used. Consequently, it allows the integration of the cognitive model and the risk assessment model into one single framework, provides a means of examining if the risk awareness is calibrated to the true risk levels of the institutions, and a better understanding of the issues with adverse events notification systems. In this paper we discuss how the situation awareness model can be used in the assessment of risk awareness, for understanding risk awareness and safety culture, and finally, for designing more effective risk management systems. For the purpose of this paper, we focus on the adverse event notification system.

How do I keep myself safe? Patient perspectives on including reason for use information on prescriptions and medication labels: a qualitative thematic analysis.

BACKGROUND: Medications are crucial for maintaining patient wellness and improving health in modern medicine, but their use comes with risks. Helping patients to understand why they are taking medications is important for patient-centered care and facilitates patient adherence to prescribed medications. One strategy involves enhancing communication between patients, physicians, and pharmacists through the sharing of reason for use (RFU) information or the indication for medications. METHODS: Semi-structured interviews were conducted with 20 patients in Ontario, Canada, to gain perspectives on how patients currently store their medication information and benefits and disadvantages of adding RFU to prescriptions and medication labels. An interview guide was used by the two interviewers, and the interviews were recorded, transcribed, and thematically coded. RESULTS: The analysis yielded three main themes: patient decision making with RFU, RFU in modern, patient-centered care, and logistical aspects of communicating RFU. The patients that were interviewed expressed the value of having RFU when deciding if a medication was effective or to stop taking the medication. Patients felt comfortable with RFU being added to prescriptions and acknowledged the value in adding RFU to medication labels, helping patients and others identify and distinguish medications. Patients generally expressed interest in having RFU written in lay language and identified strengths and weaknesses of having access to RFU via a website or app. CONCLUSIONS: Patients rated the importance of knowing RFU very highly, identified the value in sharing RFU with pharmacists on prescriptions, and in having RFU on medication labels. These results can be used to inform policy on the addition of RFU on prescriptions and medication labels and support improved communication between patients, pharmacists, and physicians about RFU.

Place of death for people with noncancer and cancer illness in South Australia: a population-based survey.

A large representative population survey of 9,500 households reports the association between place of death, diagnosis (cancer vs. noncancer), and use of palliative care services of terminally ill South Australians. Thirty-one percent (1,920) indicated that someone close to them had died of a terminal illness in the preceding five years; 18% had died of noncancer illness and 82% of cancer. Sixty-two percent of deceased individuals accessed palliative care services. More patients with cancer than noncancer had had palliative care (65% vs. 48%; p < 0.0001). Compared with cancer patients, those with noncancer illness had died in hospices less frequently (9% vs. 15%; p = 0.0015) and in nursing homes more frequently (15% vs. 5%; p < 0.0001). Similar proportions had died in hospital (60%) and at home (16%-20%). Palliative care service involvement did not reduce institutional deaths, but shifted them from hospital to hospice.

Using human factors methods to evaluate the labelling of injectable drugs.

Adverse drug events, including in-hospital medication errors, are a well-documented world-wide problem. This interdisciplinary team set out to examine the issues related to the labelling of injectable drugs. We sought answers to the following two questions: (1) To what extent do injectable drug labels adhere to existing Canadian design practice recommendations and regulations for labelling and (2) is there a need to make changes to the recommendations or regulations for labelling of injectable drugs in Canada? The project contained three phases. The first phase involved taking a sample of vials and ampoules from a hospital pharmacy and identifying adherence to the 1999 Canadian Standards Association standard for the labelling of drug ampoules, vials and prefilled syringes, as well as with the Canadian (Health Canada) Food and Drug Regulations for labelling. The second phase involved a failure mode and effects analysis of the label-reading process in order to identify information on the label considered critical for safe medication use. The third phase involved a preliminary human factors experiment addressing one problem identified with existing labels. Our finding is that existing injectable drug labels do not adhere sufficiently to available best design standards for labels and also do not adhere to all Canadian Food and Drug Regulations. Recommendations are made to inform future enhancements to labelling standards, guidelines and regulations.

Design and evaluation of a safety-centered user interface for radiation therapy.

PURPOSE: As radiation therapy treatment grows more complex over time, treatment delivery has become more susceptible to adverse events and patient safety risks from use error. The radiation therapy monitoring and treatment delivery user interface explored in this study was redesigned using ecological interface design, a human factors engineering method, and evaluated to improve treatment safety. METHODS AND MATERIALS: An initial design concept was created based on previously completed analysis and informally evaluated in focus groups with radiation therapists. Sixteen newly graduated radiation therapists used both the redesigned and current system in a usability test to determine if the redesigned system better supported detection of errors. RESULTS: The redesigned system successfully improved the error detection rate of 2 errors: wrong treatment volume and wrong treatment site (P < .03 and P < .01, respectively). It also improved level 2 and level 3 situation awareness (ie, comprehension of the meaning of the information and the projection of the behavior of the technology: P < .01 and P < .01, respectively) and achieved a higher user satisfaction. CONCLUSIONS: The ecological interface design approach was found to be effective in redesigning a radiation therapy treatment delivery interface. Radiation therapists were able to deliver simulated radiation therapy with a higher rate of error detection and improved higher-level situation awareness, and participants preferred the redesigned interface to the current interface. Overall, the redesigned interface improved the radiation therapists' system understanding and ability to detect errors that affect patient safety.