Usage and Usability of a National e-Library for Chemotherapy Regimens: Mixed Methods Study.

BACKGROUND: Accurate information about chemotherapy drugs and regimens is needed to reduce chemotherapy errors. A national e-library, as a common knowledge source with standardized chemotherapy nomenclature and content, was developed. Since the information in the library is both complex and extensive, it is central that the users can use the resource as intended. OBJECTIVE: The aim of this study was to evaluate the usage and usability of an extensive e-library for chemotherapy regimens developed to reduce medication errors, support the health care staff in their work, and increase patient safety. METHODS: To obtain a comprehensive evaluation, a mixed methods study was performed for a broad view of the usage, including a compilation of subjective views of the users (web survey, spontaneous user feedback, and qualitative interviews), analysis of statistics from the website, and an expert evaluation of the usability of the webpage. RESULTS: Statistics from the website show an average of just over 2500 visits and 870 unique visitors per month. Most visits took place Mondays to Fridays, but there were 5-10 visits per day on weekends. The web survey, with 292 answers, shows that the visitors were mainly physicians and nurses. Almost 80% (224/292) of respondents searched for regimens and 90% (264/292) found what they were looking for and were satisfied with their visit. The expert evaluation shows that the e-library follows many existing design principles, thus providing some useful improvement suggestions. A total of 86 emails were received in 2020 with user feedback, most of which were from nurses. The main part (78%, 67/86) contained a question, and the rest had discovered errors mainly in some regimen. The interviews reveal that most hospitals use a computerized physician order entry system, and they use the e-library in various ways, import XML files, transfer information, or use it as a reference. One hospital without a system uses the administration schedules from the library. CONCLUSIONS: The user evaluation indicates that the e-library is used in the intended manner and that the users can interact without problems. Users have different needs depending on their profession and their workplace, and these can be supported. The combination of methods applied ensures that the design and content comply with the users' needs and serves as feedback for continuous design and learning. With a broad national usage, the e-library can become a source for organizational and national learning and a source for continuous improvement of cancer care in Sweden.

Electrical injury in relation to voltage, "no-let-go" phenomenon, symptoms and perceived safety culture: a survey of Swedish male electricians.

PURPOSE: Professional electricians are highly subjected to electrical injuries. Previous studies describing symptoms after electrical injury have not included people with less severe initial injuries. The purpose of the present study was to describe symptoms at different time points after electrical injury, the impact of "no-let-go" phenomenon and different electrical potential [high voltage (HV) vs. low voltage (LV)], and the safety culture at the workplace. METHODS: A retrospective survey was conducted with 523 Swedish electricians. Two questionnaires were issued: the first to identify electricians who had experienced electrical injury and the second to gain information about symptoms and safety culture. Self-reported symptoms were described at different time points following injury. Symptoms for HV and LV accidents were compared. Occurrence or nonoccurrence of "no-let-go" phenomenon was analysed using two-tailed Chi-2. Safety culture was assessed with a validated questionnaire. RESULTS: Nearly all reported having symptoms directly after the injury, mainly paraesthesia and pain. For the first weeks after injury, pain and muscle weakness dominated. The most frequently occurring symptoms at follow-up were pain, muscle weakness and loss of sensation. HV injuries and "no-let go" phenomenon were associated with more sustained symptoms. Deficiencies in the reporting routines were present, as well as shortage of preventive measures. CONCLUSION: The results indicate that symptoms are reported also long time after an electrical injury and that special attention should be paid to HV injuries and "no-let go" accidents. The workplace routines to reduce the number of work-related electrical injuries for Swedish electricians can be improved.

Understanding safety culture by visualization of scenarios--development and evaluation of an interactive prototype.

To be able to disseminate knowledge about maritime safety culture and safety management to different actors in the Swedish maritime sector, a preliminary pedagogical concept was developed and evaluated. As a first user group, students at upper secondary maritime schools were chosen and the pedagogical concept was adapted for this group. The concept includes an interactive prototype and a teacher's guide and is based on a model for experience-based learning which connects theory and practice by a cyclic approach. The concept was tested in a classroom setting including interaction with the students and a follow-up one week later. A preliminary evaluation of the results shows a very positive response among the students as well as the lecturers. The educational material was successful in immediately creating a relevant discussion about safety culture, and one week later, students could remember many of the safety scenarios included in the pedagogical concept.

Efficient and effective learning for safety from incidents.

Learning from incidents is important for improving safety. Many companies spend a great deal of time and money on such learning procedures. The objectives of this paper are to present some early results from a project aimed at revealing weaknesses in the procedures for learning from incidents and to discuss improvements in these procedures, especially in chemical process industries. The empirical base comes from a project assessing organizational learning and the effectiveness of the different steps of the learning cycle for safety and studying relations between safety-specific transformational leadership, safety climate, trust, safety-related behavior and learning from incidents. The results point at common weaknesses in the organizational learning, both in the horizontal learning (geographical spread) and in vertical learning (double-loop learning). Furthermore, the effectiveness in the different steps of the learning cycle is low due to insufficient information in incident reports, very shallow analyses of reports, decisions that focus at solving the problem only at the place where the incident took place, late implementations and weak solutions. Strong correlations with learning from incidents were found for all safety climate variables as well as for safety-related behaviors and trust. The relationships were very strong for trust, safety knowledge, safety participation and safety compliance.

Organizational climate in air traffic control Innovative preparedness for implementation of new technology and organizational development in a rule governed organization.

A positive and innovative organizational climate is of great importance in order to manage and adapt to change. Such a climate seldom evolves in organizations closely governed by rules and regulations. Because of ongoing organizational and technical changes within the Swedish Air Navigation Services Provider, a study concerning the organizational climate for changes and innovations was conducted to investigate the organization's capacity to cope with changes. Study locations were the two Swedish main air traffic control centers and parts of the civil aviation administration headquarters. In the study 390 subjects took part and the CCQ questionnaire was used to measure the organizational climate. The results show that the organizational climate is quite positive despite the rule-governed work. The results also show that administrative personnel assess the organizational climate as more positive than operative personnel. Comparisons between management positions did not result in any differences.