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Physical Environments That Promote Safe Medication Use
In 2010, the U.S. Pharmacopeia (USP) published a new chapter on environments that promote the safe use of medications.1 The chapter describes the optimal physical environment needed to promote accurate medication use and how organizations can establish a safe workplace. Standards are provided in five key areas—illumination, interruptions and distractions, sound and noise, physical design and organization, and medication safety zones. This article discusses each area as well as recommendations from the new USP chapter.
Improper lighting has contributed to medication errors. In a case cited in the USP, poor lighting led to the incorrect attachment of tubing to a patient-controlled analgesia (PCA) unit, causing the medication to run onto the floor. In another instance, dicyclomine (e.g., Bentyl, Axcan Scandipharm) 10-mg capsules were used to fill a prescription for 20-mg capsules because of poorly lit pharmacy shelves. Proper lighting improves accuracy and efficiency of medication-related tasks. Lighting should be brighter for workers older than 45 years of age and near the end of the work shift, when visual fatigue increases. The USP recommends the following steps to promote safety:
INTERRUPTIONS AND DISTRACTIONS
Almost 45% of medication errors are attributed to distractions.2 In one pharmacy study, the most frequent sources of interruptions were requests by coworkers who asked for assistance. Because individuals have differing levels of distractibility, preventing interruptions is best accomplished by providing staff with the ability to control their exposure to disturbances. To maximize staff concentration when critical tasks are being performed, the USP recommends the following:
SOUND AND NOISE
Noise can interfere with effective work performance and may pose a health hazard to hospitalized patients. Hospitals are particularly noisy, with studies reporting an average of 45 to 65 decibels (dB) of noise with peaks between 85 and 90 dB. At shift changes, noise levels have been recorded as high as 113 dB, well above the peak levels set by the Environmental Protection Agency (EPA)—45 dB during the day and 35 dB at night—and by the World Health Organization, which calls for 35 dB of background noise in patient rooms. In fact, the EPA requires ear protection for workers exposed to sound levels averaging 90 dB.
Of 58 studies reviewed by the USP, 29 showed that noise impaired performance, but seven studies showed that it improved performance. In one of the seven studies, unpredictable but controllable sounds improved accuracy in filling prescriptions. This finding may indicate that some environmental stimuli are needed to maintain optimal alertness and attention. To maintain a safe level of noise, USP recommends the following steps:
PHYSICAL DESIGN AND ORGANIZATION OF WORKSPACE
The physical design of the workspace can influence the ability of staff members to use information and perform tasks. The height of counters and drug-storage areas can affect visibility. Dispensing errors occur more frequently when medications are stored on cluttered shelves because the items are more difficult to differentiate. The design of the workspace can also contribute to poor lighting conditions, distractions, interruptions, high noise levels, and hazardous medication safety zones. To reduce the risk of errors, the USP suggests the following steps:
MEDICATION SAFETY ZONE
The USP defines a medication safety zone as any critical area where medications are prescribed, transcribed, prepared, and administered. Examples include work surfaces in a medication room or countertops on medication carts or automated dispensing cabinets, locations where prescribing decisions are made, pharmacies, and patients’ bedsides or homes where medications are administered. Mistakes have been linked to the faulty physical design of these safety zones, and methods prone to error have been used within these zones. Applying principles described in human factors literature, the USP recommends the following steps:
U.S. Pharmacopeia Revision Bulletin, Physical environments that promote safe use. General Chapter, No. 1066. October 1, 2010. Available at: www.usp.org/sites/default/files/usp_pdf/EN/USPNF/gc1066PhysicalEnvironments.pdf. Accessed June 7, 2012.
- In: Hicks RW, Becker SC, Cousins DD. MEDMARX data report A report on the relationship of drug names and medication errors in response to the Institute of Medicine’s call for action. Rockville, Md: Center for the Advancement of Patient Safety. U.S. Pharmacopeia 2008;