Biomedical subjects

Kim J Vicente

Publications and source records attributed to Kim J Vicente.

3 recordsLinked to original sources

PubMed2003

Programming errors contribute to death from patient-controlled analgesia: case report and estimate of probability.

PURPOSE: To identify the factors that threaten patient safety when using patient-controlled analgesia (PCA) and to obtain an evidence-based estimate of the probability of death from user programming errors associated with PCA. CLINICAL FEATURES: A 19-yr-old woman underwent Cesarean section and delivered a healthy infant. Postoperatively, morphine sulfate (2 mg bolus, lockout interval of six minutes, four-hour limit of 30 mg) was ordered, to be delivered by an Abbott Lifecare 4100 Plus II Infusion Pump. A drug cassette containing 1 mg.mL(-1) solution of morphine was unavailable, so the nurse used a cassette that contained a more concentrated solution (5 mg.mL(-1)). 7.5 hr after the PCA was started, the patient was pronounced dead. Blood samples were obtained and autopsy showed a toxic concentration of morphine. The available evidence is consistent with a concentration programming error where morphine 1 mg.mL(-1) was entered instead of 5 mg.mL(-1). Based on a search of such incidents in the Food and Drug Administration MDR database and other sources and on a denominator of 22,000,000 provided by the device manufacturer, mortality from user programming errors with this device was estimated to be a low likelihood event (ranging from 1 in 33,000 to 1 in 338,800), but relatively numerous in absolute terms (ranging from 65-667 deaths). CONCLUSION: Anesthesiologists, nurses, human factors engineers, and device manufacturers can work together to enhance the safety of PCA pumps by redesigning user interfaces, drug cassettes, and hospital operating procedures to minimize programming errors and to enhance their detection before patients are harmed.

Adult↗

PubMed2002

Ecological interface design: progress and challenges.

Ecological interface design (EID) is a theoretical framework for designing human-computer interfaces for complex sociotechnical systems. Its primary aim is to support knowledge workers in adapting to change and novelty. This literature review shows that in situations requiring problem solving, EID improves performance when compared with current design approaches in industry. EID has been applied to industry-scale problems in a broad variety of application domains (e.g., process control, aviation, computer network management, software engineering, medicine, command and control, and information retrieval) and has consistently led to the identification of new information requirements. An experimental evaluation of EID using a full-fidelity simulator with professional workers has yet to be conducted, although some are planned. Several significant challenges remain as obstacles to the confident use of EID in industry. Promising paths for addressing these outstanding issues are identified. Actual or potential applications of this research include improving the safety and productivity of complex sociotechnical systems.

Data Display↗

PubMed2002

Designing for adaptation to novelty and change: functional information, emergent feature graphics, and higher-level control.

Ecological interface design (EID) is a theoretical framework that aims to support worker adaptation to change and novelty in complex systems. Previous evaluations of EID have emphasized representativeness to enhance generalizability of results to operational settings. The research presented here is complementary, emphasizing experimental control to enhance theory building. Two experiments were conducted to test the impact of functional information and emergent feature graphics on adaptation to novelty and change in a thermal-hydraulic process control microworld. Presenting functional information in an interface using emergent features encouraged experienced participants to become perceptually coupled to the interface and thereby to exhibit higher-level control and more successful adaptation to unanticipated events. The absence of functional information or of emergent features generally led to lower-level control and less success at adaptation, the exception being a minority of participants who compensated by relying on analytical reasoning. These findings may have practical implications for shaping coordination in complex systems and fundamental implications for the development of a general unified theory of coordination for the technical, human, and social sciences. Actual or potential applications of this research include the design of human-computer interfaces that improve safety in complex sociotechnical systems.

Adaptation, Psychological↗