Nurses' behaviors and visual scanning patterns may reduce patient identification errors.

Abstract

Patient identification (ID) errors occurring during the medication administration process can be fatal. The aim of this study is to determine whether differences in nurses' behaviors and visual scanning patterns during the medication administration process influence their capacities to identify patient ID errors. Nurse participants (n = 20) administered medications to 3 patients in a simulated clinical setting, with 1 patient having an embedded ID error. Error-identifying nurses tended to complete more process steps in a similar amount of time than non-error-identifying nurses and tended to scan information across artifacts (e.g., ID band, patient chart, medication label) rather than fixating on several pieces of information on a single artifact before fixating on another artifact. Non-error-indentifying nurses tended to increase their durations of off-topic conversations-a type of process interruption-over the course of the trials; the difference between groups was significant in the trial with the embedded ID error. Error-identifying nurses tended to have their most fixations in a row on the patient's chart, whereas non-error-identifying nurses did not tend to have a single artifact on which they consistently fixated. Finally, error-identifying nurses tended to have predictable eye fixation sequences across artifacts, whereas non-error-identifying nurses tended to have seemingly random eye fixation sequences. This finding has implications for nurse training and the design of tools and technologies that support nurses as they complete the medication administration process.

Eye-Tracking in the Study of Visual Expertise: Methodology and Approaches in Medicine

“…Eyetracking has also been a useful technique for the study of real world disruptions in the medical training environment. For example, in simulated emergency room settings, medical professionals who visually engaged an interruption during a visual task were more likely to commit an error (Marquard et al, 2011). Taken together, these studies of gaze patterns in procedural settings suggest a role for eye-tracking as both a training and assessment tool in medical education, and the necessity of a realistic clinical environment for the application of trained visual patterns of gaze.…”

“…The scanpaths of trainees in these procedural settings can sometimes be used to assess best practices in medicine, as well as assure competency. This was performed as a follow-up to the study of errors in medication administration (Marquard et al, 2011;Amster, 2015), to analyze patterns of gaze most associated with identification errors among nurses. Nurses who recognized errors were more likely to focus on one piece of identification information at one time, comparing medication labels and the corresponding patient information on an ID badge in sequence, as opposed to reading either the badge or medication bottle in full before changing the point of fixation.…”

Bar-code Verification

“…Many nurses looked at multiple identifiers in between key VPtID steps, such as looking at the patient's name and MRN in between looking at the DOB on 2 artifacts. 12 Although this could be considered an appropriate match between the 2 artifacts, the nurse likely could not keep the DOB in working memory so could not remember the DOB correctly. We also observed random visual scanning patterns by nurses who did not identify patient ID errors.…”

Validating Eye Tracking as an Objective Assessment Tool in Simulation

“…Validating Eye Tracking as an Objective Assessment Toolsubsequent simulations (Henneman & Cunningham, 2005) and in demonstrating differences in visual scanning patterns of nursing students who were able to identify patient errors in identification (Marquard et al, 2011). Studies have shown ETG to be useful in distinct skill assessment in the hospital setting (Ahmidi et al, 2010;Chetwood et al, 2012;Matsumoto et al, 2011;Richstone et al, 2010;Schulz et al, 2011;Voisin, Pinto, Morin-Ducote, Hudson, & Tourassi, 2013) and as an assessment tool in testing novice and expert clinicians (Koh, Park, Wickens, Ong, & Chia, 2011).…”