Abstract

TORRES, Yaniel; RODRIGUEZ, Yordán  and  PEREZ, Elizabeth. Procedure for the analysis and prevention of medication errors using the ergonomics approach. Rev. Fac. Nac. Salud Pública [online]. 2022, vol.40, n.2, e05.  Epub May 30, 2023. ISSN 0120-386X.  https://doi.org/10.17533/udea.rfnsp.e346223.

Medication errors represent a public health problem that affects patient safety and the quality of healthcare services globally. This article presents a procedure for the analysis and prevention of medication errors from the perspective of ergonomics, exemplifying its application through a case study. The well-known Hierarchical Task Analysis (HTA) and the Systematic Human Error Reduction and Prediction Approach (SHERPA) methods are included. The risk assessment was based on the risk matrix proposed in the ISO 45001 standard. The proposed procedure is structured in four stages: 1) selection of the task to be analysed, 2) detailed analysis of the task, 3) prediction of the possibility of error, 4) error reduction strategies. The use of the procedure is exemplified through a case study of the administration of an injectable drug. The systematic use of this procedure is expected to contribute to the improvement of the quality of health services by reducing human errors and possible adverse events.

Keywords : Human Factors and Ergonomics; medication errors; wrong procedure errors; patient safety; medication systems.

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