NHS faces 'potentially serious problems' from wrong prescriptions

The Telegraph reports on the problems faced by junior doctors, who fill out five or six prescription forms on average during their  time in medical school only to have to complete dozens on their first day on the wards. The inadequate preparation contributes to errors that could harm patients - such as omitting drugs, wrong doses, not taking account of a patient's allergies, illegible handwriting or ambiguous orders. According to the General Medical Council 10 per cent of all prescriptions issued by doctors contained such errors. 

Now the British Pharmacological Society (BPS) is calling for an exam for medical students and a "prescribing simulator" complete with virtual patients to be introduced to the curriculum so that medics are better prepared when they start in hospitals. Professor Simon Maxwell, chairman of the BPS, said: "We would not accept this kind of error rate in other industries such as aviation. It is a recipe for problems." Source: Telegraph, 15 December, 2009. tinyurl.com/ybnvpnx

Nearly one in 10 prescriptions has mistakes

Nearly one in 10 hospital prescriptions contains a mistake, ranging from the minor to the potentially lethal, according to research commissioned by the General Medical Council. However, very few errors would have caused serious harm. The research team, led by Professor Tim Dornan of the University of Manchester, examined the issue amid rising fears inexperienced doctors were making prescription errors which could, at worst, result in a patient dying. 

The team examined 124,260 prescriptions across 19 hospitals - and found just under 9% contained errors. Of these 11,077 errors, overwhelmingly intercepted and corrected before reaching the patient, about 2% contained potentially lethal instructions - such as failing to take account of a patient's allergies. More than half involved errors in which a patient's medication was not prescribed and 40% were involved illegible or ambiguous prescriptions.

Very few of these mistakes caused actual harm to a patient because on the whole they were stopped by senior doctors, nurses - and in particular pharmacists. But the study did not find doctors fresh out of medical school were making the most mistakes - as has often been suggested,

"The research shows the complexity of the circumstances in which errors occur and argues against education as a single quick-fix solution”, said Professor Dornan. However, the GMC is calling for a UK-wide standard prescription chart as exists in Wales. Support for the idea is provided by Professor Peter Rubin (chairman of the GMC), Dr Hamish Meldrum (British Medical Association), and Joyce Robins (Co-Director of Patient Concern). A Department of Health spokesman said it would continue to look into the benefits of electronic prescribing system. 

However, Professor Simon Maxwell, of the British Pharmacological Society said he was “dismayed at the suggestion that improved education and training is not a central part of the solution. There is plenty of evidence from around the world to show that when appropriate education and training are delivered, prescribing improves." Source: BBC, 3 December 2009. http://tinyurl.com/ydfbepb

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Ford develops airbags for seat belts

Inflatable seat belts will appear in the back seat of a new Ford Explorer four-by-four to be launched next autumn in the US, and if they prove to be popular the belts could be used in Britain.

They have a cylindrical air bag that stretches from the buckle to the shoulder and fits inside a pocket sewn into the belt. In a crash, the car sends a signal that releases the bag, which inflates more gently than air bags found in steering wheels or dashboards, making it safer for children.

Dr Srini Sundararajan, the Ford engineer who was chiefly responsible for developing the device, said “The top two life-saving devices today are the seat belt and the air bag. This combines them into one great feature”. The wider belt and airbags help  to spread the forces resulting from a crash across the occupant’s chest, reducing injury risk.

Clarence Ditlow, of the Centre for Auto Safety in the US, said the belts were particularly effective at protecting elderly people, especially from broken ribs.

Ford also carried out a significant amount of testing to make sure the bags would protect children, even if they were sleeping and their heads drooping.

Sue Cischke, Ford’s group vice president for sustainability, environmental and safety engineering said the technology was expensive and it would be offered as an option. Source: Telegraph, 7 November. tinyurl.com/yfavuwt

Crash me if you can

Richard Blackburn of the Sydney Morning Herald discusses forthcoming automotive technologies that may bring us closer to "the world's first uncrashable cars". Some of the advanced technologies available now or soon should help drivers to remain stability, stay in lane, avoid low-speed rear-end collisions. Looking further ahead, your car could tell you whether it's safe to overtake or whether you're approaching a corner too fast, help you decide if you have enough time to get across an intersection before the oncoming traffic arrives. You car could even drive itself in a “platoon” formation on the freeway, and automatically avoid pedestrians.

Toyota's product planning manager, Peter Evans, is cautious about predicting dramatic reductions in the road toll in the next decade: you can build an intelligent car but developing intelligent roads and drivers is more of a challenge. "It's that old saying about the nut behind the wheel being the most unreliable part of the car," he says.

The SMH points to intelligent speed adaptation technology being considered by the New South Wales Government in Australia. The technology relies on satellite-linked devices which can read road signs and alert the driver if he or she is speeding. The technology has the potential to actively decrease the flow of fuel to the engine if a car is speeding. Unlike some of the devices being used in the NSW Government trial, a BMW system provides information only. It doesn't intervene to slow the car down. The responsibility for that remains with the driver. 

Meanwhile in Japan, car companies including Toyota and Nissan are working with the Government to develop intelligent freeways. Toyota is about to debut technology that will feed real-time traffic information from roadside sensors into a car's cabin. The technology has the potential to stop minor collisions becoming deadly pile-ups.  

Interested readers should view the whole article. Source: Sydney Morning Herald. 25 September 2009. tinyurl.com/yea4ma3

Pedestrian friendly cars within sight

According to the Sydney Morning Herald, hundreds of lives could be saved if new pedestrian avoidance technology filters its way in to mainstream cars in the near future. Volvo will soon introduce a car that can automatically apply maximum braking to avoid hitting a pedestrian or reduce injuries. The “Collision Warning with Full Auto Brake and Pedestrian Detection” will arrive in the new S60 in 2010. 

Using a radar and a camera, it can react within 50ms, avoid an impact below 25km/h and reduce speed by 25km/h (at higher speeds). Volvo says its system, also being developed by Audi and Mercedes-Benz, has the potential to reduce injury risk to pedestrians by 83 per cent. 

Software was ‘trained’ after analysing 530,000 kilometres of real world driving to recognise people of all shapes and sizes in thousands of scenarios and even take in to account prams and special clothes. Applying the brakes before a collision is intended to help account for the inattention, which Volvo says contributes to 93 per cent of crashes. “In 47 per cent of crashes the driver doesn’t do anything [brake or steer] before the collision”, said Volvo manager of active safety functions Jonas Tisell.

The SMH warns the hundreds of thousands of kangaroos killed on Australian roads each year not to get too excited. Tisell noted that “The next step is handling animals. But the difficulty with animals is that they are shaped by evolution not to be seen.” Pedestrians will still need their wits about them too. The system may not detect a person stepping out from behind a bus or truck and is unable to detect pedestrians at night. The system is as an iterative step in safety improvement.

The Volvo pedestrian detection system is part of a trend towards crash avoidance rather than vehicle occupant protection. Mercedes-Benz is working on an innovative anchor-like metal and rubber-faced airbag that deploys beneath the car on to the road surface when it detects a collision is imminent. Source: Sydney Morning Herald, 18 September 2009. tinyurl.com/yfk6vuy

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Human factors concerns as Samoan drivers switch to the left-hand side

On 7 September, drivers in Samoa in the Pacific switched from driving on the right-hand side of the road to the left. The change was pitched as economically beneficial by the Government, allowing tens of thousands of expatriate Samoans living in New Zealand and Australia to send used cars to their families back home, making cars will cheaper and more available in rural areas.

There are fewer than 20,000 vehicles on Samoa's roads, and about 4,000 are currently right-hand drive. The changeover met with fierce opposition. Critics claimed that the government has failed to consult the public on the change or conduct any feasibility studies. In April last year an estimated 18,000 people - about 10% of Samoa's population - demonstrated against the change. 

Opponents argued that confused drivers will forget which lane to pull into and pedestrians will look the wrong way. "Cars are going to crash, people are going to die - not to mention the huge expense to our country," said lawyer Tole'afoa Solomona Toa'iloa, who  headed a legal challenge in the Supreme Court. Traffic analysts testifying in court agreed that more accidents were likely to occur. But the Supreme Court rejected the legal challenge. Local bus owners are furious about having to either buy new vehicles or convert their old ones so passengers don't have to step off into the middle of the road. 

New signs directing drivers to keep left have been removed, and directional arrows on the road have been painted over to point the wrong way. But critics insist not enough has been done to prepare drivers. Samoa's Chamber of Commerce estimates that it will cost at least $300m (£185m) in direct and indirect costs. Source: BBC, 6 September 2009. tinyurl.com/ljyo42

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Report highlights Chicago air traffic controller fatigue

Air traffic controllers at Chicago O'Hare International Airport have too little time off between shifts, according to a federal audit released Thursday. The report by the U.S. Department of Transportation criticised the Federal Aviation Administration for not acting sooner to alleviate air traffic controller fatigue at three of the country's busiest air traffic control facilities and recommended immediate changes. The audit showed most controllers at the three Chicago ATC facilities have had fewer than 10 hours rest between some shifts, progressively earlier start times on consecutive shifts and increased overtime hours. "This type of work schedule offers minimal opportunity for sleep when the time required for commuting, eating and other necessary daily activities is taken into account," the report said. The report stated that the FAA has failed to act on earlier National Transportation Safety Board recommendations on controller fatigue and that the agency "does not consistently address human factors issues, such as fatigue and situational awareness" in incident investigations. Source: Associated Press, 2 July 2009. tinyurl.com/neesfg

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Public safety signs "ugly, patronising and bossy"

A collection of photographs of safety signs around the UK has been taken and compiled in a book called "Attention please" by The Manifesto Club, a London-based libertarian campaign group. The signs highlight a plethora of 'hazards' such as uneven beach surfaces, the potential of cemetery memorials to harm and the need to use escalators safely. A double-decker bus, it is claimed, displays 24 separate cautions. According to The Telegraph, the convenor of the Manifesto Club Josie Appleton said: "This collection of cones, safety tape and caution notices, which hang like Christmas decorations off the urban architecture, provides no useful information about hazards. Instead they are only an excuse to regulate public behaviour." Rather than effectively highlighting hazards, the safety signs are "swamping public space" and "ugly, patronising and bossy", says Appleton. Source: Telegraph, 2 July 2009. tinyurl.com/luo4he

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Naked safety video aims to get attention

Human factors research has shown that passengers often fail to watch airline safety demonstrations because they feel they have seen them before. Well, Air New Zealand have a video that is unlikely to have the same turn-off effect, featuring a pilot and cabin crew dressed only in body paint made to resemble their normal uniforms. The video is upbeat and perky, with crews' private parts obscured by carefully positioned oxygen masks, life jackets, seat belts and luggage. According to the Telegraph, the "Bare essentials of safety" clip and a similar television advertisement introduced six weeks ago, have had passengers glued to their mini television sets. A copy of the au naturel briefing has been posted on YouTube, attracting over 3.8 million hits to date. It would be interesting to see the retention rate and emergency performance among flyers, compared to that of flyers after viewing a more staid production. Source: Telegraph, 2 July 2009. tinyurl.com/kuoc4k

Human factors 'emerge as trend' in air crashes

Reuters report that Bill Voss, president of the U.S.-based Flight Safety Foundation, has stated that "human factors are emerging as a worrisome trend in global air crashes and other incidents as fatigue, complex flight systems, inconsistent training and regulation pose new challenges to airlines". Voss reportedly told industry and government officials that 2009 could be the worst year in a decade for major commercial aviation accidents. There have been 12 crashes this year through June and carriers globally are on pace to equal the 10-year high of 24 crashes in 1999, according to safety foundation figures. "We've seen an increase in loss of control," Voss said of reported in-flight mishaps linked to turbulence or other unexpected situations that usually do not result in crashes. "We're back in the human factors business," according to Voss. Source: Reuters, 30 June 2009. tinyurl.com/nb255j

Washington Metro crash highlights automation paradox

A collision on the Washington Metro on 22 June killed nine people and injured 76. According to The Washington Post, early indications suggest a computer system may have malfunctioned, and various accounts have raised questions about whether the driver of the speeding train applied the brakes in time. Investigations often focus attention on discrete aspects of machine or human error, whereas the real problem tends to lie in the relationship between humans and their automated systems. "It is easy to focus on the last act that may or may not have prevented the collision," said John D. Lee, professor of industrial and systems engineering at the University of Wisconsin. "But you can trace the accident back to purchasing decisions, maintenance decisions and track layout. To lay the blame on the end result of when and how quickly someone activated the brake may not help with improving safety." Lee pointed out that making automated systems safer leads to a paradox at the heart of all human-machine interactions: "The better you make the automation, the more difficult it is to guard against these catastrophic failures in the future, because the automation becomes more and more powerful, and you rely on it more and more." John Lee is joined by Greg Jamieson and Raja Parasuraman later in the article to acknowledge the consensus that automated systems should be designed to enhance human performance rather than to supplant operators or make them complacent. Source: Washington Post, 29 June 2009. tinyurl.com/lghtq9

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Anti-stab knife soon to go on sale

The first "anti-stab" knife will soon go on sale in Britain, designed to work as normal in the kitchen, but be less effective as a weapon. The knife has a unique "combination tip" with a rounded edge instead of a point and the blade for cutting is underneath. The tip can chop vegetables, but makes penetration more difficult, instead snagging on clothing and skin. An ergonomic handle also reduces the aggressiveness of the knife. Doctors have lobbied in the past for kitchen knives to be redesigned. They argue that while a redesign is not a complete solution to the complex problem of knife crime, it could help to save lives. The New Point knife has been developed by industrial designer John Cornock, who was inspired to create the product after watching a documentary on knife crime. It has taken four years to develop. Source: BBC, 15 June 2009. tinyurl.com/nm3c7f

From input error to near disaster at Melbourne airport

An Emirates flight EK-407 from Melbourne to Dubai narrowly avoided disaster, with 275 people on the Airbus jet. On the flight deck, the first officer and the captain fed routine information, including the plane's weight and fuel load, into a computer. The procedure was for them to check each other's work to avoid mistakes. The first officer opened the throttles and headed down runway. As the first officer tried to ease the aircraft off the runway, the jet stayed grounded. On a second attempt, the nose came up — but the jet's rear repeatedly hit and dragged along runway, puncturing the skin of the jet, tearing off a panel and breaching the air pressurisation. Eventually, at the end of the runway, the jet began climbing. But it was still too low, hitting a runway light, then antenna equipment on the ground, and scraping the grass. With seconds to spare, the jet climbed and finally reached a safe height. The pilots dumped most of their fuel over the bay and, with smoke in the cabin, the plane was given emergency clearance to land. When the pilots checked their instruments they spotted the potentially fatal mistake. Before take-off, their fuelled-up jet weighed 362 tonnes. But they had accidentally keyed in 262 tonnes, resulting in too little engine power. Only the captain's rapid reactions averted a disaster. Source: Sydney Morning Herald, 01 May 2009. tinyurl.com/kjd3r2
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Intensive care errors ‘frequent’

Errors in the administration of injected medication occur frequently in intensive care units, a study of 113 units across 27 countries suggests. Over a 24-hour period, 441 patients out of 1,300 were subject to errors, and seven suffered permanent harm. Nearly half of the affected patients suffered more than one mistake. The most frequent errors related to the wrong time of administration and missing doses. Stress, tiredness, recent changes in the drug’s name, poor communication, and protocol violations were cited as contributing factors. Lead researcher Dr Andreas Valentin recommended error reporting systems and routine checks at shift changes. The Intensive Care Society said many units had developed patient safety training programmes, including measures to learn from ‘near misses’. Work was also under way to standardise concentrations of some drugs for critically ill patients, refine the use of antibiotics and minimise the risk of adverse drug reactions. Source: BBC, 13 March 2009. http://tinyurl.com/b9cqz6

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Pedestrian crossings: Animal kwackers

Comedian Frank Skinner reports on the planned Tokyo-style ‘scramble crossing’ at Oxford Circus in The Times. According to Skinner, the crossings work in Japan and Canada because its inhabitants are, “extremely polite and civilised, so both crossings were a delight to use”. But in London, “It’ll only need a brushed elbow or a blocked step to spin the whole thing into a whirl of aggressive indignation”. In the 1960s, the Ministry of Transport developed ‘panda crossing’. Unlike its zebra-esque colleague, the panda road pattern took the form of triangles. It also had stop lights and a sign for pedestrians that said ‘CROSS’. However, it didn’t have a sign that said ‘DON’T CROSS’ because, quaintly, this would have contravened the existing right-of-way law. (The now defunct crossing used a coding mechanism based on flashing and pulsating amber phases which were subtle yet very significant.) Skinner laments the misuse of acronyms and lack of animal resemblance in this and other animal-inspired crossings, including the pelican crossing, puffin crossing, toucan crossing, and pegasus crossing. But “despite the DfT’s idiosyncrasies – maybe even because of them – I love pedestrian crossings. They seem to epitomise man’s struggle to tame technology”, says Skinner. Source: The Times, April 17 2009. http://tinyurl.com/czeahm

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How to survive a plane crash

Two experts offer some tips. Ed Calea, Professor of mathematical modelling at the University of Greenwich in London: keep your footwear on during climb and descent; sit close to an exit; sit by the aisle; seat your family together; practise releasing your seat belt; know where the exit is; and practise the brace position. According to Amanda Ripley, author of 'The Unthinkable: Who Survives When Disaster Strikes – And Why': take the lead - don't just sit there; listen to the safety briefing; near the exit, take responsibility and prepare to throw the exit door out; educate yourself on why the safety procedures are life-saving; and realise accidents are survivable, and that what you do can make the difference - an active, engaged, confident outlook about your role in the situation is very powerful. Source: Guardian. http://tinyurl.com/bnewa2

Aviation safety still on course

The Turkish Airlines crash is thankfully a rare occurrence in Europe. The European Aviation and Safety Agency report three in 2007, and six in 2006, with a decade average of six fatal air accidents per year, against a trend of increasing traffic. Only five per cent of worldwide fatal air accidents involved European carriers last year. "Take a million flights and the likelihood of being involved in a fatal accident anywhere in the world is still just 0.79 per cent." Source: Times. http://tinyurl.com/d67tp6
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Safety issues cause one-third of deaths in Britain’s military

Ministry of Defence figures obtained by The Independent on Sunday reportedly reveal that nearly 800 service personnel have been killed over 10 years in accidents ranging from car crashes to electric shocks. According to IoS, MoD figures reveal that 201 members of the armed forces died in 2007. Eighty of these deaths were caused by accidents, 50 of them in land transport accidents. The Corporate Manslaughter and Corporate Homicide Act 2007 removes the MoD’s Crown immunity in health and safety matters, leaving senior defence officials open to the same risk of prosecution as employers in the private and public sectors. Source: Independent, 22 Feb 2009. http://tinyurl.com/c8hygw

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