Abstract
BackgroundThe design of medical devices impacts upon the performance of healthcare professionals and patient safety. However, multiple devices serving the same function are often available. The purpose of this study was to use simulation as a means of examining the impact of differences in device design on (1) learning of, or attainment of behavioral fluency in, peripheral intravenous cannulation (PIVC); and (2) the generalization, or transfer, of learning on one device to performance of PIVC using an untrained device.MethodsA total of 25 final cycle medical students participated in this study which used a randomized two-group design. Participants were randomly assigned to learn PIVC using either a closed PIVC device (a single device which consists of an intravenous cannula with a pre-attached extension tube; n = 14) or an open PIVC device (a two-piece device made up of an intravenous cannula and a separate extension tube which is attached following insertion of the cannula; n = 11). Task analyses were developed for the performance of PIVC using each device. Subsequently, simulation-based fluency training was delivered to both groups using their assigned PIVC device, and continued for each participant until the fluency criterion was achieved. Following achievement of fluency, participants were asked to perform PIVC using the untrained device (i.e., the PIVC device that they had not been trained on).ResultsAll participants in both groups met the fluency criterion, and no significant differences were observed in the number of trials or total training required by groups to achieve fluency. Participants in both groups improved significantly from baseline (M = 11.69) to final training trial (M = 100). However, a significant decrement in performance (M = 81.5) was observed when participants were required to perform PIVC using the untrained device.ConclusionsParticipants achieved fluency in PIVC regardless of the device used. However, significant decrements in performance were observed when participants were required to perform PIVC using a novel device. This finding supports the need for careful consideration of devices purchased and supplied in the clinical setting, and the need for training prior to the introduction of novel devices or for new staff members.
Highlights
The design of medical devices impacts upon the performance of healthcare professionals and patient safety
The purpose of this study was to examine the impact of differences in device design on (1) learning, or attainment of behavioral fluency in, a targeted procedural skill; and (2) generalization, or transfer, of learning on one device to performance of the same skill using an untrained device
Previous research [14, 15] has demonstrated the efficacy of fluency training for producing a high level of performance, and learning that is stable [32], retains [32], and generalizes to the clinical setting
Summary
The design of medical devices impacts upon the performance of healthcare professionals and patient safety. The safe use of medical devices by healthcare professionals is compromised by the diversity of devices available in the clinical environment which serve the same function [7, 8] It is common for hospital trusts in the UK to have more than 30 different infusion pump devices [7]. Substantial variance in the design of resuscitation equipment has been observed in UK hospitals [9]. This variety of devices creates a considerable opportunity for errors, and patient harm [8]. Healthcare professionals who work across various locations, or are new to an organization, may fail to identify or recognize crucial differences in device design [5] which can negatively impact on technique and performance
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