Presentation
Development of a Task Analysis Supporting Fingerstick Glucose Monitoring
SessionMethods & Perspectives (PS8)
DescriptionBackground:
The understanding of glucose monitoring and the healthcare personnel (HCP) task load and fatigue due to repetitive processes has recently been highlighted as an area for Human Factors Engineering (HFE) intervention. This is especially true in the current COVID-19 pandemic era where HCP are continuing to suffer with disrupted sleep schedules, burnout, and perceived high levels of mental workload. The vast applicability of the glucose monitoring task provides ample opportunity for human factors in healthcare. In a recent article analyzing error within medical devices, researchers noted several themes related to glucose management and monitoring, speaking to the current real-world challenges of the issue. The Centers for Disease Control and Prevention (CDC) report from 2019, estimates 37.3 million Americans have diabetes. There has been a rise in prevalence with 10.3% from 2001 to 2004 to 13.2% during 2017 to 2020. People with diabetes are well familiar with finger stick glucose monitoring to ensure their health and well-being. Occurring up to several times a day, this task involves sampling blood and then transferring the sample to the glucometer for analysis. However, this process can pose a risk of exposure to blood borne pathogens such as HIV, hepatitis B, and hepatitis C viruses.
The CDC highlighted this risk of transmission of blood borne pathogens and concern of healthcare associated outbreaks of Hepatitis B and C due in reports documenting incorrect use of glucometers. From 2008-2019, outbreaks and exposures due to incorrect use of glucometers in assisted living facilities and skilled nursing facilities have been reported. Furthermore, accreditation organization, such as The Joint Commission highlighted the need for acute healthcare facilities (hospitals) to train staff and ensure safe practices of glucometer use, including the correct practices for cleaning and disinfection.
Proper glucose monitoring can be associated with several areas of human error. The widespread and frequent use of glucose monitoring make sustained resolution of this issue a challenge. Safe glucose monitoring requires appropriate cleaning and disinfection, proper handling of blood and materials, successful use of personal protective equipment, and hand hygiene, among others Therefore, discussions on additional safety procedures and proper processes are both necessary and warranted. The possibility of increasing independence by reducing chances of human error can greatly impact patients across all settings.
As a part of a health system-wide emphasis on HFE, a library of common error-prone tasks for healthcare is under continued development and expansion. The goal of this collection is to help other health systems learn from and contribute to improving human performance and patient safety. Specifically, the target of glucose monitoring was added since HFE has the tools necessary to help assess, prioritize, and address these challenges. One of the most fundamental tools available to human factors practitioners is the task analysis. A task analysis is a tool which allows the practitioner to break down tasks, subtasks, and user goals associated with operating a device or demonstrating multiple ways (e.g., plans) to successfully perform complex tasks. It was expected that as various hospital related tasks were broken down in terms of perception, cognition, and action (PCA) task analyses, that gaps in the human understanding as well as the usability of the technology and workflows in place would be identified. Being that PCA are common terminologies among human factors practitioners, it also provides an opportunity for constructive feedback, relationships with existing frameworks, and adaptability based on experience and use. For the purposes of this discussion the operational definitions are as follows: Perception refers to information to be noticed or detected by user. Cognition refers to the sense making process of taking perceived information and putting it together to make decisions. Action refers to the user performing a psychomotor activity to achieve an end goal.
In addition to the creation of a resource library, as well as building allies within the healthcare human factors community, this research is an initial step in assessing the healthcare-related areas and procedures prone to human error, which can help process re-design as well as appropriate modeling and simulation interventions (in-situ, training lab based) from which continuous quality improvement can be measured. This can also serve to benefit safety and quality personnel as they begin to look at risk from an occupational health perspective. Currently, HFE and IP personnel are engaged in active training and evaluation campaigns with HCP leadership, such that these documents can be used to build a reference library on processes, tools, and techniques that can be used to maximize patient satisfaction and service quality while reducing healthcare-acquired infection risk.
Goals: To develop a task analysis on finger stick glucose measurement with use of glucometer, to assist HCP identify tasks, sub tasks, goals, challenges, and solutions for safe and effective use of glucometers. A secondary goal is provide a resource for human factors and healthcare personnel in the form of task analyses.
Setting: The Yale New Haven Health System actively working to incorporate HFE processes, guidance, and techniques across the workflows of various types of HCPs. This includes not only providing knowledge, but adapting to change, making content available for other interested HCPs, and continuing to grow capabilities within HFE and supporting simulation and training environments.
Methodology: Together with infectious diseases physicians trained in Infection Prevention (IP), human factors professionals sought to understand the human-system-environment considerations from the HFE perspective, and opportunities to prevent patient exposure to bloodborne pathogens. We reviewed the hospital standard operating procedure for finger-stick blood glucose measurement. Each “step” outlined in this validation document was operationally defined as a ‘task’, with tasks further divided into subtasks as needed. For each task and subtask, we determined a corresponding perception, cognition, and action. Then, by identifying corresponding challenges, harms, and solutions, we developed areas for improvement for each of these tasks and subtasks.
Dissemination of the FSG TTA: The initial version of the TTA that was developed will be reviewed, using a convenience sample method, with key users of the glucose meters. Based on feedback, especially of the challenges and corresponding solutions identified by the users, it will be further revised. This TTA will be then disseminated with the staff of acute care, as well as ambulatory sites. The TTA can also be provided as education tool for training of new hires, as well as retraining of staff. It can also be used to facilitate the learning and knowledge sharing among the human factors and healthcare community.
Conclusions:
This research strives to map the challenging healthcare process of fingerstick glucose monitoring with HFE tools and techniques (specifically tabular task analysis) to reduce human error and increase human performance. Through the development of these processes, future research can be driven and collaborated upon to demonstrate value of integrating HFE and IP for healthcare settings.
Funding disclosures:
This CK22-2203: Strengthening Healthcare Infection Prevention and Control and Improving Patient Safety in the United States work is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.
The understanding of glucose monitoring and the healthcare personnel (HCP) task load and fatigue due to repetitive processes has recently been highlighted as an area for Human Factors Engineering (HFE) intervention. This is especially true in the current COVID-19 pandemic era where HCP are continuing to suffer with disrupted sleep schedules, burnout, and perceived high levels of mental workload. The vast applicability of the glucose monitoring task provides ample opportunity for human factors in healthcare. In a recent article analyzing error within medical devices, researchers noted several themes related to glucose management and monitoring, speaking to the current real-world challenges of the issue. The Centers for Disease Control and Prevention (CDC) report from 2019, estimates 37.3 million Americans have diabetes. There has been a rise in prevalence with 10.3% from 2001 to 2004 to 13.2% during 2017 to 2020. People with diabetes are well familiar with finger stick glucose monitoring to ensure their health and well-being. Occurring up to several times a day, this task involves sampling blood and then transferring the sample to the glucometer for analysis. However, this process can pose a risk of exposure to blood borne pathogens such as HIV, hepatitis B, and hepatitis C viruses.
The CDC highlighted this risk of transmission of blood borne pathogens and concern of healthcare associated outbreaks of Hepatitis B and C due in reports documenting incorrect use of glucometers. From 2008-2019, outbreaks and exposures due to incorrect use of glucometers in assisted living facilities and skilled nursing facilities have been reported. Furthermore, accreditation organization, such as The Joint Commission highlighted the need for acute healthcare facilities (hospitals) to train staff and ensure safe practices of glucometer use, including the correct practices for cleaning and disinfection.
Proper glucose monitoring can be associated with several areas of human error. The widespread and frequent use of glucose monitoring make sustained resolution of this issue a challenge. Safe glucose monitoring requires appropriate cleaning and disinfection, proper handling of blood and materials, successful use of personal protective equipment, and hand hygiene, among others Therefore, discussions on additional safety procedures and proper processes are both necessary and warranted. The possibility of increasing independence by reducing chances of human error can greatly impact patients across all settings.
As a part of a health system-wide emphasis on HFE, a library of common error-prone tasks for healthcare is under continued development and expansion. The goal of this collection is to help other health systems learn from and contribute to improving human performance and patient safety. Specifically, the target of glucose monitoring was added since HFE has the tools necessary to help assess, prioritize, and address these challenges. One of the most fundamental tools available to human factors practitioners is the task analysis. A task analysis is a tool which allows the practitioner to break down tasks, subtasks, and user goals associated with operating a device or demonstrating multiple ways (e.g., plans) to successfully perform complex tasks. It was expected that as various hospital related tasks were broken down in terms of perception, cognition, and action (PCA) task analyses, that gaps in the human understanding as well as the usability of the technology and workflows in place would be identified. Being that PCA are common terminologies among human factors practitioners, it also provides an opportunity for constructive feedback, relationships with existing frameworks, and adaptability based on experience and use. For the purposes of this discussion the operational definitions are as follows: Perception refers to information to be noticed or detected by user. Cognition refers to the sense making process of taking perceived information and putting it together to make decisions. Action refers to the user performing a psychomotor activity to achieve an end goal.
In addition to the creation of a resource library, as well as building allies within the healthcare human factors community, this research is an initial step in assessing the healthcare-related areas and procedures prone to human error, which can help process re-design as well as appropriate modeling and simulation interventions (in-situ, training lab based) from which continuous quality improvement can be measured. This can also serve to benefit safety and quality personnel as they begin to look at risk from an occupational health perspective. Currently, HFE and IP personnel are engaged in active training and evaluation campaigns with HCP leadership, such that these documents can be used to build a reference library on processes, tools, and techniques that can be used to maximize patient satisfaction and service quality while reducing healthcare-acquired infection risk.
Goals: To develop a task analysis on finger stick glucose measurement with use of glucometer, to assist HCP identify tasks, sub tasks, goals, challenges, and solutions for safe and effective use of glucometers. A secondary goal is provide a resource for human factors and healthcare personnel in the form of task analyses.
Setting: The Yale New Haven Health System actively working to incorporate HFE processes, guidance, and techniques across the workflows of various types of HCPs. This includes not only providing knowledge, but adapting to change, making content available for other interested HCPs, and continuing to grow capabilities within HFE and supporting simulation and training environments.
Methodology: Together with infectious diseases physicians trained in Infection Prevention (IP), human factors professionals sought to understand the human-system-environment considerations from the HFE perspective, and opportunities to prevent patient exposure to bloodborne pathogens. We reviewed the hospital standard operating procedure for finger-stick blood glucose measurement. Each “step” outlined in this validation document was operationally defined as a ‘task’, with tasks further divided into subtasks as needed. For each task and subtask, we determined a corresponding perception, cognition, and action. Then, by identifying corresponding challenges, harms, and solutions, we developed areas for improvement for each of these tasks and subtasks.
Dissemination of the FSG TTA: The initial version of the TTA that was developed will be reviewed, using a convenience sample method, with key users of the glucose meters. Based on feedback, especially of the challenges and corresponding solutions identified by the users, it will be further revised. This TTA will be then disseminated with the staff of acute care, as well as ambulatory sites. The TTA can also be provided as education tool for training of new hires, as well as retraining of staff. It can also be used to facilitate the learning and knowledge sharing among the human factors and healthcare community.
Conclusions:
This research strives to map the challenging healthcare process of fingerstick glucose monitoring with HFE tools and techniques (specifically tabular task analysis) to reduce human error and increase human performance. Through the development of these processes, future research can be driven and collaborated upon to demonstrate value of integrating HFE and IP for healthcare settings.
Funding disclosures:
This CK22-2203: Strengthening Healthcare Infection Prevention and Control and Improving Patient Safety in the United States work is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.
Event Type
Oral Presentations
TimeWednesday, March 279:15am - 9:37am CDT
LocationSalon A-3
Patient Safety Research and Initiatives