This blog post was published by the Healthcare Safety Investigation Branch (HSIB). Find out more about HSIB legacy.
Consider this situation: you are a healthcare worker called to see a patient. A patient you have never met before, in an environment you have never been to before. How do you know you are seeing the correct patient? How do you quickly and accurately access information about them?
A lack of information can affect decision making, particularly in time-pressured situations. The expectation is that you first identify the patient by asking appropriate questions, checking their identifiers (including NHS number), and checking their identity wristband if they are in hospital.
To access other information, you probably have to ask someone or read it in the clinical records. However, accessing clinical records that are reliably accurate can be time consuming as they may not be readily available.
We recently completed a national investigation where NHS staff faced difficulties accessing critical information about a patient at the bedside. The access to critical information investigation highlighted how the choice of information to display – and the visibility and accuracy of that information – can influence how NHS staff access and use it.
Can I see what I need?
Healthcare staff are good at adapting to their surroundings and try to overcome problems to care effectively for their patients. The need for adaptation highlights how work environments are not always designed to support NHS staff to do their jobs. While this is inconsequential much of the time, as we found in our investigation, poor design can contribute to patient harm.
To address poor design, we need to consider the ‘users’ (the staff who work in clinical environments) and their needs. ‘User-centred design’ principles highlight the need to understand:
- who is working in the workplace
- what tasks they are doing
- what successful and supported tasks look like
- what makes staff able to do these tasks effectively, efficiently, safely, and in comfort.
When thinking about patient information, design means knowing what information is needed by who, for what, and how best to make it visible. Information may relate to a patient’s identity, what they are able to eat and drink, and/or whether they can walk without support. Any information displayed must be helpful to patient care, otherwise there is no benefit in it being visible.
When displaying information, we also need to consider confidentiality and whether certain information is appropriate to be on open display. Our recent investigation helped to highlight that NHS staff and organisations should not be afraid to display ‘a patient’s full name above their bed or on the door of their room so that they may be correctly identified in an emergency.’ The National Data Guardian told us that this is consistent with Caldicott Principle 7 and the Health and Social Care (Safety and Quality) Act (2015).
Information needs to be ‘accessible’ which means it needs to be usable by people with a range of different characteristics and capabilities. The people who need to use it, need to be able to see it and understand it. We can often forget that many people may have specific needs that impact how they can access information. For example, 1 in 12 men and 1 in 200 women are colour blind, and some groups may not be able to understand written information as much as we would assume. Information also needs to be expected and consistent. We need to ask staff whether the information they need is located where they expect it to be and need to ensure consistency across clinical environments. There are also easy fixes, such as ensuring that visible information is not obstructed by things like curtains.
There is a lot more to the design of workplaces and display of information that are beyond the ability of this blog to describe. For example, we also learned about ‘ward lighting’ and its under recognised but fundamental role in supporting safe practice, and the role of technology in presenting bedside information. Find out more about these in our access to critical information investigation report.
Can I read what I see?
Having the necessary information visible is only part of the solution for safe practice. That information also needs to be readable (easy to understand the words) and legible (easy to recognise the letters, words, and lines from each other). Much of the information we saw in our recent investigation was on laminated paper or whiteboards above bedheads, with varying amounts of glare and contrast between colours. While the future may be digitisation of this information, for now many organisations still rely on handwriting and drawings which are not always accessible.
In the above investigation we were introduced to the concept and role of typography in the communication of written information. Typography is the study of the style and appearance of information. It considers the layout of information, the typeface chosen and colour scheme. Again, a full exploration of the role of typography is beyond this blog, but we learned about some useful principles when considering how to present information, such as:
- Consider the size of words to support readability and write horizontally. If typed, use simple fonts.
- Avoid italics, block capitals, and decoration of words such as with smiley faces.
- Do not use too much text if you can avoid it and try to avoid acronyms (they often differ between teams/people).
- Be conscious of letter and numbers that may look similar to each other, such as 3 and 8.
- Images may be useful but need to be meaningful.
- Consider colour and contrast. Dark colour on light background is often good but remember that some people will have difficulty distinguishing between red and green.
- Avoid glare, particularly with shiny surfaces.
You can find out more via documents such as those published by the Chartered Institute of Ergonomics and Human Factors, Cabinet Office Disability Unit and the University of Reading.
Make it easier for staff
This blog highlights the benefits of considering what information is available about patients and what it looks like. Healthcare environments may make it difficult for staff to do their jobs, but organisations can help staff by considering some seemingly simple but overlooked solutions to help improve patient safety.
- Work with staff to help understand ‘work as done’ and the information they need to do their jobs.
- Consider how information may be displayed or shared as part of the design or renovation of clinical environments.
- Consider if the right information is visible to staff for the particular clinical context they are working in, particularly where environments may be repurposed for different patient or staff groups.
- Consider the accessibility of information, the different needs staff may have, and how they can be met.
- Test how information is displayed to learn what works, what does not and how displays can be improved.