Lung ventilators are frequently used in healthcare and over 300,000 patients are ventilated in the United States every year (1). However, the use of lung ventilators is associated with a number of complications and use errors. While use errors by clinicians can result in inadequate ventilation, overventilation, barotrauma, patient-ventilator asynchrony, they can also worsen complications generally associated with ventilators including ventilator-associated pneumonia (VAP), sepsis, psychological distress, acute respiratory distress syndrome (ARDS) and pulmonary edema which can increase the risk of patient disability and death (1). Moreover, medical device manufacturers use inconsistent nomenclature on user interfaces of lung ventilators. For example, the term ‘continuous mandatory ventilation’ or CMV can have different meanings on different ventilator models (2). Similarly, a mode for ‘volume-targeted pressure controlled ventilation’ has five different names on different ventilator products. While several such inconsistencies in terminology between different ventilator models exist, there has also been considerable debate on the correctness of some of the terms used by manufacturers and the extent to which terms can be intuitively interpreted by clinician users (3). The discrepant nature of ventilator terminology is a factor underlying increased training costs, human error, and is an impediment to communication between clinicians, electronic health records, and ventilators. Human factors problems and communication issues are the two most frequent root causes underlying ventilator-related sentinel events that were reported to The Joint Commission and occurred between 2004 and 2015. The discrepant nomenclature in existing lung ventilators is an issue inseparable from issues in human factors, communication, and training.
To address this issue, Dr. Catherine Burns, Director of the Advanced Interface Design Lab and Professor in the Department of Systems Design Engineering, has taken on a new project to determine whether a standardized vocabulary proposed by the International Organization for Standardization (ISO) will improve the usability and reduce usage errors of ventilators. As part of the Sorbonne Universities and the University of Waterloo, Philippe Portailler, an exchange student from Université de Technologie de Compiègne, France, is assisting Professor Burns with research regarding the usability of current ventilator design interfaces, and their terminology.
It is believed that adapting a standardized terminology for the display and controls of ventilators will enhance their usability and minimize user errors. In particular, if clinicians must switch between the ventilators of different manufacturers, the risk of errors increases. To determine whether a standardized vocabulary is indeed more efficient, Philippe comments that different mock-ups of ventilator interfaces will be developed, including a mock-up incorporating the ISO’s nomenclature. Then, these mock-ups will be tested amongst participating clinicians to collect data on their response accuracy and task completion time when using the ventilators, in comparison to the existing nomenclature. The test will involve a simulated clinical scenario where clinicians must switch between different ventilators. The hypothesis is that standardized mode nomenclature will reduce errors.
The results of this research will help to inform designers on how to maximize ventilator usability through interface layout, and remove barriers in communication between clinicians. It is hopeful that a the research will provide supporting evidence that a standardized vocabulary will also help to reduce increased training costs associated with learning ventilator use.
References
-
Centers for Disease Control and Prevention Device-associated module of the Patient Safety Component of the Natioanal Health Safety Network. 2014. [2017-08-03]. Ventilator-associated event (VAE)https://www.cdc.gov/nhsn/pdfs/pscmanual/10-vae_final.pdf webcite.
-
Association for the Advancement of Medical Instrumentation Report on the 2014 AAMI/FDA Summit on Ventilator Technology. 2014. [2017-08-03]. http://s3.amazonaws.com/rdcms-aami/files/production/public/FileDownloads/Summits/Ventilator/2014_Ventilator_Summit_Report.pdfwebcite.
-
Chatburn R. Terminology vs Physiology and Mechanics. CHEST Journal. 1994;106(5):1630–1631.[PubMed]