Feature Patient safety

Safer by design

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39426.511759.AD (Published 24 January 2008) Cite this as: BMJ 2008;336:186

This article has a correction. Please see:

  1. Alison Tonks, associate editor
  1. 1BMJ, London WC1H 9JR
  1. atonks{at}bmj.com

    Thousands of patients each year are harmed by medical errors, many of which could be prevented. Alison Tonks reports on steps to make the NHS mistake-proof

    While a badly designed chair might be a little uncomfortable, and a badly designed oven might test your ability to turn out evenly browned cakes, a badly designed piece of hospital equipment can kill you. In 2001, Wayne Jowett, a leukaemia patient in a UK hospital, died from an intrathecal injection of the intravenous drug vincristine. Intravenous and intraspinal connections were, and still are, interchangeable—a fundamental design flaw according to the chairman of the subsequent external inquiry.1 A similar design flaw contributed to the death in 2004 of a new mother who was given a bolus of bupivacaine intravenously instead of into her epidural catheter.2

    In 2003, 16 year old Natalie Dibden died of a head injury soon after falling out of a badly designed ambulance.3 4 These tragedies and many others would never have happened in a world where hospitals, equipment, drug packaging and information, computer systems, and patient transport were specifically designed to prevent them—to protect patients from every conceivable harm, and particularly from human error. Cars, nuclear power stations, and aeroplanes are designed to be safe. They have to be. Rather belatedly, healthcare authorities all over the world are starting to learn from these industries and to think seriously about how good design can save lives.

    Starting from scratch

    It could be a long hard slog, according to a 2003 joint report by the Department of Health and the Design Council.[5 ] The report concluded that the NHS was complex, chaotic, and clueless about design.

    “The NHS is seriously out of step with modern thinking and practice with regard to design. A consequence of this has been a significant incidence …

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