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Publications

Research Team

A world-class team of researchers continue to study anesthetic safety and derived clinical outcomes from the SAFERsleep System.

The team includes:

Professor Alan Merry
Dr. Craig Webster

Safer Sleep: Research and publications

Safer Sleep research began in 1994 with a focus on the incidence and nature of drug error in anesthesia. Initial findings led to further research regarding approaches that could reduce the risk of drug error and improve patient safety during anesthesia. A number of innovations were designed and researched; this led to the development of the Integrated Drug Administration System, or IDAS®, which has been re-branded as the SAFERsleep System. More recent research has involved SAFERsleep System observation in clinical anesthetic environments. SAFERsleep System-related research projects are listed below. Publications resulting from this research are listed in the following section.

Development of Safety Concepts

SAFERsleep System
development

[1-3]

Most anesthetists admit making drug errors - the SAFERsleep System is an attempt to engineer a safer work environment consistent with what is known about the psychology of human error and safe-systems theory developed in other high-reliability organizations.

 

Decreased drug administrative error

 

 [28] Reduction of bolus to bolus anesthetic drug error by 40.8%.

Bar-code component

[4]

Consistent with the Food and Drug Administration’s New Rule, SAFERsleep System labeling contains bar-codes which are scanned by computer just prior to drug administration

 

Color-coded label
component

[5, 6, 29]

International color-codes for anesthetic drugs exist – the SAFERsleep System incorporates these into drug labeling systems.

 

Pre-filled syringe
component

[7, 8]

Pre-filling syringes avoids an error-prone step in the drug administration process.

 

Infusion syringe label
system

 

 [27] A new design for infusion syringe labels contributes to reduction in drug error.

Flag-labeled
ampoule component

[9]

SAFERsleep System flag-labels are available for drugs which cannot be pre-filled.

Full anesthetic
record component

[1]

The SAFERsleep System is capable of creating a full automated anesthetic record, therefore giving anesthetists more time to focus on patient care.

 

System safety
concepts

[3,5 10-16]

Identifying dangerous aspects of work systems through incident data collection and the redesign of such aspects of the work environment is the most effective known method of improving safety. Multiple safety systems should be in place when lives are at stake.

 

Guidelines for safer
drug administration

[16, 17]

Meta-analysis of safety literature in anesthesia supports the systems approach and allows the identification of 11 evidence-based safety recommendations.

 

Extension of
SAFERsleep principles

[18-21]

The systems safety approach can be extended to other hospital areas. Present work involves the development of a pre-op assessment and post-op prescription module for the SAFERsleep System. Integration with hospital information networks will allow in-theatre on-line access to patient records and lab results, and enable automatic drug contra-indication alerts. Integration with hospital stock control and billing systems is also possible.

 

Drug error incident
monitoring

[22, 23]

By studying 10,806 anesthetics we estimate that a drug error occurs once in every 133 anesthetics. Such a rate would mean every anesthetist can expect to harm an average of 2 patients through drug administration error in the course of their careers. On-going incident data collection should demonstrate a quantitative advantage for the SAFERsleep System in terms of actual error reduction in the near future.


Survey of attitudes
to safety & cost

[21, 24, 25]

Anesthetists recognize the value of pre-filled syringes for emergency use. Costs involved to supply the most common drugs in a pre-filled format for every-day use should be manageable due to the avoidance of expensive patient harm.

 

Simulator trial of the
SAFERsleep System

[26]

The SAFERsleep System was judged as offering a significant safety advantage over conventional methods in a high-fidelity anesthesia simulator.

Clinical assessment of the SAFERsleep System

Clinical observation
study

[8]

The SAFERsleep System was used successfully in the clinical setting and again judged as offering significant safety advantages over conventional methods. The SAFERsleep also saved time before and during anesthesia. The SAFERsleep System is now in routine clinical use in a number of New Zealand hospitals.
Improved accuracy of drug administration capture [30]

Use of the SAFERsleep system resulted in 21.7% increase in documented drug use capture compared against traditional handwritten anestheisa record.

 

Focus discussion
group study
- Pre-filled syringes.
- Full anesthetic record.

 

Paper in
prep.

Pre-filled syringes and automatic anesthetic record judged as significant and valuable by anesthetists in clinical practice.

Reaction time and
accuracy study

Study in progress.

Fine-tuning and validation of aspects of SAFERsleep System labels will be undertaken in laboratory-based reaction-time and accuracy trials.

Simulator-based fatigue
and error project

Study in funding acquisition phase.

High-fidelity anesthesia simulator scenarios will be developed which pre-dispose error, thus allowing error counter measures (including the SAFERsleep System) to be assessed and validated systematically in reasonable time.

Publication Reference

 

1.   Merry AF, Webster CS, Mathew DJ. A new, safety-oriented, integrated drug administration and automated anesthesia record system. Anesthesia and Analgesia 2001;93:385-390.
2.   Merry AF, Peck DJ. Anaesthetists, errors in drug administration and the law. New Zealand Medical Journal 1995;108:185-187.
3.   Merry AF, McCall Smith A. Errors, Medicine and the Law. Cambridge University Press, Cambridge 2001.
4.   Merry AF, Webster CS. Bar codes and the reduction of drug administration error in anaesthesia. Seminars in Anesthesia, Perioperative Medicine and Pain 2004;23:260-270.
5.   Merry AF, Webster CS. Labelling and drug administration error. Anaesthesia 1996;51:987-988.
6.   Webster CS, Merry AF. British syringe label “standards” are an accident waiting to happen. Anaesthesia 2000;55:618.
7.   Webster CS, Merry AF, Ducat CM. Safety, cost and predrawn emergency drugs. Anaesthesia 2001;56:818-820.
8.   Webster CS, Merry AF, Gander PH, Mann NK. A prospective, randomised clinical evaluation of a new safety-orientated injectable drug administration system in comparison with conventional methods. Anaesthesia 2004;59:80-87.
9.   Webster CS, Mathew DJ, Merry AF. Effective labelling is difficult, but safety really does matter. Anaesthesia 2002;57:201-202.
10. Webster CS. The nuclear power industry as an alternative analogy for safety in anaesthesia and a novel approach for the conceptualisation of safety goals. Anaesthesia 2005;60:1115-1122.
11. Webster CS. Doctors must implement new safety systems, not whinge about them. Anaesthesia 2002;57:1231-1232.
12. Merry AF, Webster CS. Anaesthetists and drug administration error—towards an irreducible minimum. In: Keneally J, Jones M, editors. Australasian Anaesthesia. Australian and New Zealand College of Anaesthetists, Melbourne 1996. p. 53-61.
13. Webster CS. Human psychology applies to doctors too. Anaesthesia 2000;55:929-930.
14. Webster CS. Why anaesthetising a patient is more prone to failure than flying a plane. Anaesthesia 2002;57:819-820.
15. Gander PH, Merry AF, Millar MM, Weller J. Hours of work and fatigue-related error: a survery of New Zealand Anaesthetists. Anaesthesia and Intensive Care 2000;28:178-183.
16. Webster CS. Implementation and Assessment of a New Integrated Drug Administration System (SAFERsleep System) as an Example of a Safety Intervention in a Complex Socio-technological Workplace [PhD Thesis]. University of Auckland, Auckland 2004.
17. Jensen LS, Merry AF, Webster CS, Weller J, Larsson L. Evidence-based strategies for preventing drug administration error during anaesthesia. Anaesthesia 2004;59:493-504.
18. Webster CS, Anderson D, Murtagh S. Safety and peri-operative medical care. Anaesthesia 2001;56:496-497.
19. Webster CS, Anderson DJ. A practical guide to the implementation of an effective incident reporting scheme to reduce medication error on the hospital ward. International Journal of Nursing Practice 2002;8:176-183.
20. Anderson DJ, Webster CS. A systems approach to the reduction of medication error on the hospital ward. Journal of Advanced Nursing 2001;35:34-41.
21. Webster CS. The iatrogenic-harm cost equation and new technology. Anaesthesia 2005;60:843-846.
22. Webster CS, Merry AF, Larsson L, McGrath KA, Weller J. The frequency and nature of drug administration error during anaesthesia. Anaesthesia and Intensive Care 2001;29:494-500.
23. Runciman B, Merry A, McCall Smith A. Improving patients' safety by gathering information - anonymous reporting has an important role. British Medical Journal 2001;323:298.
24. Ducat CM, Merry AF, Webster CS. Attitudes and practices of New Zealand anaesthetists with regard to emergency drugs. Anaesthesia and Intensive Care 2000;28:692-697.
25. Webster CS, Grieve DJ. Attitudes to error and the improvement of patient safety in the complex technological workplace of modern anaesthesia. Prometheus 2005;23:3.
26. Merry AF, Webster CS, Weller J, Henderson S, Robinson B. Evaluation in an anaesthetic simulator of a prototype of a new drug administration system designed to reduce error. Anaesthesia 2002;57:256-263.
27. Merry AF, Webster CS, Connell H. A new infusion syringe label system designed to reduce task complexity during drug preparation. Anaesthesia 2007;62:486-491.
28. Merry AF, Webster CS, Larssen L, Wells J, Fryben C. Prospective assessment of a new anaesthetic drug administration system designed to improve safety. Anesthesiology 2006;106:A138.
29. Webster CS, Merry AF. Editorial Comment: Colour coding, drug administration error and the systems approach to safety. European Journal of Anestrhesiology 2006;24:377-386.
30. Nolan A, Rhodes WD. Implementing a barcoded anesthetic system for improved documentation and patient safety. Pharmacy Purchasing and Products April 2007, Vol 4 Number 4.

 

Books: medical error

 

Safety and Ethics in Healthcare:
A Guide to Getting it Right
Bill Runciman, Alan Merry, Merrilyn Walton

Errors, Medicine and the Law
Alan Merry and Alexander McCall Smith

Human Error
James Reason

Managing the Risk of Organizational Accidents
James Reason

To Err is Human
Institute of Medicine
(Ebook)

Crossing the Quality Chasm
Institute of Medicine
(Ebook)