Effect of Environmental Design on Reducing Nursing and Medication Errors in Acute Care Settings

by Habib Chaudhury, Ph.D. and Atiya Mahmood, Ph.D.

Published by The Center for Health Design, August 2007

ABSTRACT

It has been estimated that approximately 44,000 Americans die in hospitals each year as a result of preventable medical errors (Kohn et al., 2000a). The estimated national costs of adverse events in the United States is 37.6 billion dollars, while the national costs of preventable adverse events has been estimated to be 17 billion dollars (Kohn et al., 2000b). Physical environment is an important component in the acute care setting that can directly impact patient safety, nursing and medication errors, as well as contribute to staff fatigue, stress and burnout resulting in errors. 

This study examines this issue in the medical-surgical units with multiple methods that include:

• Literature Review and Analysis
• Survey on Nursing Staff in Four Hospitals in the Pacific Northwest
• Focus Groups with Nursing, Administration and Pharmacy Staff Members
• Site Visits to Three Selected Facilities that have implemented Design for Enhanced Patient Safety and Reduction of Errors 

The review and analysis demonstrated that the following environmental variables contribute to work place errors: spatial design, micro-environmental design, ergonomics, noise levels, lighting, color, heating, ventilation, and air conditioning. Staffing levels, age and health of workers were among non-environmental variables associated with workplace errors. These variables contributed to errors through workers’ fatigue, stress, disruptions, distractions, and other mediating factors. Ten major design recommendations are given based on the findings of the study. For example, the authors suggest finding a balance between patient accessibility and a reduction of disruptions. In addition, standardization and automation are emphasized.