Using a human factors and ergonomic methodology to improve medication safety outcomes in a hospital setting; a systematic review

Introduction: Medication errors in healthcare pose a significant global health challenge and are particularly prevalent in hospital settings. Evidence of the application of human factors and ergonomics (HFE) to improve patient safety has been forthcoming over the last two decades. However, there is a dearth of research systematically examining the impact of HFE methodologies to improve medication safety in a hospital setting. We undertook a systematic review to address this current research gap. Methods: Four databases were searched in April 2023 and again in November 2024: EMBASE, PubMed, Web of Science and PsycINFO (EBSCOHOST), as well as reference lists and conference proceedings. All interventional studies using a HFE methodology to improve medication safety in a hospital setting were included. A synthesis of HFE characteristics and medication safety-related outcomes was conducted. Results: A total of 30 papers were included, with the majority of these undertaken in a simulated clinical setting (n=16) by specialists working in anaesthetics or paediatrics. Interventions primarily focused on digital health technologies or devices (n=18). HFE methods frequently examined task analysis, usability and workload, and were mainly used to evaluate the intervention. The degree to which HFE was embedded in these studies was variable. Observed or self-reported medication errors were measured in all studies, with two papers also measuring patient mortality. Four studies assessed staff perception of safety. Conclusion: The application of HFE methods in medication safety research is variable and not reported in the literature consistently. To effectively integrate HFE methodologies into medication safety research, practitioners should apply a systems-based approach and focus on designing interventions in clinical practice. This process would be further supported by educating staff on HFE principles, learning from other healthcare sciences, and developing standardised reporting guidelines for HFE research in healthcare.