CHALLENGE
In 2007, 5,000 medication errors were reported in the Danish healthcare system. Many of these errors originate in the drug room.

Fredericia Hospital assessed that their existing drug room had an error rate of 5-10%, the equivalent of 45-90 errors a day – errors that prolong hospital stays and cause anxiety for staff and patients alike. Fredericia Hospital and the regional Centre for Quality wanted to reduce the occurrence of medication errors. Could design be the answer?

FINDINGS
The nurses had to find their own organising system due to a bad design of the facilities in the room.

Drugs were organised according to three different systems, which increased the risk for medication errors.

The observation videos revealed that up to five nurses might be present in the drug room at the same time, even though the regulations had a maxi- mum limit of two.

SOLUTION
The lock-operated key was replaced with a card reader, which provided easy access to the room. The existing doors were replaced with glass doors, which made it possible to see how many people were in the drug room. A waste collection system, a shelf system and new drug trays were developed to
increase order and transparency and thus prevent errors stemming from automated behaviour. The new drug room has well-being overall and has reduced the number of medication errors.

Design Harrit-Sørensen
Project partners Fredericia Hospital, Force Tecnology, Centre for Quality