14 - Cognitive Factors and Error (10/23)

Define Skill-based behavior

• Behaviors that is highly automatic and learned

• Don’t need to allocate significant amounts of attention to the execution of a task

Define rule-based behaviors

• Dealing with a familiar problem where a cognitive solution to this problem is available in the form of a learned rule (if X, then Y)

• required to allocate attention

Define knowledge-based behaviors

• Dealing with a new and unfamiliar problem

• requires undivided attention and the cognitive process involved are slow and sequential

2. Describe how cognitive strain is related to the three kinds of behavior.

• Skill-based level (slip and lapse) ← LOW cognitive strain

• Rule-based level (RB mistakes) ← MID cognitive strain

• Knowledge-based level (KB mistakes) ← HIGH cognitive strain

What type of behaviors do individuals prefer to avoid and use instead when possible

Individuals prefer to MINIMIZE the cognitive strain and will use SKILL BASED behavior when possible!!

Define SLIP errors + category

Skilled based category

• action-based

• due to distractions/preoccupations

A nurse has programmed an infusion pump many times and developed automaticity in doing so, accidentally presses an incorrect key that results in administration for the incorrect dose of drug.

This is an example of what type of error and its category?

Slip

Define Lapse + category

Skill-based

• failure of memory (something didn’t happen)

Define rule-based mistakes

errors in planning actions

• Good rule/wrong time

• we are looking for familarity

Define knowledge-based mistakes

error in planning actions

• created an incorrect solution

• unfamiliar problem

Define signs, countersigns, non signs

Signs: tell you the rule is good or applicable

Countersigns: tell you the rules do not apply in this situation

Non-signs: unrelated noise

Mechanic with no medical training witnessing a person fall unconscious at a public park. The mechanic attempts to provide CPR. The patient’s heart is still beating and CPR is inappropriate

This is an example of what type of error?

Knowledge based mistake

Define violation + category

Rule-based error

• optimizing (thrill-seeking)

• necessary ( impossible to follow the rule)

• routine (corner-cutting)

Define cognitive biases

results from your brain’s attempt to simplify information processing; we often rely on mental shortcuts (called heuristics) to help make sense of the world with relative speed. 

List the examples of cognitive bias

• Selective attention

• Inattentional blindness

• Availability heuristic

• Confirmation bias

Define selective attention

process of directing our awareness to relevant stimuli while ignoring irrelevant stimuli in the environment

During rounds, a pharmacy student recommended that a drug be d/c based on the patient’s deteriorating renal function. However, the drug was being used to make the patient comfortable at the end of life, and the patient's renal function was not relevant to decision-making.

This is an example of what type of cognitive bias? What type of error occurred?

Selective attention

• attention is being given to the wrong feature

• Rule-based mistake - good rule misapplied

  • usually we will adj meds for renal function

Define inattentional blindness

occurs when one fails to notice a readily visible yet unexpected visual stimulus in ones sigh, likely to stem from an abundance of visual stimuli meriting ones notice

inattentional blindness is an example of what type of error?

Skill-based error - failure of attention

Define availability heuristic

tendency to think that examples of things that readily come to mind are more common than what is actually the case

• out of sight, out of mind

A pharmacy student recently completed a rotation in an intensive care unit, and they are now in a community pharmacy setting. While counseling patients, the pharmacy student overemphasizes the likelihood of a bad outcome based on their recent experience in caring for critically ill patients.

This is an example of what type of cognitive bias? What type of error has occurred?

availability heuristic

rule-based mistake - good rule misapplied

Define confirmation bias

Tendency of people to favor information that confirms their existing beliefs or hypotheses

A nurse practitioner suspects a patient has RA and orders labs to confirm this diagnosis. They do not order labs to explore other likely diagnoses. When the labs return and are inconsistent with RA, the NP believes this is just an unusual case and treats the patient for this medical condition.

This is an example of which cognitive bias?

Confirmation bias