1
|
Galiano MA, Moreno Fergusson ME, Guerrero WJ, Muñóz MF, Ortiz Basto GA, Cardenas Ramírez JS, Guevara Lozano M, Larraín Sundt A. Technological innovation for workload allocation in nursing care management: an integrative review. F1000Res 2024; 12:104. [PMID: 38434658 PMCID: PMC10904957 DOI: 10.12688/f1000research.125421.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 03/05/2024] Open
Abstract
Background Technology reduces the nursing workload, improve the quality care processes, patient's safety, and avoid staff burnout. Innovative technologies are disrupting healthcare systems by improving the efficiency of processes and management. There is a discussion on the benefits, challenges, and barriers of these technologies and considering human factors of nursing management. The aim was to analyze the influence of technologies on the distribution of workload for nursing care management. Methods An integrative literature review was performed. Four databases were searched: Scopus, Scielo, PUBMED, and CINALH following PRISMA guidelines. Articles published from January 2016 to December 2020, published in English, Spanish and Portuguese were included. Studies were excluded when they were not original research, did not met the quality criteria or they did not answer the research questions. Quality appraisal was performed using the Crowe Critical Appraisal Tool version 1.4 (CCAT). Two reviewers independently examined the title and abstract for eligibility according to the inclusion and exclusion criteria. Results 2818 potentially relevant articles were found, but once the inclusion and exclusion criteria in the abstracts were analyzed, 177 remained for evaluation. After following the PRISMA Guidelines, 35 studies were included in the review. Three categories were identified: Nursing workload; Information technologies and technological means for management; Technology acceptance. Conclusions Technology has the potential to improve care management by estimating nurse workload in ICUs and non-critical units, but scientific evidence is more detailed in the former type of services. The literature provides insights about the factors that factors and the barriers that promote the technology acceptance and usability. We did not find studies comparing technologies and no scientific evidence proving improvements in care.
Collapse
|
2
|
Sloss EA, Jones TL, Baker K, Robins JLW, Thacker LR. Factors Influencing Medication Administration Outcomes Among New Graduate Nurses Using Bar Code-Assisted Medication Administration. Comput Inform Nurs 2024; 42:199-206. [PMID: 38206171 PMCID: PMC10925919 DOI: 10.1097/cin.0000000000001083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Paramount to patient safety is the ability for nurses to make clinical decisions free from human error. Yet, the dynamic clinical environment in which nurses work is characterized by uncertainty, urgency, and high consequence, necessitating that nurses make quick and critical decisions. The aim of this study was to examine the influence of human and environmental factors on the decision to administer among new graduate nurses in response to alert generation during bar code-assisted medication administration. The design for this study was a descriptive, longitudinal, observational cohort design using EHR audit log and administrative data. The study was set at a large, urban medical center in the United States and included 132 new graduate nurses who worked on adult, inpatient units. Research variables included human and environmental factors. Data analysis included descriptive and inferential analyses. This study found that participants continued with administration of a medication in 90.75% of alert encounters. When considering the response to an alert, residency cohort, alert category, and previous exposure variables were associated with the decision to proceed with administration. It is important to continue to study factors that influence nurses' decision-making, particularly during the process of medication administration, to improve patient safety and outcomes.
Collapse
Affiliation(s)
- Elizabeth A Sloss
- Author Affiliation: School of Nursing, Virginia Commonwealth University (Dr Sloss), Richmond; College of Nursing, University of Utah (Dr Sloss), Salt Lake City; Department of Adult Health and Nursing Systems, School of Nursing, Virginia Commonwealth University (Dr Jones and Robins), Richmond, Virginia; UVA Health (Dr Baker), Charlottesville, Virginia; and Department of Biostatistics, School of Medicine, Virginia Commonwealth University (Dr Thacker)
| | | | | | | | | |
Collapse
|
3
|
Tedone AM, Lanz JJ. Staying silent during a crisis: How workplace factors influence safety decisions in U.S. nurses. Soc Sci Med 2024; 341:116548. [PMID: 38171213 DOI: 10.1016/j.socscimed.2023.116548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/16/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
RATIONALE It is critical for healthcare organizations to promote upward communication of safety information to ensure safety issues experienced on the work floor are promptly identified and addressed, especially during crisis events. OBJECTIVE This study investigates mechanisms through which workplace factors affect nurses' motivation to speak up about safety issues, and ultimately their safety behaviors, in a pandemic work environment. METHOD The work experiences of 152 frontline U.S. nurses were captured across three time-points during the height of a global pandemic. RESULTS Findings indicate that nurses who experienced a greater frequency of pandemic-related demands and/or perceived a greater social risk associated with voicing concerns were more likely to remain silent about safety issues due to job-related constraints or a fear of negatively impacting their reputation, respectively. As a consequence, nurses were more likely to bypass safety protocols while completing work tasks, especially those who had a lower risk propensity. CONCLUSION These findings advance the literature on workplace safety by investigating factors that affect employee communication and ultimately safety workarounds in nurses within the context of a global pandemic.
Collapse
Affiliation(s)
| | - Julie J Lanz
- Department of Psychology, University of Nebraska at Kearney, USA
| |
Collapse
|
4
|
Hogerwaard M, Stolk M, Dijk LV, Faasse M, Kalden N, Hoeks SE, Bal R, Horst MT. Implementation of barcode medication administration (BMCA) technology on infusion pumps in the operating rooms. BMJ Open Qual 2023; 12:bmjoq-2022-002023. [PMID: 37217240 DOI: 10.1136/bmjoq-2022-002023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 05/05/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Medication administration errors (MAEs) are a major cause of morbidity and mortality. An updated barcode medication administration (BCMA) technology on infusion pumps is implemented in the operating rooms to automate double check at a syringe exchange. OBJECTIVE The aim of this mixed-methods before-and-after study is to understand the medication administrating process and assess the compliance with double check before and after implementation. METHODS Reported MAEs from 2019 to October 2021 were analysed and categorised to the three moments of medication administration: (1) bolus induction, (2) infusion pump start-up and (3) changing an empty syringe. Interviews were conducted to understand the medication administration process with functional resonance analysis method (FRAM). Double check was observed in the operating rooms before and after implementation. MAEs up to December 2022 were used for a run chart. RESULTS Analysis of MAEs showed that 70.9% occurred when changing an empty syringe. 90.0% of MAEs were deemed to be preventable with the use of the new BCMA technology. The FRAM model showed the extent of variation to double check by coworker or BCMA.Observations showed that the double check for pump start-up changed from 70.2% to 78.7% postimplementation (p=0.41). The BCMA double check contribution for pump start-up increased from 15.3% to 45.8% (p=0.0013). The double check for changing an empty syringe increased from 14.3% to 85.0% (p<0.0001) postimplementation. BCMA technology was new for changing an empty syringe and was used in 63.5% of administrations. MAEs for moments 2 and 3 were significantly reduced (p=0.0075) after implementation in the operating rooms and ICU. CONCLUSION An updated BCMA technology contributes to a higher double check compliance and MAE reduction, especially when changing an empty syringe. BCMA technology has the potential to decrease MAEs if adherence is high enough.
Collapse
Affiliation(s)
| | - Muriël Stolk
- Quality and Patientcare, Erasmus MC, Rotterdam, The Netherlands
| | | | - Mariët Faasse
- Anesthesiology, Erasmus MC, Rotterdam, The Netherlands
| | - Nico Kalden
- Department of Medical Technology/I&T, Erasmus MC, Rotterdam, The Netherlands
| | | | - Roland Bal
- School of Health Policy & Management, Erasmus Universiteit, Rotterdam, The Netherlands
| | | |
Collapse
|
5
|
Enwereuzor IK. Dispositional greed and knowledge sabotage: the roles of cutting corners at work and ethical leadership. Curr Psychol 2023. [DOI: 10.1007/s12144-023-04361-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
|
6
|
Knox MK, Mehta PD, Dorsey LE, Yang C, Petersen LA. A Novel Use of Bar Code Medication Administration Data to Assess Nurse Staffing and Workload. Appl Clin Inform 2023; 14:76-90. [PMID: 36473498 PMCID: PMC9891851 DOI: 10.1055/a-1993-7627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of the study is to introduce an innovative use of bar code medication administration (BCMA) data, medication pass analysis, that allows for the examination of nurse staffing and workload using data generated during regular nursing workflow. METHODS Using 1 year (October 1, 2014-September 30, 2015) of BCMA data for 11 acute care units in one Veterans Affairs Medical Center, we determined the peak time for scheduled medications and included medications scheduled for and administered within 2 hours of that time in analyses. We established for each staff member their daily peak-time medication pass characteristics (number of patients, number of peak-time scheduled medications, duration, start time), generated unit-level descriptive statistics, examined staffing trends, and estimated linear mixed-effects models of duration and start time. RESULTS As the most frequent (39.7%) scheduled medication time, 9:00 was the peak-time medication pass; 98.3% of patients (87.3% of patient-days) had a 9:00 medication. Use of nursing roles and number of patients per staff varied across units and over time. Number of patients, number of medications, and unit-level factors explained significant variability in registered nurse (RN) medication pass duration (conditional R2 = 0.237; marginal R2 = 0.199; intraclass correlation = 0.05). On average, an RN and a licensed practical nurse (LPN) with four patients, each with six medications, would be expected to take 70 and 74 minutes, respectively, to complete the medication pass. On a unit with median 10 patients per LPN, the median duration (127 minutes) represents untimely medication administration on more than half of staff days. With each additional patient assigned to a nurse, average start time was earlier by 4.2 minutes for RNs and 1.4 minutes for LPNs. CONCLUSION Medication pass analysis of BCMA data can provide health systems a means for assessing variations in staffing, workload, and nursing practice using data generated during routine patient care activities.
Collapse
Affiliation(s)
- Melissa K. Knox
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Paras D. Mehta
- Department of Medicine, University of Houston, Houston, Texas, United States
| | | | - Christine Yang
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Laura A. Petersen
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
| |
Collapse
|
7
|
Redley B, Douglas T, Hoon L, de Courten B, Hutchinson AM. Nurses' harm prevention practices during admission of an older person to the hospital: A multi-method qualitative study. J Adv Nurs 2022; 78:3745-3759. [PMID: 35799461 PMCID: PMC9796868 DOI: 10.1111/jan.15351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/23/2022] [Accepted: 06/20/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Nurses' harm prevention practices during the admission of older persons to hospital have important consequences for patient safety, preventable patient harm and length of hospital stay. Novel solutions are needed to assist nurses to balance complexity, high workload burden and patient safety during admission processes. AIM Explore the nurses' experiences of harm prevention practices during the admission of an older person to the hospital. DESIGN A multi-method qualitative study informed by frameworks of behaviour change and human-centred co-design. METHODS The purposive sample included 44 nurses, 5 clinicians from other disciplines and 3 consumers recruited from five general medicine wards across three hospitals of a large public health service in metropolitan Melbourne, Australia. Data were collected over 12 h of naturalistic observations of nurses during eight patient admissions, and during four participatory human-centred co-design workshops between August 2019 and January 2020. Observation, field notes and workshop artefact data were integrated for qualitative content and thematic analysis. RESULTS Analysis revealed a 5-step journey map, with a temporal logic, that captured nurses' experiences, as well as the enablers and barriers to harm prevention practices when admitting an older person to the hospital. The consensus was reached on three priority features to assist nurses to implement harm prevention practices when they admit an older person to the hospital: (1) prioritize important care; (2) tailor care to the individual and (3) see the big picture for the patient. CONCLUSION The novel research approach identified five steps in nurses' activities and harm prevention practices during admission of an older person to the hospital, and key features for a solution to assist nurses to keep patients safe. The findings provide the foundation for further research to develop interventions to assist nurses to manage high workloads during this complex activity.
Collapse
Affiliation(s)
- Bernice Redley
- Centre for Quality and Patient Safety Research – Monash Health Partnership, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health TransformationDeakin UniversityBurwoodVictoriaAustralia
| | - Tracy Douglas
- Centre for Quality and Patient Safety Research – Monash Health Partnership, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health TransformationDeakin UniversityBurwoodVictoriaAustralia
| | - Leonard Hoon
- Applied Artificial Intelligence InstituteDeakin UniversityBurwoodVictoriaAustralia
| | - Barbora de Courten
- Department of Medicine, School of Clinical SciencesMonash UniversityClaytonVictoriaAustralia,Monash HealthClaytonVictoriaAustralia
| | - Alison M. Hutchinson
- Centre for Quality and Patient Safety Research – Monash Health Partnership, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health TransformationDeakin UniversityBurwoodVictoriaAustralia
| |
Collapse
|
8
|
Valdez A. Medication safety: implications for teaching and learning. Teaching and Learning in Nursing 2022. [DOI: 10.1016/j.teln.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
9
|
Smith-Love J. Reducing Near Miss Medication Events Using an Evidence-Based Approach. J Nurs Care Qual 2022. [PMID: 35483027 DOI: 10.1097/NCQ.0000000000000630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Near miss medication events are pervasive without patient harm, mostly because of coincidence. Dynamic clinical environments challenge nurse compliance with medication administration rights and proper use of electronic technology. PROBLEM All nurses are educated in appropriate medication management, but our unit's barcoded medication administration scanning and electronic patient identification practices fell below the 97% benchmarks, representing hundreds of near miss medication events each month. APPROACH Transformative leadership guided frontline staff to identify gaps in care processes and determined root causes for unsanctioned medication administration practices using a FOCUS (Find-Organize-Clarify-Understand-Select)-PDSA (Plan-Do-Study-Act) methodology. OUTCOMES An interdisciplinary team committed to zero events of preventable harm overcame challenges to improve care delivery. Medication management scores exceeded organizational benchmarks, with sustainable gains over 2 years. CONCLUSIONS A rapid-cycle, evidence-based approach engaged staff to reduce near miss medication events. Workable solutions driven by transparent communication and interpersonal collaboration influenced positive safety behaviors.
Collapse
|
10
|
Tolley CL, Watson NW, Heed A, Einbeck J, Medows S, Wood L, Campbell L, Slight SP. The impact of a novel medication scanner on administration errors in the hospital setting: a before and after feasibility study. BMC Med Inform Decis Mak 2022; 22:86. [PMID: 35351096 DOI: 10.1186/s12911-022-01828-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/16/2022] [Indexed: 11/29/2022] Open
Abstract
Objective The medication administration process is complex and consequently prone to errors. Closed Loop Medication Administration solutions aim to improve patient safety. We assessed the impact of a novel medication scanning device (MedEye) on the rate of medication administration errors in a large UK Hospital. Methods We performed a feasibility before and after study on one ward at a tertiary-care teaching hospital that used a commercial electronic prescribing and medication administration system. We conducted direct observations of nursing drug administration rounds before and after the MedEye implementation. We calculated the rate and type (‘timing’, ‘omission’ or ‘other’ error) of medication administration errors (MAEs) before and after the MedEye implementation. Results We observed a total of 1069 administrations before and 432 after the MedEye intervention was implemented. Data suggested that MedEye could support a reduction in MAEs. After adjusting for heterogeneity, we detected a decreasing effect of MedEye on overall errors (p = 0.0753). Non-timing errors (‘omission’ and ‘other’ errors) reduced from 51 (4.77%) to 11 (2.55%), a reduction of 46.5%, which had borderline significance at the 5% level, although this was lost after adjusting for confounders. Conclusions This pilot study detected a decreasing effect of MedEye on overall errors and a reduction in non-timing error rates that was clinically important as such errors are more likely to be associated with harm. Further research is needed to investigate the impact on a larger sample of medications. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01828-3.
Collapse
|
11
|
Abstract
The COVID- 19 pandemic has demonstrated the value of digital solutions to patient care and to patient safety. here are many solutions that have yet to be fully implemented. In this commentary we discuss the value of barcode technology to ensure secure supply chains and the delivery of reliable and efficient processes in healthcare. This will facilitate the implementation of WHO policies on supply chains as well as support initiatives on medication safety.
Collapse
Affiliation(s)
- Peter Lachman
- Quality Improvement, Royal College of Physicians of Ireland (RCPI), Dublin, Ireland
| | | |
Collapse
|
12
|
Vest TA, Gazda NP, O'Neil DP, Schenkat DH, Eckel SF. Practice-enhancing publications about the medication-use process in 2020. Am J Health Syst Pharm 2021; 79:244-267. [PMID: 34758060 DOI: 10.1093/ajhp/zxab428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE This article identifies, prioritizes, and summarizes published literature on the medication-use process (MUP) from calendar year 2020 that can impact health-system pharmacy daily practice. SUMMARY The MUP is the foundational system that provides the framework for safe medication utilization within the healthcare environment. The MUP is defined in this article as having the following components: prescribing/transcribing, dispensing, administration, and monitoring. Articles evaluating at least one step of the MUP were assessed for their usefulness in practice improvement. A PubMed search for articles published in calendar year 2020 was conducted in January 2021 using targeted Medical Subject Headings (MeSH) keywords, and the table of contents of selected pharmacy journals was searched, providing a total of 9,433 articles. A thorough review identified 49 potentially practice-enhancing articles: 15 for prescribing/transcribing, 10 for dispensing, 6 for administration, and 18 for monitoring. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest-ranked articles are briefly summarized, with a mention of why they are important within health-system pharmacy. The other articles are listed for further review and evaluation. CONCLUSION It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article assists in identifying and summarizing the most impactful recently published literature. Health-system pharmacists have an active role in improving the MUP in their institution, and awareness of the moist significant published studies can assist in changing practice at the institutional level.
Collapse
Affiliation(s)
- Tyler A Vest
- Duke University Hospital, Durham, NC, and University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | | | | | | | - Stephen F Eckel
- University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, and University of North Carolina Medical Center, Chapel Hill, NC, USA
| |
Collapse
|
13
|
Rossler KL, Sankaranarayanan G, Hurutado MH. Developing an immersive virtual reality medication administration scenario using the nominal group technique. Nurse Educ Pract 2021; 56:103191. [PMID: 34534723 DOI: 10.1016/j.nepr.2021.103191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 08/13/2021] [Accepted: 08/31/2021] [Indexed: 01/05/2023]
Abstract
AIM This paper aims to describe how the Nominal Group Technique was applied to obtain focused content to develop medication administration error scenarios for future use to educate practicing RNs with immersive virtual reality simulation. BACKGROUND In the United States, medication errors account for up to $46 million in daily loss to hospital operational budgets. Each phase of prescribing, dispensing, administration, monitoring, and reconciliation is crucial in reducing potentially life-threatening outcomes associated with medication errors. Registered Nurses are responsible for safely administering diverse classifications of medications to patients in various healthcare settings. However, human and system factors can contribute to the exposure of hospitalized patients to a medication error. Virtual reality simulation-based education can be a methodology to educate practicing Registered Nurses on safe medication practices. DESIGN A Nominal Group Technique process was used to generate consensus from participating Registered Nurses on human and system factors that can contribute to medication administration errors. METHODS The process consisted of (a) preparation, (b) running the group with an introduction of the subject, (c) generation of ideas, (d) listing of ideas, (e) discussion of ideas, (f) ranking of top ideas, (g) voting on top ideas, (h) discussion of the vote outcome, and (i) re-ranking and rating the top items. Human and system factor idea items encompassed medication errors during ordering, prescribing, or administering medications. Both novice and experienced Registered Nurses rank-ordered these factors as those most likely to encounter or which would most likely occur during one working shift. RESULTS Descriptive statistics of frequencies and percentages were used to analyze the findings when grouped by human and system factor categories. Non-parametric testing with a Kruskal-Wallis test was conducted to compare the human and system factors by categories and years of Registered Nurse experience. Findings revealed that the factors of Time Management: getting behind, hurried, urgent (KW-H 11.2, df 4, p = .025) and Right Medication: medications have similar look and sound-alike names (KW-H 11.1, df 4, p = .025) impacted safe medication administration for both the novice and experienced nurse. CONCLUSION The NGT process identified human and system factors contributing to errors and impacting safe medication administration practices. Findings will support the creation of medication administration scenarios for use with immersive virtual reality simulation.
Collapse
Affiliation(s)
- Kelly L Rossler
- Baylor University Louise Herrington School of Nursing, 333N. Washington Ave., Dallas, TX 75246, USA.
| | - Ganesh Sankaranarayanan
- Department of Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Mariana H Hurutado
- Baylor Scott and White Health, University Medical Center, 3535 Worth St., Dallas, TX 75204, USA.
| |
Collapse
|
14
|
de Hond T, Keuning B, Oosterheert JJ, Blom-Ham W, Schoonhoven L, Kaasjager K. Differences in Documented and Actual Medication Administration Time in the Emergency Department: A Prospective, Observational, Time-Motion Study. J Emerg Nurs 2021; 47:860-869. [PMID: 34392956 DOI: 10.1016/j.jen.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Retrospective studies suggest that a rapid initiation of treatment results in a better prognosis for patients in the emergency department. There could be a difference between the actual medication administration time and the documented time in the electronic health record. In this study, the difference between the observed medication administration time and documentation time was investigated. Patient and nurse characteristics were also tested for associations with observed time differences. METHODS In this prospective study, emergency nurses were followed by observers for a total of 3 months. Patient inclusion was divided over 2 time periods. The difference in the observed medication administration time and the corresponding electronic health record documentation time was measured. The association between patient/nurse characteristics and the difference in medication administration and documentation time was tested with a Spearman correlation or biserial correlation test. RESULTS In 34 observed patients, the median difference in administration and documentation time was 6.0 minutes (interquartile range 2.0-16.0). In 9 (26.5%) patients, the actual time of medication administration differed more than 15 minutes with the electronic health record documentation time. High temperature, lower saturation, oxygen-dependency, and high Modified Early Warning Score were all correlated with an increasing difference between administration and documentation times. DISCUSSION A difference between administration and documentation times of medication in the emergency department may be common, especially for more acute patients. This could bias, in part, previously reported time-to-treatment measurements from retrospective research designs, which should be kept in mind when outcomes of retrospective time-to-treatment studies are evaluated.
Collapse
|
15
|
Hong JY, Ivory CH, VanHouten CB, Simpson CL, Novak LL. Disappearing expertise in clinical automation: Barcode medication administration and nurse autonomy. J Am Med Inform Assoc 2021; 28:232-238. [PMID: 32909610 DOI: 10.1093/jamia/ocaa135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/01/2020] [Accepted: 06/09/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Using the case of barcode medication administration (BCMA), our objective is to describe the challenges nurses face when informatics tools are not designed to accommodate the full complexity of their work. MATERIALS AND METHODS Autonomy is associated with nurse satisfaction and quality of care. BCMA organizes patient information and verifies medication administration. However, it presents challenges to nurse autonomy. Qualitative fieldwork, including observations of everyday work and interviews, was conducted during the implementation of BCMA in a large academic medical center. Fieldnotes and interview transcripts were coded and analyzed to describe nurses' perspectives on medication safety. RESULTS Nurses adopt orienting frames to structure work routines and require autonomy to ensure safe task completion. Nurses exerted agency by trusting their own judgment over system information when the system did not consider workload complexity. Our results indicate that the system's rigidity clashed with adaptive needs embodied by nurses' orienting frames. DISCUSSION Despite the fact that the concept of nurse as knowledge worker is foundational to informatics, nurses may be perceived as doers, rather than knowledge workers. In practice, nurses not only make decisions, but also engage in highly complex task-related work that is not well supported by process-oriented information technology tools. CONCLUSIONS Information technology developers and healthcare organization managers should engage and better understand nursing work in order to develop technological and social systems to support it.
Collapse
Affiliation(s)
- Jennifer Y Hong
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Catherine H Ivory
- Center for Evidenced-Based Practice and Nursing Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Courtney B VanHouten
- IBM Corporation, Watson Health, Center for AI, Research and Evaluation, Armonk, New York
| | - Christopher L Simpson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laurie Lovett Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
16
|
Carpenter JS, Draucker CB, Ellis RJB, Ferren MD, Gilbert JH, Newhouse RP, Von Ah D. A study of Indiana University Health's spirit of inquiry and innovation during COVID. Nurs Outlook 2021; 70:137-144. [PMID: 34627616 PMCID: PMC8495053 DOI: 10.1016/j.outlook.2021.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
Background COVID-19 has required nursing innovations to meet patient care needs not previously encountered. Purpose The purpose of this study was to describe nursing innovations conceived, implemented, and desired during the first COVID-19 surge. Methods The investigators invited registered nurses employed across 16 Midwest hospitals (6,207) to complete the survey. Respondents provided demographics and written descriptions of innovations they conceived, witnessed, and desired. Investigators analyzed text responses using standard content analytic procedures and summarized quantitative demographics using percentages. Findings Nurses reported seven types of innovations that would (a) improve personal protective equipment (PPE), (b) limit the need to repeatedly don and doff PPE, (c) ensure safer practice, (d) conserve and access supplies, (e) provide patient and family education and support, (f) make team member communication more efficient, and (g) improve peer support. Discussion Nurses are in a unique position to generate innovative solutions to meet patient care needs under adverse and rapidly changing situations.
Collapse
Affiliation(s)
- Janet S Carpenter
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, 46202.
| | - Claire B Draucker
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, 46202
| | | | - Melora D Ferren
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, 46202; Indiana University Health, Fairbanks Hall, 340 W. 10th Street, Indianapolis, IN 46202
| | - Jason H Gilbert
- Indiana University Health, Fairbanks Hall, 340 W. 10th Street, Indianapolis, IN 46202
| | - Robin P Newhouse
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, 46202; Indiana University Health, Fairbanks Hall, 340 W. 10th Street, Indianapolis, IN 46202
| | - Diane Von Ah
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, 46202
| |
Collapse
|
17
|
Williams R, Aldakhil R, Blandford A, Jani Y. Interdisciplinary systematic review: does alignment between system and design shape adoption and use of barcode medication administration technology? BMJ Open 2021; 11:e044419. [PMID: 34210721 PMCID: PMC8252881 DOI: 10.1136/bmjopen-2020-044419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In order to reduce safety risks associated with medication administrations, technologies such as barcode medication administration (BCMA) are increasingly used. Examining how human factors influence adoption and usability of this technology can potentially highlight areas for improvement in design and implementation. OBJECTIVE To describe how human factors related determinants for BCMA have been researched and reported by healthcare and human-computer interaction disciplines. DATA SOURCES The Cumulative Index of Nursing, and Allied Health Literature, PubMed, OVID MEDLINE and Google Scholar. STUDY ELIGIBILITY CRITERIA Primary research published from April 2000 to April 2020, search terms developed to identity different disciplinary research perspectives that examined BCMA use, used a human factors lens and were published in English. SYNTHESIS METHODS Computerised systematic searches were conducted in four databases. Eligible papers were systematically analysed for themes. Themes were discussed with a second reviewer and supervisors to ensure they were representative of content. RESULTS Of 3707 papers screened, 11 were included. Studies did not fit neatly into a clinical or human-computer interaction perspective but instead uncovered a range of overlapping narratives, demonstrating consensus on the key themes despite differing research approaches. Prevalent themes were misaligned design and workflow, adaptation and workarounds, mediating factors, safety, users' perceptions and design and usability. Inadequate design frequently led to workarounds, which jeopardised safety. Reported mediating factors included clarity of user needs, pre/post implementation evaluations, analysis of existing workarounds and appropriate technology, infrastructure and staffing. LIMITATIONS Most studies were relatively small and qualitative, making it difficult to generalise findings. CONCLUSION Evaluating interdisciplinary perspectives including human factors approaches identified similar and complementary enablers and barriers to successful technology use. Often, mediating factors were developed to compensate for unsuitable design; a collaborative approach between system designer and end users is necessary for BCMA to achieve its true safety potential.
Collapse
Affiliation(s)
- Rachel Williams
- Centre for Medicines Optimisation Research and Education, University College London NHS Foundation Trust, London, UK
| | - Reham Aldakhil
- Clinical and Research Informatics Unit, UCL Institution of Health informatics, University College London, London, UK
| | - Ann Blandford
- UCL Institute of Healthcare Engineering, University College London, London, UK
| | - Yogini Jani
- Centre for Medicines Optimisation Research and Education, University College London NHS Foundation Trust, London, UK
- UCL School of Pharmacy, University College London, London, UK
| |
Collapse
|
18
|
van der Veen W, Taxis K, Wouters H, Vermeulen H, Bates DW, van den Bemt PMLA. Factors associated with workarounds in barcode-assisted medication administration in hospitals. J Clin Nurs 2020; 29:2239-2250. [PMID: 32043705 PMCID: PMC7328795 DOI: 10.1111/jocn.15217] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/11/2020] [Accepted: 02/03/2020] [Indexed: 01/25/2023]
Abstract
Aims and objectives To identify that workarounds (defined as “informal temporary practices for handling exceptions to normal procedures or workflow”) by nurses using information technology potentially compromise medication safety. Therefore, we aimed to identify potential risk factors associated with workarounds performed by nurses in Barcode‐assisted Medication Administration in hospitals. Background Medication errors occur during the prescribing, distribution and administration of medication. Errors could harm patients and be a tragedy for both nurses and medical doctors involved. Interventions to prevent errors have been developed, including those based on information technology. To cope with shortcomings in information technology‐based interventions as Barcode‐assisted Medication Administration, nurses perform workarounds. Identification of workarounds in information technology is essential to implement better‐designed software and processes which fit the nurse workflow. Design We used the data from our previous prospective observational study, performed in four general hospitals in the Netherlands using Barcode techniques, to administer medication to inpatients. Methods Data were collected from 2014–2016. The disguised observation was used to gather information on potential risk factors and workarounds. The outcome was a medication administration with one or more workarounds. Logistic mixed models were used to determine the association between potential risk factors and workarounds. The STROBE checklist was used for reporting our data. Results We included 5,793 medication administrations among 1,230 patients given by 272 nurses. In 3,633 (62.7%) of the administrations, one or more workarounds were observed. In the multivariate analysis, factors significantly associated with workarounds were the medication round at 02 p.m.–06 p.m. (adjusted odds ratio [OR]: 1.60, 95% CI: 1.05–2.45) and 06 p.m.–10 p.m. (adjusted OR: 3.60, 95% CI: 2.11–6.14) versus the morning shift 06 a.m.–10 a.m., the workdays Monday (adjusted OR: 2.59, 95% CI: 1.51–4.44), Wednesday (adjusted OR: 1.92, 95% CI: 1.2–3.07) and Saturday (adjusted OR: 2.24, 95% CI: 1.31–3.84) versus Sunday, the route of medication, nonoral (adjusted OR: 1.28, 95% CI: 1.05–1.57) versus the oral route of drug administration, the Anatomic Therapeutic Chemical classification‐coded medication “other” (consisting of the irregularly used Anatomic Therapeutic Chemical classes [D, G, H, L, P, V, Y, Z]) (adjusted OR: 1.49, 95% CI: 1.05–2.11) versus Anatomic Therapeutic Chemical class A (alimentary tract and metabolism), and the patient–nurse ratio ≥6–1 (adjusted OR: 5.61, 95% CI: 2.9–10.83) versus ≤5–1. Conclusions We identified several potential risk factors associated with workarounds performed by nurses that could be used to target future improvement efforts in Barcode‐assisted Medication Administration. Relevance to clinical practice Nurses administering medication in hospitals using Barcode‐assisted Medication Administration frequently perform workarounds, which may compromise medication safety. In particular, nurse workload and the patient–nurse ratio could be the focus for improvement measures as these are the most clearly modifiable factors identified in this study.
Collapse
Affiliation(s)
- Willem van der Veen
- Unit PharmacoTherapy, Epidemiology & Economics, Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | - Katja Taxis
- Unit PharmacoTherapy, Epidemiology & Economics, Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | - Hans Wouters
- General Practitioners Research Institute, University of Groningen, Groningen, The Netherlands
| | - Hester Vermeulen
- Department of IQ Healthcare, Scientific Center for Quality of Healthcare, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - David W Bates
- Harvard Medical School and Brigham and Woman's Hospital, Boston, MA, USA
| | - Patricia M L A van den Bemt
- Department Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | | |
Collapse
|