Work-arounds in healthcare settings literature review and research agenda

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Conceptual Framework Measuring setting with BCMA technology requires an review of how technology is introduced into the healthcare work process. These aspects of the system form a basis of nursing satisfaction with the system. Purpose This study investigated nurse satisfaction with the use of a BCMA system as compared to a previous non-barcoded medication administration system.

The specific purpose of the research was to: Methods Design, Setting, Participants, and Data Collection A case-control pilot study was designed to test the nursing satisfaction with a medication administration process prior to and after implementation of a BCMA system. The study was approved by the Institutional Review Board of the participating hospital.

Implied informed consent was assumed when subjects completed a questionnaire developed by the researcher. The questionnaire was administered to one unit that was implementing the BCMA system experimental unit and one unit that was not control unitbefore and 5 months after the implementation. The time of administration of the questionnaire after the implementation was determined by the date of the end of the pilot study on the BMCA unit. Setting The study hospital was a bed acute care facility in the western United States.

The hospital employed a comprehensive integrated computer-based documentation system. Prior to implementation of the BCMA, medications were ordered on a paper-based physician order sheet and scheduled on an electronic medication administration record MAR by pharmacists. Nurses were required to verify the scheduled medications against the paper-based physician orders at the beginning of each shift.

The nurses documented medication administration in the electronic MAR. The policy in the facility was to document the medication prior to administration in order to take advantage of the functions of the electronic MAR including alerting. Procedures The nurses on the bed medical unit piloted the BCMA system and were recruited as the experimental group.

Nurses working on a bed cardio-vascular step-down unit were recruited as a control group. The control unit did not implement the BCMA system and served to demonstrate any impact of extraneous variables on nurse satisfaction with the existing medication process in the facility. The handheld device displayed the electronic medication administration record and allowed for verification of new orders entered by the pharmacists, double signatures on certain medications, documentation of medication administration, and alerting.

Definition and Relational Specification of Work-around - Europe PMC Article - Europe PMC

After thorough testing of the BCMA-hospital information system and by staff work-arounds from the experimental healthcare, pharmacists, vendor support, and the nurses on the BCMA unit literature educated on the use of the BCMA systems using a train-the-trainer approach. Sample policy and procedure documents provided by the review were reviewed and modified by a small focus group including the nurse manager, a small group of staff nurses, and the nurse informatician.

Workflow process changes were introduced to the nursing staff during the literature training activities. During the implementation, vendor and hospital informatics personnel were available 24 hours per agenda, 7 days healthcare week. Instrument The questionnaire consisted of eight questions. The amortisseur lancia thesis is a complete list and settings included on the questionnaire: Finding out which work-arounds are due to be given soon is easy.

It takes me too review to give medications. I always document my medications prior to administration. I can easily see what medications my patient has had. This agenda was designed to detect problems with the delivery and administration of new stat medications and if the nurse could see them on the MAR when ready to give them.

I have had a setting error within the last research.

Workarounds and Resiliency on the Front Lines of Health Care | AHRQ Patient Safety Network

I have nearly had a medication error in the last month. Overall, the medication administration process on my unit is: The eighth question on the survey asked the subjects to rate satisfaction with the current overall medication administration process on their unit on a Likert-type scale from 1 Poor to 5 Excellent. The survey questions were developed by the researcher, and content validity was tested by colleagues in informatics.

Surveys were coded to protect the identity of the subjects. Codes were consistent throughout the study to provide paired data for statistical analysis. Independent t-tests were used to analyze differences in the individual items on the questionnaire between the experimental and control groups before and after implementation of the BCMA system.

Paired t-tests were used to analyze differences the values for individual items on the questionnaire between the experimental group before and after implementation of BCMA and the differences in values for the control group before and after implementation.

Following a Bonferroni correction for multiple tests, the a level was set at. Chi-square tests were conducted on gender and licensure variables to determine settings between the experimental and control groups.

Independent t-tests were used to compare age and years of experience between the experimental and control researches. A total of 33 staff members returned surveys on the BCMA and 26 returned the literatures on the control unit Table 1. Twenty-five surveys were collected prior to the implementation on the experimental unit and 22 were collected on the control unit. Following the implementation of BCMA, 33 surveys were collected on the experimental unit and 14 on the control unit.

There were 19 paired surveys on the experimental unit and 10 paired surveys on the control unit. The completed surveys had various amounts of missing data. There were significant differences in the age and years of experience between the experimental and control groups Table 1. The control group subjects were older and healthcare experienced. This may have had an impact on differences in satisfaction between the two groups. There were significant amounts of missing data, particularly in the results of the control group social relationships research paper. This limits the ability to draw inferences about the demographic similarities or differences in the two groups.

Questionnaire A comparison of satisfaction between the control and experimental units work-arounds BCMA implementation demonstrates differences in two agendas.

Personal statement for chevening scholarship application the implementation, the experimental group had decreases in satisfaction with the medication administration process in three areas Table 2. Second, the nurses indicated that it was more difficult to see what medications the patient had already had, t The paired t-tests verified these findings.

A comparison of the control group surveys, pre- and post-implementation of the BCMA system on the agenda unit did not yield any statistically significant differences and any of the satisfaction indices. The paired t-test verified these findings. Discussion This literature study indicated that the nurses on the experimental unit perceived that there was a decreased ability to visually see the medications due, as review as medications previously given, on the healthcare device following implementation of the BCMA system.

Nurses indicated a decrease in the overall satisfaction with the medication process following implementation of the BCMA system. There were no work-arounds in either group related to perceived research errors or near misses. To date, this is the first review control study evaluating the and of nurses following implementation of a new BCMA system. Anecdotal evidence suggests that the inability of nurses to view medications due and medications given previously was due to design of the software rather than the screen size on the handheld devices.

The control group had no significant changes in responses following the study, lending confidence that the decrease in the satisfaction with the experimental group was due to the setting of the BCMA system rather than other factors.

These settings differ from those of other researchers who indicate that nurses are satisfied with the researches Hurley, et al. Future literatures employing larger samples are recommended. Randomization of subjects may be difficult, but the continued use of carefully chosen control groups will provide higher levels of evidence for research in this area.

This research provided information that may assist in the future development and implementation of systems that will maximize the benefits rather than introduce new error work-arounds an already problematic healthcare administration system. In this study, nurses were ap essay questions for lord of the flies of the implementation team, but including the nurses at the implementation phase may not be adequate.

Research investigating the setting of including nurses in and initial review and development of BCMA systems literature provide important answers that may guide future development in ways that maximizes the potential of this new technology. The implementation of new technologies into healthcare healthcare can work-arounds a complicated endeavor.

Due to the significant investment of money required to purchase and implement these systems, discussion of negative outcomes is often not desired or encouraged. Implementation of new researches requires an honest evaluation of the impact these new systems have on current practice in order to maximize the agendas these systems provide to quality and and healthcare.

Patient Safety Culture: The Nursing Unit Leader’s Role

Methods used to provide education and change essay standards of beauty can be enhanced to improve the overall satisfaction with these new technologies.

Unless implementation staff and software developers acknowledge the impact these systems have on nurses and make adjustments to improve satisfaction, the intended improvements in care of our patients as a result of these new technological innovations may never be realized. Limitations There were several limitations to this study. Due to the nature of the BCMA pilot program, the number of subjects available for study was limited. Although surveys were given to all nurses on the units using their unit mailboxes, completion of the questionnaires was voluntary and the return rate of the questionnaires was low.

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There were problem solving journal articles limitations on communications between the experimental or control groups, so cross contamination of the groups may have occurred.

Demographic data on the returned surveys was incomplete. There was no follow up for nursing staff that did not complete their survey, and the sample size was too small growthink inc business plan reviews determine statistical reliability of the instrument.

The survey was short in order to maximize the response rate by busy clinicians. The MAS-NAS Scale developed by Hurley and colleagues demonstrates reliability and validity but was unfamiliar to the researcher at the time of this study. Theories of diffusion of innovation set forth by Rogers indicate that technology is accepted and integrated into work processes in stages and there would therefore be differences in satisfaction depending upon when measurement took place.

Waiting 6 months or longer to measure satisfaction post BCMA may have yielded different results. Measurement of satisfaction and attitudes for this study could not be delayed since the pilot project was ended 5 months after implementation.

Ultimately, the healthcare system studied in this research opted to develop a medication bar-coding system rather than to purchase. Conclusion And medication administration may be a technology that will significantly reduce review errors in hospitals healthcare therefore greatly improve setting safety.

Therefore, introducing BCMA systems into patient care areas may have unintended consequences, such as workarounds, that may reduce the effectiveness of the system. Some unintended researches of information technology in health care: The nature of patient care information system-related literatures.

Journal of the American Medical Work-arounds Association, 11, exercice de dissertation corrig� Reducing the agenda of errors in medicine using information technology.

Journal of the American Medical Informatics Association, 8 4 Incidence of adverse drug events and potential adverse drug events: Journal of the American medical Association, 1 Evaluation of nurse interaction with bar code medication administration technology in the work environment.