Strategic work-arounds to accommodate new technology: The case of smart pumps in hospital care

Ann Scheck McAlearney, John Vrontos, Philip J Schneider, Christine R. Curran, Barbara S. Czerwinski, Craig A. Pedersen

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

OBJECTIVE: Computerized intravenous (IV) infusion pumps ("smart pumps") provide decision support to nurse end users at patients' bedsides during IV medication administration, but little is known about nurses' experiences using this technology in clinical practice. Our objective was to improve understanding about the use of smart pumps in clinical practice. METHODS: Four focus groups of 60 to 90 minutes were held with practicing registered nurses in March and April 2005. Sessions were audiotaped, transcribed verbatim, and analyzed using deductive and inductive methods to answer our research question about smart pump usage and to identify emergent themes in the data. RESULTS: Nurse participants had an average of 31/2 years of experience using smart pumps in diverse clinical settings. Several mechanical issues related to pump use were noted, including difficulties with tubing, battery life, and pump weight. Challenges associated with smart pump usage such as inconsistencies in the smart pump drug library and IV medication preparation were also discussed. Nurses described different strategies to overcome smart pump use challenges including disabling the safety software features of the smart pumps, especially in cases where there were differences between drug volumes and concentrations, limitations on dosing units, or limitations on medication administration rates. CONCLUSIONS: Smart pumps offer the potential to improve IV medication administration safety in the medication administration process, but work-arounds can introduce the possibility of new errors. Organizations introducing smart pumps should investigate actual usage at the point of care, and consider opportunities to accommodate modifications to the decision support software, or implement use standards to facilitate appropriate smart pump use.

Original languageEnglish (US)
Pages (from-to)75-81
Number of pages7
JournalJournal of Patient Safety
Volume3
Issue number2
DOIs
StatePublished - Jun 2007
Externally publishedYes

Fingerprint

Nurses
Technology
Intravenous Administration
Software
Point-of-Care Systems
Safety
Infusion Pumps
Focus Groups
Intravenous Infusions
Pharmaceutical Preparations
Weights and Measures
Research

Keywords

  • Informatics
  • Medical
  • Medication errors
  • Medication systems hospital
  • Qualitative research
  • Safety management
  • Technology

ASJC Scopus subject areas

  • Leadership and Management
  • Public Health, Environmental and Occupational Health

Cite this

Strategic work-arounds to accommodate new technology : The case of smart pumps in hospital care. / McAlearney, Ann Scheck; Vrontos, John; Schneider, Philip J; Curran, Christine R.; Czerwinski, Barbara S.; Pedersen, Craig A.

In: Journal of Patient Safety, Vol. 3, No. 2, 06.2007, p. 75-81.

Research output: Contribution to journalArticle

McAlearney, Ann Scheck ; Vrontos, John ; Schneider, Philip J ; Curran, Christine R. ; Czerwinski, Barbara S. ; Pedersen, Craig A. / Strategic work-arounds to accommodate new technology : The case of smart pumps in hospital care. In: Journal of Patient Safety. 2007 ; Vol. 3, No. 2. pp. 75-81.
@article{695156a689e9413f87bcbfaf92bad44f,
title = "Strategic work-arounds to accommodate new technology: The case of smart pumps in hospital care",
abstract = "OBJECTIVE: Computerized intravenous (IV) infusion pumps ({"}smart pumps{"}) provide decision support to nurse end users at patients' bedsides during IV medication administration, but little is known about nurses' experiences using this technology in clinical practice. Our objective was to improve understanding about the use of smart pumps in clinical practice. METHODS: Four focus groups of 60 to 90 minutes were held with practicing registered nurses in March and April 2005. Sessions were audiotaped, transcribed verbatim, and analyzed using deductive and inductive methods to answer our research question about smart pump usage and to identify emergent themes in the data. RESULTS: Nurse participants had an average of 31/2 years of experience using smart pumps in diverse clinical settings. Several mechanical issues related to pump use were noted, including difficulties with tubing, battery life, and pump weight. Challenges associated with smart pump usage such as inconsistencies in the smart pump drug library and IV medication preparation were also discussed. Nurses described different strategies to overcome smart pump use challenges including disabling the safety software features of the smart pumps, especially in cases where there were differences between drug volumes and concentrations, limitations on dosing units, or limitations on medication administration rates. CONCLUSIONS: Smart pumps offer the potential to improve IV medication administration safety in the medication administration process, but work-arounds can introduce the possibility of new errors. Organizations introducing smart pumps should investigate actual usage at the point of care, and consider opportunities to accommodate modifications to the decision support software, or implement use standards to facilitate appropriate smart pump use.",
keywords = "Informatics, Medical, Medication errors, Medication systems hospital, Qualitative research, Safety management, Technology",
author = "McAlearney, {Ann Scheck} and John Vrontos and Schneider, {Philip J} and Curran, {Christine R.} and Czerwinski, {Barbara S.} and Pedersen, {Craig A.}",
year = "2007",
month = "6",
doi = "10.1097/01.jps.0000242987.93789.63",
language = "English (US)",
volume = "3",
pages = "75--81",
journal = "Journal of Patient Safety",
issn = "1549-8417",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Strategic work-arounds to accommodate new technology

T2 - The case of smart pumps in hospital care

AU - McAlearney, Ann Scheck

AU - Vrontos, John

AU - Schneider, Philip J

AU - Curran, Christine R.

AU - Czerwinski, Barbara S.

AU - Pedersen, Craig A.

PY - 2007/6

Y1 - 2007/6

N2 - OBJECTIVE: Computerized intravenous (IV) infusion pumps ("smart pumps") provide decision support to nurse end users at patients' bedsides during IV medication administration, but little is known about nurses' experiences using this technology in clinical practice. Our objective was to improve understanding about the use of smart pumps in clinical practice. METHODS: Four focus groups of 60 to 90 minutes were held with practicing registered nurses in March and April 2005. Sessions were audiotaped, transcribed verbatim, and analyzed using deductive and inductive methods to answer our research question about smart pump usage and to identify emergent themes in the data. RESULTS: Nurse participants had an average of 31/2 years of experience using smart pumps in diverse clinical settings. Several mechanical issues related to pump use were noted, including difficulties with tubing, battery life, and pump weight. Challenges associated with smart pump usage such as inconsistencies in the smart pump drug library and IV medication preparation were also discussed. Nurses described different strategies to overcome smart pump use challenges including disabling the safety software features of the smart pumps, especially in cases where there were differences between drug volumes and concentrations, limitations on dosing units, or limitations on medication administration rates. CONCLUSIONS: Smart pumps offer the potential to improve IV medication administration safety in the medication administration process, but work-arounds can introduce the possibility of new errors. Organizations introducing smart pumps should investigate actual usage at the point of care, and consider opportunities to accommodate modifications to the decision support software, or implement use standards to facilitate appropriate smart pump use.

AB - OBJECTIVE: Computerized intravenous (IV) infusion pumps ("smart pumps") provide decision support to nurse end users at patients' bedsides during IV medication administration, but little is known about nurses' experiences using this technology in clinical practice. Our objective was to improve understanding about the use of smart pumps in clinical practice. METHODS: Four focus groups of 60 to 90 minutes were held with practicing registered nurses in March and April 2005. Sessions were audiotaped, transcribed verbatim, and analyzed using deductive and inductive methods to answer our research question about smart pump usage and to identify emergent themes in the data. RESULTS: Nurse participants had an average of 31/2 years of experience using smart pumps in diverse clinical settings. Several mechanical issues related to pump use were noted, including difficulties with tubing, battery life, and pump weight. Challenges associated with smart pump usage such as inconsistencies in the smart pump drug library and IV medication preparation were also discussed. Nurses described different strategies to overcome smart pump use challenges including disabling the safety software features of the smart pumps, especially in cases where there were differences between drug volumes and concentrations, limitations on dosing units, or limitations on medication administration rates. CONCLUSIONS: Smart pumps offer the potential to improve IV medication administration safety in the medication administration process, but work-arounds can introduce the possibility of new errors. Organizations introducing smart pumps should investigate actual usage at the point of care, and consider opportunities to accommodate modifications to the decision support software, or implement use standards to facilitate appropriate smart pump use.

KW - Informatics

KW - Medical

KW - Medication errors

KW - Medication systems hospital

KW - Qualitative research

KW - Safety management

KW - Technology

UR - http://www.scopus.com/inward/record.url?scp=34249946087&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34249946087&partnerID=8YFLogxK

U2 - 10.1097/01.jps.0000242987.93789.63

DO - 10.1097/01.jps.0000242987.93789.63

M3 - Article

AN - SCOPUS:34249946087

VL - 3

SP - 75

EP - 81

JO - Journal of Patient Safety

JF - Journal of Patient Safety

SN - 1549-8417

IS - 2

ER -