Rework and workarounds in nurse medication administration process: Implications for work processes and patient safety
Rework and workarounds in nurse medication administration process: Implications for work processes and patient safety
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DOI：
10.1097/hmr.0b013e3181d116c2
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发表时间：
2010-04-01
影响因子：
2.5
通讯作者：
Wakefield, Bonnie J.
中科院分区：
文献类型：
--
作者：
Halbesleben, Jonathon R. B.;Savage, Grant T.;Wakefield, Bonnie J.
背景：医疗保健组织重新设计了现有的工作流程并实施了新的工作流程，旨在提高患者安全。由于这些流程的变化，现在故意设计了“障碍”或障碍，限制了具体工作行动（例如订购和给药药物）的执行方式。遇到这些设计障碍的医疗保健专业人员可以选择遵循新流程，采取变通办法来克服障碍，或者可能重复工作（返工）。不幸的是，这些变通办法和返工可能会导致其他安全问题。目的：本研究的目的是检查医院用药中的返工和变通办法方法/途径：对来自四家医院重症监护病房的 58 名护士进行了观察和半结构化访谈，重点关注药物管理流程，我们分析了观察和访谈数据，以制定有关返工和解决方法的主题。结果：参与者报告了总共 12 个区块，这些区块与信息交换、信息输入和内部相关。供应链问题往往会导致返工，而内部供应链问题更有可能导致解决方法。实践意义：单位中的分散药剂师可能会减少工作流程障碍（因此，解决方法和返工）工作流程的重新设计可能会进一步解决解决方法和返工的问题。
Background: Health care organizations have redesigned existing and implemented new work processes intended to improve patient safety. As a consequence of these process changes, there are now intentionally designed "blocks'' or barriers that limit how specific work actions, such as ordering and administering medication, are to be carried out. Health care professionals encountering these designed barriers can choose to either follow the new process, engage in workarounds to get past the block, or potentially repeat work (rework). Unfortunately, these work arounds and rework may lead to other safety concerns.Purpose: The aim of this study was to examine rework and workarounds in hospital medication administration processes.Methodology/Approach: Observations and semistructured interviews were conducted with 58 nurses from four hospital intensive care units focusing on the medication administration process. Using the constant comparative method, we analyzed the observation and interview data to develop themes regarding rework and workarounds. From this analysis, we developed an integrated process map of the medication administration process depicting blocks.Findings: A total of 12 blocks were reported by the participants. Based on the analysis, we categorized them as related to information exchange, information entry, and internal supply chain issues. Whereas information exchange and entry blocks tended to lead to rework, internal supply chain issues were more likely to lead to workarounds.Practice Implications: A decentralized pharmacist on the unit may reduce work flow blocks (and, thus, workarounds and rework). Work process redesign may further address the problems of workarounds and rework.