Technology implementation and workarounds in the nursing home
Technology implementation and workarounds in the nursing home
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DOI：
10.1197/jamia.m2378
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发表时间：
2008-01-01
影响因子：
6.4
通讯作者：
Scott-Cawiezell, Jill R.
中科院分区：
文献类型：
--
作者：
Vogelsmeier, Amy A.;Halbesleben, Jonathon R. B.;Scott-Cawiezell, Jill R.
目的：本研究旨在探讨的关系的变通方法有关的实施电子给药记录和用药安全的做法在五个中西部nursing homes.Design：作为一个更大的研究的一部分，进行了定性评估，以确定变通方法与实施电子给药记录。使用多种方法收集数据，包括直接观察、流程图、关键知情人访谈和药物安全团队会议现场记录的审查。测量：使用开放和轴向编码技术来识别和分类与工作流程块相关的工作区类型。工作区以两种不同的模式呈现，这些问题涉及技术带来的工作流程障碍，以及没有重新设计组织流程以有效融入技术的问题。解决方法，如安全警报覆盖和快捷方式，以文件产生的第一阶问题解决的直接块。护理之家的工作人员作为个人经常使用的第一阶问题的解决，而不是更复杂的第二阶问题的解决方法所使用的药物safety team.Conclusion：这项研究提供了重要的实际例子，护理之家的工作人员如何围绕工作流程块在实施技术。了解这些解决方法作为解决问题的一级手段是了解药物安全风险的重要考虑因素。
Objective: This study sought to explore the relationship of workarounds related to the implementation of an electronic medication administration record and medication safety practices in five Midwestern nursing homes.Design: As a part of a larger study, this qualitative evaluation was conducted to identify workarounds associated with the implementation of an electronic medication administration record. Data were collected using multimethods including direct observation, process mapping, key informant interviews, and review of field notes from medication safety team meetings.Measurements: Open and axial coding techniques were used to identify and categorize types of workarounds in relation to work flow blocks.Results: Workarounds presented in two distinct patterns, those related to work flow blocks introduced by technology and those related to organizational processes not reengineered to effectively integrate with the technology. Workarounds such as safety alert overrides and shortcuts to documentation resulted from first-order problem solving of immediate blocks. Nursing home staff as individuals frequently used first-order problem solving instead of the more sophisticated second-order problem solving approach used by the medication safety team.Conclusion: This study provides important practical examples of how nursing home staff work around work flow blocks encountered during the implementation of technology. Understanding these workarounds as a means of first-order problem solving is an important consideration to understanding risk to medication safety.