Automation and adaptation: Nurses' problem-solving behavior following the implementation of bar coded medication administration technology.
The most common change facing nurses today is new technology, particularly bar coded medication administration technology (BCMA). However, there is a dearth of knowledge on how BCMA alters nursing work. This study investigated how BCMA technology affected nursing work, particularly nurses' operational problem-solving behavior. Cognitive systems engineering observations and interviews were conducted after the implementation of BCMA in three nursing units of a freestanding pediatric hospital. Problem-solving behavior, associated problems, and goals, were specifically defined and extracted from observed episodes of care. Three broad themes regarding BCMA's impact on problem solving were identified. First, BCMA allowed nurses to invent new problem-solving behavior to deal with pre-existing problems. Second, BCMA made it difficult or impossible to apply some problem-solving behaviors that were commonly used pre-BCMA, often requiring nurses to use potentially risky workarounds to achieve their goals. Third, BCMA created new problems that nurses were either able to solve using familiar or novel problem-solving behaviors, or unable to solve effectively. Results from this study shed light on hidden hazards and suggest three critical design needs: (1) ecologically valid design; (2) anticipatory control; and (3) basic usability. Principled studies of the actual nature of clinicians' work, including problem solving, are necessary to uncover hidden hazards and to inform health information technology design and redesign.
Departments of Medicine and Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, US.
Richard J
RJ
Holden
Department of Industrial Engineering, Clemson University, Clemson, SC, US.
A Joy
AJ
Rivera-Rodriguez
Institut de Radioprotection et de Sûreté Nucléaire, Direction Sûreté des Réacteurs-Service d'Etude des Facteurs Humains, Fontenay-aux-Roses, France.
Héléne
H
Faye
Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Wauwatosa, WI, USA.
Matthew C
MC
Scanlon
Departments of Industrial & Systems Engineering, Family Medicine, Population Health Sciences, and Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, US.
Ben-Tzion
BT
Karsh
Adaptation; bar coded medication administration (BCMA); health information technology; nursing; problem solving