Background: Medication administration errors (MAEs) have long been a prevalent problem and endanger patient safety. Bar-code medication administration (BCMA) systems were developed for the purpose of preventing the occurrence of MAEs. However, it has been demonstrated that the implementation of BCMA has brought about unanticipated consequences on nursing work and new, potential predictable paths to MAEs. More recently, investigators have introduced a new approach to describe the impact of BCMA on nursing work, which reflects nurses’ adaptations to the operational problems of BCMA under difficult circumstances. A more complete understanding of the process of nurses’ adaptations to technology will better inform intervention program for performance and safety improvement.
Specific Aims: The specific aims of this study were to: 1) conduct an integrative literature review about operational problems of BCMA, 2) validate a typology of operational problems of BCMA yielded in the literature review, and 3) assess nurses’ adaptations to BCMA operational problems and describe their perceptions about the adaptations.
Conceptual Framework: The conceptual framework guided this study was an integration of the work system from the Systems Engineering Initiative for Patient Safety (SEIPS) model and the frames perspective. When there is a collision between the frames (system frame and practice frame), the operational problems occur, and then nurses make adaptations to the operational problems. In this study, it is considered that the “system frame” is functionalized as the “work system”, which is the core of the SEIPS model.
Methods: A prospective, exploratory design was conducted to meet the study aims. This descriptive study included two convenience samples of registered nurses working on identified medical and surgical adult acute care units. An observation of BCMA use and a semi-structured interview was conducted with each participant of one group of sample (N=22) to collect data about the operational problems of BCMA. Another group of sample (N=21) conducted scenario interviews and follow-up interviews to describe their adaptations to the operational problems of BCMA.
Results: This study found that 1) the triggers of operational problems of BCMA can be categorized according to the elements of the work system of the SEIPS model, which are technology and tools, tasks, person, environment, and organization; 2) the five elements of the SEIPS work system were validated for use as a typology of the triggers of operational problems of BCMA; 3) nurses conducted different adaptations with various strategies to accommodate to the operational problems of medication administration using BCMA; and 4) the perceptions of nurses about the adaptations to the operational problems of BCMA can be addressed by the sequential steps, implying nurses think in a logic and objective way during adaptations.
Conclusions: This study provides a new way to approach the impact of BCMA on nursing work – adaptations. This is one of the first studies that attempts to understand nurses’ adaptations to the operational problems of BCMA, and also one of the first studies that investigates nurses’ perceptions about adaptations. Future research should more rigorously study nurses’ adaptive behaviors to operational problems.PHDNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/146043/1/liujia_1.pd
