Higher scores on the PAM were associated with higher rates of self-care behaviors and ease in managing diabetes; however, the indigent urban population reported higher activation scores than found in previous studies. The relationship between activation and outcomes needs to be explored further prior to expanding use of this measure in this patient population.

The objective of this study was to identify facilitators and barriers to the implementation of 10 National Quality Forum (NQF) medication processes and the culture of safety practices in Georgia hospitals. In-depth interviews with hospital administrators were conducted to identify facilitators and barriers to the implementation of programs that support the NQF safe practices. Hospitals identified significant as well as other key factors that resulted in the adoption and/or nonadoption of medication and culture of safety practices. Informants also identified strategies used to overcome barriers that were experienced. Facilitators to both practices include administrative leadership support and education and training. The resistance to change was the most significant barrier identified in both the safe medication process interviews and the culture of safety interviews. Implementing safety practices can be a difficult process, replete with organizational, financial, and professional barriers. Strategies identified by our informants to overcome these barriers may assist other hospitals currently facing this challenge.

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The purpose of this article was to describe facilitators and barriers to the implementation of a commercially available electronic medication administration record system at two pediatric hospitals. Qualitative interviews were conducted at 6 and 18 months after implementation with a convenience sample of nurses working on either the medical-surgical or ICUs. The 18-month interview reassessed barriers identified to the adoption of the electronic medication administration record system at the 6-month interview. The vast majority of respondents (85%) indicated that the implementation plan met their expectations. The most significant barrier to adoption (identified by 72% of respondents) was excessive time for logging into the system. After 18 months, respondent satisfaction increased considerably as modifications to the electronic medication administration record system were made, and adjustments to workflow resulted in streamlined nurse work processes coupled with increased productivity and enhanced patient safety. While this study confirms that nursing staff acceptance of health information technology is aided by the system's ability to improve patient safety and accessibility of patient information, we also found that factors unrelated to the actual software or the system could be important determinants of users' satisfaction.

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