Co‐administration of multiple intravenous medicines: Intensive care nurses' views and perspectives

Oduyale, Mosopefoluwa S; Patel, Nilesh; Borthwick, Mark; Claus, Sandrine P.

doi:10.1111/nicc.12497

Cited by 12 publications

(43 citation statements)

References 33 publications

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“…An example of a tension is when a nurse is instructed to give a list of medicines that the patient cannot receive all at once, so they need to prioritise what to give first (e.g. Oduyale et al, 2020). So, the tensions or contradiction is built into the objective (or goal) of the function <administer medications>, because the patient should get all required medications, but they cannot all be given at the same time.…”

Section: Discussionmentioning

confidence: 99%

“…It has also been applied to understand workarounds when managing the co-administration of infusions in ICU, e.g. when there are compatibility issues and inadequate venous access (Oduyale et al, 2020). We build on these examples to use FRAM to explore sources of performance variability for intravenous infusion administration in an intensive care unit (ICU) in England, focusing on sources of performance variability and underlying systems contradictions.…”

Section: Introductionmentioning

confidence: 99%

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Using FRAM to explore sources of performance variability in intravenous infusion administration in ICU: A non-normative approach to systems contradictions

et al. 2020

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Systems contradictions present challenges that need to be effectively managed, e.g. due to conflicting rules and advice, goal conflicts, and mismatches between demand and capacity. We apply FRAM (Functional Resonance Analysis Method) to intravenous infusion practices in an intensive care unit (ICU) to explore how tensions and contradictions are managed by people. A multi-disciplinary team including individuals from nursing, medical, pharmacy, safety, IT and human factors backgrounds contributed to this analysis. A FRAM model investigation resulting in seven functional areas are described. A tabular analysis highlights significant areas of performance variability, e.g. administering medication before a prescription, prioritising drugs, different degrees of double checking and using sites showing early signs of infection for intravenous access. Our FRAM analysis has been non-normative: performance variability is not necessarily wanted or unwanted, it is merely necessary where system contradictions cannot be easily resolved and so adaptive capacity is required to cope.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Using FRAM to explore sources of performance variability in intravenous infusion administration in ICU: A non-normative approach to systems contradictions

et al. 2020

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“…Resiliency in health care was another concept discussed in eight (25.8%) of the included papers 10,18,21,23,28,30,43,45 . The majority of papers in this review provide a definition or description of the FRAM by explaining activities or functions in a process and the steps necessary to operationalize the FRAM (n = 25; 80.6%) 2,7,10,20-33,35-37,40,41,43-45 . Descriptions of the FRAM in the papers included in this review are provided in Appendix III.…”

Section: Resultsmentioning

confidence: 99%

The Functional Resonance Analysis Method as a health care research methodology: a scoping review

McGill

Smith

Morris

et al. 2021

JBI Evidence Synthesis

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Objective:The objective of this review was to examine and map the literature on the use of the Functional Resonance Analysis Method (FRAM) in health care research.Introduction:The FRAM is a resilient health care tool tat offers an approach to deconstruct complex systems by mapping health care processes to identify essential activities, how they are interrelated, and the variability that emerges, which can strengthen or compromise outcomes. Insight into how the FRAM has been operationalized in health care can help researchers and policy-makers understand how this method can be used to strengthen health care systems.Inclusion criteria:This scoping review included research and narrative reports on the application of the FRAM in any health care setting. The focus was to identify the key concepts and definitions used to describe the FRAM; the research questions, aims, and objectives used to study the FRAM; the methods used to operationalize the FRAM; the health care processes examined; and the key findings.Methods:A three-step search strategy was used to find published and unpublished research and narrative reports conducted in any country. Only papers published in English were considered. No limits were placed on the year of publication. CINAHL, MEDLINE, Embase, PsycINFO, Inspec Engineering Village, ProQuest Nursing & Allied Health were searched originally in June 2020 and again in March 2021. A search of the gray literature was also completed in March 2021. Data were extracted from papers by two independent reviewers using a data extraction tool developed by the reviewers. Search results are summarized in a flow diagram, and the extracted data are presented in tabular format.Results:Thirty-one papers were included in the final review, and most (n = 25; 80.6%) provided a description or definition of the FRAM. Only two (n = 2; 6.5%) identified a specific research question. The remaining papers each identified an overall aim or objective in applying the FRAM, the most common being to understand a health care process (n = 20; 64.5%). Eleven different methods of data collection were identified, with interviews being the most common (n = 21; 67.7%). Ten different health care processes were explored, with safety and risk identification (n = 8; 25.8%) being the most examined process. Key findings identified the FRAM as a mapping tool that can identify essential activities or functions of a process (n = 20; 64.5%), how functions are interdependent or coupled (n = 18; 58.1%), the variability that can emerge within a process (n = 20; 64.5%), discrepancies between work as done and work as imagined (n = 20; 64.5%), the resiliency that exists within a process (n = 12; 38.7%), and the points of risk within a process (n = 10, 32.3%). Most papers (n = 27; 87.1%) developed models representing the complexity of a process.Conclusions:The FRAM aims to use a systems approach to examine complex processes and, as evidenced by this review, is suited for use within the health care domain. Interest in the FRAM is growing, with most of ...

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“…For example, a recent study found that despite the use of strategies to maximise venous access, intensive care unit nurses sometimes ran out of sufficient venous access for VRIIIs. Although the use of workarounds such as prioritising infusions and swapping line of infusion was perceived as important to accomplish the task, the study claimed that these workarounds could decrease patient safety by creating new pathways to VRIIIs administration errors [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Using video reflexive ethnography to explore the use of variable rate intravenous insulin infusions

Iflaifel

Lim

Crowley

et al. 2022

BMC Health Serv Res

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Background The use of variable rate intravenous insulin infusion (VRIII) is a complex process that has consistently been implicated in reports of error and consequent harm. Investment in patient safety has focused mainly on learning from errors, though this has yet to be proved to reduce error rates. The Resilient Health Care approach advocates learning from everyday practices. Video reflexive ethnography (VRE) is an innovative methodology used to capture everyday practices, reflect on and thereby improve these. This study set out to explore the use of VRIIIs by utilising the VRE methodology. Methods This study was conducted in a Vascular Surgery Unit. VRE methodology was used to collect qualitative data that involved videoing healthcare practitioners caring for patients treated with VRIII and discussing the resulting clips with participants in reflexive meetings. Transcripts of these were subjected to thematic analysis. Quantitative data (e.g. blood glucose measurements) were collected from electronic patient records in order to contextualise the outcomes of the video-observed tasks. Results The use of VRE in conjunction with quantitative data revealed that context-dependent adaptations (seeking verbal orders to treat hypoglycaemia) and standardised practices (using VRIII guidelines) were strategies used in everyday work. Reflexive meetings highlighted the challenges faced while using VRIII, which were mainly related to lack of clinical knowledge, e.g. prescribing/continuing long-acting insulin analogues alongside the VRIII, and problems with organisational infrastructure, i.e. the wireless blood glucose meter results sometimes not updating on the electronic system. Reflexive meetings also enabled participants to share the meanings of the reality surrounding them and encouraged them to suggest solutions tailored to their work, for example face-to-face, VRIII-focused training. Conclusions VRE deepened understanding of VRIII by shedding light on its essential tasks and the challenges and adaptations entailed by its use. Future research might focus on collecting data across various units and hospitals to develop a full picture of the use of VRIIIs.

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Co‐administration of multiple intravenous medicines: Intensive care nurses' views and perspectives

Cited by 12 publications

References 33 publications

Using FRAM to explore sources of performance variability in intravenous infusion administration in ICU: A non-normative approach to systems contradictions

Using FRAM to explore sources of performance variability in intravenous infusion administration in ICU: A non-normative approach to systems contradictions

The Functional Resonance Analysis Method as a health care research methodology: a scoping review

Using video reflexive ethnography to explore the use of variable rate intravenous insulin infusions

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