Medication errors in residential aged care facilities: A distributed cognition analysis of the information exchange process

Tariq, Amina; Georgiou, Andrew; Westbrook, Johanna I.

doi:10.1016/j.ijmedinf.2012.08.006

Cited by 53 publications

(50 citation statements)

References 60 publications

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“…7,9 Studies investigating nursing care activities primarily focus on medication management because it is crucial to resident safety. [11][12][13][14][15][16] For example, Ellis et al conducted focus group discussions with nurses to investigate medication administration in two Canadian RAC homes and found that nurses 'race against time' to complete medication administration. 12 In another Canadian study, Thomson et al conducted a time-motion study to examine the time nurses spent on each of seven pre-defined steps in medication administration in a single RAC home and found that medication preparation and provision required longer than any of the other steps.…”

Section: Introductionmentioning

confidence: 99%

Nursing staff work patterns in a residential aged care home: a time–motion study

Qian¹,

Yu²,

Hailey³

2016

Aust. Health Review

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Objective. Residential aged care services are challenged by an increasing number of residents and a shortage of nursing staff. Developing strategies to overcome this challenge requires an understanding of nursing staff work patterns. The aim of the present study was to investigate the work processes followed by nursing staff and how nursing time is allocated in a residential aged care home.Methods. An observational time-motion study was conducted at two aged care units for 12 morning shifts. Seven nurses were observed, one per shift.Results. In all, there were 91 h of observation. The results showed that there was a common work process followed by all nurse participants. Medication administration, documentation and verbal communication were the most time-consuming activities and were conducted most frequently. No significant difference between the two units was found in any category of activities. The average duration of most activities was less than 1 min. There was no difference in time utilisation between the endorsed enrolled nurses and the personal carers in providing nursing care.Conclusion. Medication administration, documentation and verbal communication were the major tasks in morning shifts in a residential aged care home. Future research can investigate how verbal communication supports nursing care. What is known about the topic?The aging population will substantially increase the demand for residential aged care services. There is a lack of research on nurses' work patterns in residential aged care homes. What does this paper add? The present study provides a comprehensive understanding of nurses' work patterns in a residential aged care home. There is a common work process followed by nurses in providing nursing care. Medication administration, verbal communication and documentation are the most time-consuming activities and they are frequently conducted in the same period of time. Wound care, physical review and documentation on desktop computers are arranged flexibly by the nurses. What are the implications for practitioners? When developing a task reallocation strategy to improve work efficiency, effort can be put into tasks that can be arranged more flexibly.

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Section: Introductionmentioning

confidence: 99%

Nursing staff work patterns in a residential aged care home: a time–motion study

Qian¹,

Yu²,

Hailey³

2016

Aust. Health Review

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“…As various healthcare workers such as doctors, pharmacists and nursing staff collaboratively work in the medication management process [6], and each needs to make specific decisions and actions, this process can be error-prone [7].…”

Section: Introductionmentioning

confidence: 99%

The impact of electronic medication administration records in a residential aged care home

Qian¹,

Yu²,

Hailey³

2015

International Journal of Medical Informatics

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This study aimed to compare between electronic medication administration records and paper-based records in the nursing time spent on various activities in a medication round and the medicationadministration processes followed by nurses in an Australian residential aged care home. It also aimedto identify the benefits and unintended adverse consequences of using the electronic medication admin-istration records.Methods: Time-motion observation, taking of field notes, informal conversation and document reviewwere used to collect data in two units of a residential aged care home. Each unit had one nurse admin-ister medication. Seven nurses were observed over 12 morning shifts. Unit 1 used electronic medicationadministration records and Unit 2 used paper-based records.Results: No significant difference between the two units was found in the nursing time spent on variousactivities in a medication round, including documentation, verbal communication, medication adminis-tration, infection control and transit.Comparison of the medication administration processes between the electronic and paper-basedmedication administration records identified a procedural problem which violated the organization'sdocumentation requirement. This problem was documenting before providing medication to a residentwhen using the paper-based records. It was not observed with the electronic medication administrationrecords.Benefits of introducing the electronic medication administration records included improving nurses'compliance with documentation requirements, freedom from the error of signing twice, reducing thepossibility of forgetting to medicate a resident, facilitating nurses to record the time of medicationadministration to a resident and increasing documentation space. Unintended adverse consequencesof introducing the electronic medication administration records included inadequate information aboutresidents, late addition of a new resident's medication profile in the records and nurses' forgetting tomedicate a resident due to power outage of the portable device.Conclusions: The electronic medication administration records may not change nursing time spent onvarious activities in a medication round or substantially alter the medication administration processes,but can generate both benefits and unintended adverse consequences. Future research may investigatewhether and how the adverse consequences can be prevented.

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“…Tariq et al [28] used DCog to identify gaps in information exchanges that could contribute to medication errors in residential aged care facilities. They found that DCog helped move from attributing error to individual care providers to looking at weaknesses and vulnerabilities in the information flow more broadly, e.g.…”

Section: Distributed Cognition and Dicotmentioning

confidence: 99%

“…Hazlehurst et al [25] privilege action in an activity system. They and other researchers use a combination of recordings, interviews and observations to explore how activities within a system are structured and coordinated [26][27][28].…”

Section: Distributed Cognition and Dicotmentioning

confidence: 99%

Exploring medical device design and use through layers of Distributed Cognition: How a glucometer is coupled with its context

Furniss

Masci

Curzon

et al. 2015

Journal of Biomedical Informatics

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Medical devices are becoming more interconnected and complex, and are increasingly supported by fragmented organizational systems, e.g. through different processes, committees, supporting staff and training regimes. Distributed Cognition has been proposed as a framework for understanding the design and use of medical devices. However, it is not clear that it has the analytic apparatus to support the investigation of such complexities. This paper proposes a framework that introduces concentric layers to DiCoT, a method that facilitates the application of Distributed Cognition theory. We use this to explore how an inpatient blood glucose meter is coupled with its context. The analysis is based on an observational study of clinicians using a newly introduced glucometer on an oncology ward over approximately 150h (11days and 4 nights). Using the framework we describe the basic mechanics of the system, incremental design considerations, and larger design considerations. The DiCoT concentric layers (DiCoT-CL) framework shows promise for analyzing the design and use of medical devices, and how they are coupled with their context.

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Medication errors in residential aged care facilities: A distributed cognition analysis of the information exchange process

Cited by 53 publications

References 60 publications

Nursing staff work patterns in a residential aged care home: a time–motion study

Nursing staff work patterns in a residential aged care home: a time–motion study

The impact of electronic medication administration records in a residential aged care home

Exploring medical device design and use through layers of Distributed Cognition: How a glucometer is coupled with its context

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