Workarounds to Medication Preparation and Administration within an Intensive Care Unit: A Qualitative Study

Abstract

Objectives: To gain a comprehensive understanding of medication safety and potential improvements in a Brazilian intensive care unit (ICU), we included an exploration of related workarounds. Methods:We adapted participatory photographic research methods from the field of ecological restoration to study a Brazilian ICU. Using focus groups, nurse-led photo-narrated walkabouts, and photo elicitation in iterative phases of data collection and analysis, we identified a theme of 'living with workarounds on a day-today basis'.Results: Participants recognized barriers within their work environment that might contribute to perpetuating medication workarounds, and the visual methods enabled them identify ideas to minimize workarounds related to these processes of care. Conclusions:The participatory photo methods helped participants and researchers to develop in depth discussions to understand how nurses work around systemic vulnerabilities to optimize the delivery of patient care. The methods also increased participants' awareness of such behaviors and provided opportunities to identify ideas to reduce risk. We expect that similar methods could be successfully used in the future in a variety of practice settings to improve medication processes and other patient safety issues.