Abstract
The most common change facing nurses today is new technology, particularly bar-coded medication administration technology (BCMA). However, there is a dearth of knowledge on how BCMA alters nursing work. This study investigated how BCMA technology affected nursing work, particularly nurses’ operational problem-solving behavior. Cognitive systems engineering observations and interviews were conducted after the implementation of BCMA in three nursing units of a freestanding pediatric hospital. Problem-solving behavior, associated problems, and goals were specifically defined and extracted from observed episodes of care. Three broad themes regarding BCMA’s impact on problem solving were identified. First, BCMA allowed nurses to invent new problem-solving behavior to deal with pre-existing problems. Second, BCMA made it difficult or impossible to apply some problem-solving behaviors that were commonly used pre-BCMA, often requiring nurses to use potentially risky workarounds to achieve their goals. Third, BCMA created new problems that nurses were either able to solve using familiar or novel problem-solving behaviors, or unable to solve effectively. Results from this study shed light on hidden hazards and suggest three critical design needs: (1) ecologically valid design; (2) anticipatory control; and (3) basic usability. Principled studies of the actual nature of clinicians’ work, including problem solving, are necessary to uncover hidden hazards and to inform health information technology design and redesign.
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Acknowledgments
The authors wish to thank the study participants and colleagues involved in the Bar Coding study. This work was supported by a grant from the Agency for Healthcare Research and Quality (AHRQ) (R01 HS013610) and National Library of Medicine (R01 LM008923) to author BK and by a National Institutes of Health pre-doctoral training grant (TL1 RR025013-01), AHRQ post-doctoral training grant (T32 HS000083-11), and Hertz Foundation Fellowship to author RJH. None of those agencies had any role in the study or publication except for providing funding for the study.
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Holden, R.J., Rivera-Rodriguez, A.J., Faye, H. et al. Automation and adaptation: nurses’ problem-solving behavior following the implementation of bar-coded medication administration technology. Cogn Tech Work 15, 283–296 (2013). https://doi.org/10.1007/s10111-012-0229-4
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DOI: https://doi.org/10.1007/s10111-012-0229-4