Medical College of Wisconsin
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Automation and adaptation: Nurses' problem-solving behavior following the implementation of bar coded medication administration technology. Cogn Technol Work 2013 Aug 01;15(3):283-296

Date

01/21/2014

Pubmed ID

24443642

Pubmed Central ID

PMC3891738

DOI

10.1007/s10111-012-0229-4

Scopus ID

2-s2.0-84880703871 (requires institutional sign-in at Scopus site)   60 Citations

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.

Author List

Holden RJ, Rivera-Rodriguez AJ, Faye H, Scanlon MC, Karsh BT

Author

Matthew C. Scanlon MD Professor in the Pediatrics department at Medical College of Wisconsin