A recent AHRQ-sponsored conference on health IT and patient safety highlighted two important points when considering the implementation of IT in order to improve patient safety: (1) while the technology is important, understanding how people use (or don't use) the technology is arguably more important and (2) there are unintended consequences that arise in the implementation of technology that may have critical implications for patient safety. This proposal begins to bring those two issues together by studying the notion of workarounds in the medication process in two hospitals. A workaround is a situation where an employee devises a solution to address a block in work flow. Researchers have consistently argued that workarounds are associated with risks to patients through medical error, but there has been little research conducted to develop clear definitions of workarounds that distinguish them from other forms of deviation from intended work processes. Further, no research exists that has documented the extent that workarounds occur in health care or their associated risk to patients. As such, the proposed study has two aims.
Aim 1 : To develop a conceptual definition, operational definition, and measurement strategy for workarounds in the context of the medication process.
Aim 2 : To document the nature and extent to which medication administration workarounds occur in intensive care units and the extent to which these workarounds can lead to medication errors. To achieve these aims, a team of investigators from the University of Missouri-Columbia and the Harry S. Truman Memorial Veterans' Hospital will survey physicians, nurses, and pharmacists working in (or associated with) the intensive care units of two facilities regarding the medication process, blocks in the process, workarounds of those blocks, and potential ? medication errors. Based on these surveys, a conceptual and operational definition will be developed through the grounded theory method. Further, process maps that outline the medication process will be produced. The maps will be amended to include common blocks in the process and workarounds of those blocks. By developing conceptual background on the notion of workarounds and initial links to safety outcomes, this research will serve as a departure point for future studies of workarounds and unintended consequences of work process design. ? ? ?

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Small Research Grants (R03)
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Health Care Quality and Effectiveness Research (HQER)
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Kelly, Carmen
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University of Missouri-Columbia
Schools of Medicine
United States
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Halbesleben, Jonathon R B; Savage, Grant T; Wakefield, Douglas S et al. (2010) Rework and workarounds in nurse medication administration process: implications for work processes and patient safety. Health Care Manage Rev 35:124-33