Essay on "Healthcare Setting Workarounds"

Essay 8 pages (2547 words) Sources: 4

[EXCERPT] . . . .

5% were adverse drug events (ADEs) that were both serious and life threatening. It is pertinent to mention that the researchers reported 'process workarounds' to the main cause of errors, thus resulting in incorrect dosage form, incorrect medication, incorrect strength of medicine. All these were within the category of ADEs (Cina, et al., 2006; p. 78). While many researchers study the computing related workarounds taking place due to IS design or lack of training to work in IS infrastructure, few researchers have also suggested that emotional exhaustion also results in application of workarounds.

The aspect of emotional exhaustion and physical tiredness of healthcare staff including nurses is not included in the scope of this study. However, it may be so that physical and emotional exhaustion results in increased likelihood of using workarounds to accomplish the tasks quickly. This however is only speculation by me and requires pertinent literature to be reviewed for substantiating the argument. The literature review on workarounds indicate that there are two main categories of workarounds commonly observed by the researchers, these are a) individual & collective computer-based workarounds, and b) individual paper-based workarounds. In this context, to mitigate IT-based workarounds, there is overwhelming evidence that research-based technology shall be inducted in the work environment of health facilities. Mere adoption of technology results in overlapping IT infrastructures resulting in slow down of the system, thereby encouraging nurses and health practitioners to use workarounds. To reduce paper-based workarounds, application of easily understandable computing applications are useful. Physical and emotional exhaustion elements should also be studied regarding their impact/relationship with workarounds.

Ethical, Legal, and Risk Related Issues of Workarounds

There are several ethical and legal issues related to the use of workarounds as standard practice. It is also observed that workarounds get entrenched in those healthcare facilities whose management lacks monitoring function. Further, there are more legal implications than ethical ones while engaging in excessive workarounds in healthcare delivery. A relatively old study is one that was conducted by Obradovich and Woods (1996) in which the researchers investigated the threat of workarounds to induce legally barred access assumed by nurses when using computer based infusion devices that are used for terbutaline infusion in high risk pregnancies. The researchers indicated that there are adverse legal consequences such as failing the programming of device if nurses keep working around the system to gain access when failing initially.

Quantitative data collected in a study by McKeon, Fogarty and Hegney (2006) indicate that nurses in rural and remote areas of Queensland, Australia did not take into consideration the legal compliance issues. For instance, in small hospitals, a common workaround (due to absence of doctor) is to initiate, administer, and supply medication without MOs order. This may be invasive and legal codes of medical practice disallow the nurse to do so. In case any harm occurs to the patient, MOs and nurses as well as hospital leaders are exposed to the risk of litigation. It is also not ethically commendable to engage in workarounds as a matter of habitual practice. I acknowledge that there are instances when medical officers, clinicians, and nurses face issues and delays in providing care-service to their patients. However, workarounds should only be used as exceptions and the need that caused using workaround should be reported to the hospital management.

Solution to Workarounds

In most circumstances, lack of awareness of 'at-risk' behaviors results in high tolerance to workarounds. By making the healthcare staff aware of the negative consequences (in context of patient care and legal compliance) of at-risk behaviors, healthcare staff can be made to decrease the use of workarounds. Individuals that regularly engage in workarounds and develop tolerance for at-risk behaviors in healthcare delivery should be held accountable. Rewards can be used as a means to de-incentivize the use of workarounds. Workarounds, as discussed earlier may in several instances point towards system weaknesses. Therefore, process improvement and system redesign shall be used as means to reduce workarounds.

Often, lack of training on the use of HIT system may result in lack of motivation to properly use the system. This also results in devising shortcuts for overriding the standard system of service delivery. Further, hospital leaders can investigate the reasons underlying each workaround practice and introduce standardization of practice to remove the need of workarounds. Remove healthcare workers' frustration over the use of HIT by making IT department of hospitals responsive and accountable for occasional issues in HIT. Rather than being over restrictive, IT managers should integrate mobile devices of workers and enable encryption of data.

Conclusion

The report investigated the use of workarounds in HIT infrastructure by clinicians and nurses. A workaround was defined as shortcut and a temporary action to circumvent the routine procedure of accomplishing work in healthcare facilities. Common workarounds in healthcare facilities were identified that included pre-pour of medications, not placing purchase orders through computing devices, etc. The literature review identified many workarounds related to the use of automated medication dispensing cabinets, and improper use of patient ID scanners. It was also indicated that some forms of workarounds are necessitated due to poor design elements of EMRs. Mitigation strategies may include increasing awareness regarding at-risk behaviors, altering the processes and improving process designs.

References

Cina, J.L., Gandhi, T.K., Churchill, W., Fanikos, J., McCrea, M., Rothschild, J.M., & Poon, E.G. (2006). How many hospital pharmacy medication dispensing errors go undetected? Joint Commission Journal on Quality and Patient Safety, 32(2), 73-80.

Debono, D.S., Greenfield, D., Travaglia, J.F., Long, J.C., Black, D., Johnson, J., & Braithwaite, J. (2013). Nurses' workarounds in acute healthcare settings: a scoping review. BMC health services research, 13(1), 175-191.

Koppel, R., Wetterneck, T., Telles, J.L., & Karsh, B.T. (2008). Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. Journal of the American Medical Informatics Association, 15(4), 408-423. Retrieved from: http://jamia. bmjjournals. com/content/15/4/408. full. pdf

McKeon, C.M., Fogarty, G.J., & Hegney, D.G. (2006). Organizational factors: impact on administration violations in rural nursing. Journal of advanced nursing, 55(1), 115-123.

Obradovich, J.H.,… READ MORE

How to Reference "Healthcare Setting Workarounds" Essay in a Bibliography

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