Abstract
ObjectivesInfusion safety is a recognised concern internationally. While few observational studies explore the causes of the errors that occur, even fewer describe how safety is maintained in routine practice. We sought to understand safety around infusion devices. MethodsAn ethnographic study of infusion device use was conducted on a haematology ward. This included observations of 51 infusions, plus their preparation where possible, during 120 h of ward observation over 11 days. Field notes were transcribed and analysed using deductive coding informed by distributed cognition. A further inductive thematic analysis highlighted new themes for making sense of the data. ResultsThe distributed cognition analysis highlighted how infusion treatment was affected by interactions distributed across artefacts, tasks, social networks, physical space and time. These interactions occurred close to and away from the infusion: at micro, meso and macro levels according to distance from the actual process. The inductive analysis highlighted three new interdependent themes that account for how safety is constructed and compromised: structure, agency and performance variability. Discussion and conclusionSafety is constructed through the co-evolution of sociotechnical structure and agency whereby structure shapes and influences people’s behaviour and people reproduce and create structures. Everyday performance variability emerges from these interactions, including deviations in processes and outcomes (e.g. incidents, near misses and opportunities). Studies of everyday safety can explore interactions between four points of a sociotechnical structuration model: structure, agency, and satisfactory and unsatisfactory performance.
Highlights
Infusion administration has been recognised as a potential safety risk by regulators, manufacturers and healthcare providers alike (AAMI, 2010; National Patient Safety Association (NPSA), 2007; Blandford et al, 2016)
Thirty-seven distributed cognition features were identified in the data; each one has a unique case number across Tables 1–3
This study has revealed interactions influencing safety around infusion devices in hospitals that have not been previously documented
Summary
Infusion administration has been recognised as a potential safety risk by regulators, manufacturers and healthcare providers alike (AAMI, 2010; NPSA, 2007; Blandford et al, 2016). Taxis and Barber (2003a, b) used a theory of human error to explore the causes of intravenous infusion medication errors. They observed a high rate of error across ten different wards (including intensive care, paediatrics, surgery, cardiology and nephrology). Furniss et al (2011b) investigated ‘unremarkable’ errors and low-level disturbances in infusion pump use on an oncology day care unit These included nurses selfcorrecting their own errors before they reached the patient, which resonates with research that questions what should be classed as an error (Baker, 1997), and how one should respond to these low-level disturbances
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