Not by technology alone .... Project seeks to assess and aid patient safety in rural areas.

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128 March/April 2003 Publication of The Institute of Medicine’s report To Err Is Human heightened the need for concerted efforts to improve patient safety. While a number of different approaches have been suggested, technology seems to have taken center stage. Information technologies such as computerized physician order entry may decrease rates of medication errors. Other available information technologies such as computerized medication administration records, robots, automated pharmacy systems, bar coding, “smart” intravenous devices, and computerized discharge prescriptions and instructions may also be helpful.1 While the development of appropriate technology is a critical intervention, technology alone cannot ensure higher levels of patient safety. A CAT scan, for example, requires competent interpretation. Thus, technology must be part of a system-wide approach that incorporates the context of care—the social, political, economic, and cultural factors specific to a given setting. Technology requires a human interface and a welltrained workforce—one that understands the cognitive and affective component of behaviors, and how those behaviors relate to the interventions we adopt. Without attention to the human/technology interface, even well intentioned interventions may be resisted or used inappropriately. We make these claims based on data stemming from 9 studies conducted in rural communities in a 14-state area, as well as on data from an ongoing patient safety research project, as listed in Table 1. These studies reveal the culture of care and suggest that the ability to recognize and respond to potentially unsafe situations may be compromised by factors that technology alone cannot solve. These factors include staffing patterns, workplace communication, and the overall lack of resources and training. For example, our studies indicate that 67 percent of rural nurses have not attained baccalaureate level training. They define themselves as “staff nurses” who, on average, work in 3 departments on a daily basis2. Opportunities for direct communication with one another can be limited. For example, in many rural hospitals, audio taped reports have replaced the face-to-face meetings that previously occurred at changes of shifts. Rural nurses also have few opportunities for training or continuing education. Some lament the lack of educational opportunities, but they also report a hesitancy to