Strategic Work-Arounds to Accommodate New Technology

Abstract

Objective: Computerized intravenous (IV) infusion pumps (smart pumps) provide decision support to nurse end users at patients' bedsides during IV medication administration, but little is known about nurses' experiences using this technology in clinical practice. Our objective was to improve understanding about the use of smart pumps in clinical practice. Methods: Four focus groups of 60 to 90 minutes were held with practicing registered nurses in March and April 2005. Sessions were audiotaped, transcribed verbatim, and analyzed using deductive and inductive methods to answer our research question about smart pump usage and to identify emergent themes in the data. Results: Nurse participants had an average of 3½ years of experience using smart pumps in diverse clinical settings. Several mechanical issues related to pump use were noted, including difficulties with tubing, battery life, and pump weight. Challenges associated with smart pump usage such as inconsistencies in the smart pump drug library and IV medication preparation were also discussed. Nurses described different strategies to overcome smart pump use challenges including disabling the safety software features of the smart pumps, especially in cases where there were differences between drug volumes and concentrations, limitations on dosing units, or limitations on medication administration rates. Conclusions: Smart pumps offer the potential to improve IV medication administration safety in the medication administration process, but work-arounds can introduce the possibility of new errors. Organizations introducing smart pumps should investigate actual usage at the point of care, and consider opportunities to accommodate modifications to the decision support software, or implement use standards to facilitate appropriate smart pump use.