Abstract
This paper analyses the 'failure' of a patient safety intervention. Our study was part of a randomised controlled trial (RCT) of bed and bedside chair pressure sensors linked to radio pagers to prevent bedside falls in older people admitted to hospital. We use agential realism within science and technology studies to examine the fall and its prevention as a situated phenomenon of knowledge that is made and unmade through intra-actions between environment, culture, humans and technologies. We show that neither the intervention (the pressure sensor system), nor the outcome (fall prevention) could be disentangled from the broader sociomaterial context of the ward, the patients, the nurses and (especially) their work through the RCT. We argue that the RCT design, by virtue of its unacknowledged assumptions, played a part in creating the negative findings. The study also raises wider questions about the kind of subjectivities, agencies and power relations these entanglements might effect and (re)produce in the hospital ward.
Highlights
In this paper we take an agential realist approach (Barad 2007) to understanding how and why a patient safety technology ‘failed’
Our study was part of an RCT of pressure sensors linked to radio pagers being trialled to prevent bedside falls in older people admitted to hospital (Sahota et al 2013)
By moving away from individualised understandings of knowledge and action to “achievement as a collective flow” (Wohlwend et al 2017: 459), we provide more ‘situated’ and less deterministic explanations of why the production of ‘evidence’ in RCTs (Savransky and Rosengarten 2016) is often detached from the wider practice of healthcare, leaving the technologically-mediated prevention of falls trialled in isolation
Summary
In this paper we take an agential realist approach (Barad 2007) to understanding how and why a patient safety technology ‘failed’. Our study was part of an RCT of pressure sensors linked to radio pagers being trialled to prevent bedside falls in older people admitted to hospital (Sahota et al 2013). The fact that this technology was the subject of an RCT is of central importance in understanding this failure. As Webster (2002: 444, italics in original) says “technologies are only really successful when they make sense within the existing social relations within which they are to function, suggesting the crucial role played by the translation and even reinvention of technologies into everyday contexts of use” This is very different to the assumption inherent (but never really made explicit) in an RCT, where interventions are seen as being epistemologically neutral and ontologically independent.
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