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. 2011 Jul 1;41(4):370-379.
doi: 10.1016/j.ergon.2011.02.007.

That's nice, but what does IT do? Evaluating the impact of bar coded medication administration by measuring changes in the process of care

Richard J Holden  1 , Roger L Brown, Samuel J Alper, Matthew C Scanlon, Neal R Patel, Ben-Tzion Karsh
Affiliations

That's nice, but what does IT do? Evaluating the impact of bar coded medication administration by measuring changes in the process of care

Richard J Holden et al. Int J Ind Ergon. .

Abstract

Health information technology (IT) is widely endorsed as a way to improve key health care outcomes, particularly patient safety. Applying a human factors approach, this paper models more explicitly how health IT might improve or worsen outcomes. The human factors model specifies that health IT transforms the work system, which transforms the process of care, which in turn transforms the outcome of care. This study reports on transformations of the medication administration process that resulted from the implementation of one type of IT: bar coded medication administration (BCMA). Registered nurses at two large pediatric hospitals in the US participated in a survey administered before and after one of the hospitals implemented BCMA. Nurses' perceptions of the administration process changed at the hospital that implemented BCMA, whereas perceptions of nurses at the control hospital did not. BCMA appeared to improve the safety of the processes of matching medications to the medication administration record and checking patient identification. The accuracy, usefulness, and consistency of checking patient identification improved as well. In contrast, nurses' perceptions of the usefulness, time efficiency, and ease of the documentation process decreased post-BCMA. Discussion of survey findings is supplemented by observations and interviews at the hospital that implemented BCMA. By considering the way that IT transforms the work system and the work process a practitioner can better predict the kind of outcomes that the IT might produce. More importantly, the practitioner can achieve or prevent outcomes of interest by using design and redesign aimed at controlling work system and process transformations.

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Figures

Figure 1
Figure 1
A human factors model of health information technology (IT) impact.
Figure 2
Figure 2
Pre- and post-BCMA process perceptions and full model results for perceived (a) accuracy and (b) usefulness.
Figure 3
Figure 3
Pre- and post-BCMA process perceptions and full model results for perceived consistency.
Figure 4
Figure 4
Pre- and post-BCMA process perceptions and full model results for perceived (a) time efficiency and (b) ease of performance.
Figure 5
Figure 5
Pre- and post-BCMA process perceptions and full model results for perceived (a) error likelihood and (b) error detection likelihood.
See this image and copyright information in PMC

References

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    1. Karsh B, Holden RJ, Alper SJ, Or CKL. A human factors engineering paradigm for patient safety – designing to support the performance of the health care professional. Qual Saf Health Care. 2006;15:i59–i65. - PMC - PubMed
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