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Using a Real-Time Locating System to Measure Walking Activity Associated with Wandering Behaviors Among Institutionalized Older Adults

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Technology implementation and workarounds in the nursing home.

Amy A Vogelsmeier¹, Jonathon R B Halbesleben, Jill R Scott-Cawiezell

¹Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA. vogelsmeiera@missouri.edu

Journal of the American Medical Informatics Association : JAMIA

|October 20, 2007

Summary

Nursing home staff use workarounds, like overriding safety alerts, to navigate electronic medication administration record (eMAR) system issues. Understanding these workarounds is key to improving medication safety.

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Published on: February 8, 2019

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Methodology for Establishing a Community-Wide Life Laboratory for Capturing Unobtrusive and Continuous Remote Activity and Health Data

Published on: July 27, 2018

Area of Science:

Health Informatics
Nursing Home Quality Improvement
Medication Safety

Background:

Electronic medication administration records (eMAR) are increasingly implemented in nursing homes.
Technology implementation can introduce workflow challenges and necessitate workarounds.
Understanding these workarounds is crucial for assessing medication safety risks.

Purpose of the Study:

To explore the relationship between workarounds and medication safety practices.
To identify workarounds associated with eMAR implementation in Midwestern nursing homes.

Main Methods:

Qualitative evaluation using direct observation, process mapping, and key informant interviews.
Analysis of field notes from medication safety team meetings.
Open and axial coding to categorize workarounds related to workflow blocks.

Main Results:

Workarounds emerged in two patterns: technology-induced workflow blocks and un-reengineered organizational processes.
Common workarounds included safety alert overrides and documentation shortcuts, representing first-order problem-solving.
Individual staff often used first-order problem-solving, unlike the team's second-order approach.

Conclusions:

Nursing home staff develop practical workarounds for technology-related workflow blocks.
Recognizing workarounds as first-order problem-solving is vital for understanding medication safety risks.
This study offers practical insights into technology integration challenges in long-term care settings.