The mixed blessings of smart infusion devices and health care IT

From July to October 2009, a team of human factors researchers evaluated the use of a commercially available infusion device among nurses at a tertiary care hospital in the Midwest. The study's purpose was to determine the factors that may influence the adoption and "best practice" use of smart infusion devices by identifying the human, technological, environmental, and/or organizational factors and to describe how they support or impede safe practices. The study's aim was to show how technology and individual and team behavior influence each other, as well as care performance and outcomes. Research team members shadowed nursing personnel as they performed routine care activities, and conducted cognitive task analysis interviews with nurses, an engineer, and a pharmacist. They identified key themes, and then made several systematic passes through the data to identify all instances of each theme and to collect examples and illustrative quotes. Although staff members were positive in their comments about the smart pump, observations and interviews revealed discrepancies between prescriptions and infusions, and "workarounds" to cope with the mismatch between interface design and actual care requirements. Despite "smart pump" capabilities, situations continue such as the need for clinicians to perform calculations in order to deliver medications. These workarounds, which make them and patients vulnerable to adverse outcomes, confirm prior published research by Cook, Nemeth, Nunnally, Hollnagel, and Woods. The team provided recommendations based on findings for training and interface design.