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      Distributed Cognition for Evaluating Healthcare Technology

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      Proceedings of HCI 2011 The 25th BCS Conference on Human Computer Interaction (HCI)

      Human Computer Interaction

      4 - 8 July 2011

      Infusion Pump, Intensive Care Unit, Distributed Cognition, DiCoT, Resources Model

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          Abstract

          Distributed Cognition (DCog) has been proposed as being a better approach to analyzing healthcare work than traditional cognitive approaches, due to the collaborative nature of healthcare work. This study sought to explore this by applying two DCog frameworks, DiCoT and the Resources Model, to the analysis of infusion pump use in an Intensive Care Unit. Data was gathered through observations and interviews, and then analysed using DiCoT and the Resources Model to construct models representing the social structures, information flows, physical layouts and artefact use involved in infusion administration in the ICU. The findings of the study confirm that DCog can be a methodology of choice for studying healthcare work: nurses collaborated significantly, artefacts played a major role in coordinating activity, and the physical environment influenced activity – properties which DCog effectively supports reasoning about.

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          Most cited references 11

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          Distributed cognition: toward a new foundation for human-computer interaction research

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            Insights from the sharp end of intravenous medication errors: implications for infusion pump technology.

            Intravenous (IV) medication errors are a common type of error identified in hospitals and can lead to considerable harm. Over the past 20 years there have been several hundred FDA reported incidents involving IV pumps, many of which have led to patient deaths. To determine the actual types, frequency, and severity of medication errors associated with IV pumps. To evaluate the likelihood that smart pump technology without an interface to other systems could have prevented errors. Using a point prevalence approach, investigators prospectively compared the medication, dose, and infusion rate on the IV pump with the prescribed medication, doses, and rate in the medical record. Preventability with smart pump technology was retrospectively determined based on a rigorous definition of currently available technology. A total of 426 medications were observed infusing through an IV pump. Of these, 285 (66.9%) had one or more errors associated with their administration. There were 389 documented errors overall; 37 were "rate deviation" errors and three of these were judged to be due to a programming mistake. Most of the documented events would not have caused patient harm (NCC MERP category C). Only one error would have been prevented by smart pump technology without additional interface and software capabilities. Medication errors associated with IV pumps occur frequently, have the potential to cause harm, and are epidemiologically diverse. Smart pumps are a necessary component of a comprehensive safe medication system. However, currently available smart pumps will fail to generate meaningful improvements in patient safety until they can be interfaced with other systems such as the electronic medical record, computerized prescriber order entry, bar coded medication administration systems, and pharmacy information systems. Future research should focus on the effectiveness of new technology in preventing latent and active errors, and on new types of error that any technology can introduce.
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              Ethnographic study of incidence and severity of intravenous drug errors.

              To determine the incidence and clinical importance of errors in the preparation and administration of intravenous drugs and the stages of the process in which errors occur. Prospective ethnographic study using disguised observation. Nurses who prepared and administered intravenous drugs. 10 wards in a teaching and non-teaching hospital in the United Kingdom. Number, type, and clinical importance of errors. 249 errors were identified. At least one error occurred in 212 out of 430 intravenous drug doses (49%, 95% confidence interval 45% to 54%). Three doses (1%) had potentially severe errors, 126 (29%) potentially moderate errors, and 83 (19%) potentially minor errors. Most errors occurred when giving bolus doses or making up drugs that required multiple step preparation. The rate of intravenous drug errors was high. Although most errors would cause only short term adverse effects, a few could have been serious. A combination of reducing the amount of preparation on the ward, training, and technology to administer slow bolus doses would probably have the greatest effect on error rates.
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                Author and article information

                Contributors
                Conference
                July 2011
                July 2011
                : 341-350
                Affiliations
                UCLIC

                University College London

                Gower Street

                London, WC1E 6BT, UK
                Article
                10.14236/ewic/HCI2011.64
                © Atish Rajkomar et al. Published by BCS Learning and Development Ltd. Proceedings of HCI 2011 The 25th BCS Conference on Human Computer Interaction, Newcastle Upon Tyne, UK

                This work is licensed under a Creative Commons Attribution 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

                Proceedings of HCI 2011 The 25th BCS Conference on Human Computer Interaction
                HCI
                25
                Newcastle Upon Tyne, UK
                4 - 8 July 2011
                Electronic Workshops in Computing (eWiC)
                Human Computer Interaction
                Product
                Product Information: 1477-9358BCS Learning & Development
                Self URI (journal page): https://ewic.bcs.org/
                Categories
                Electronic Workshops in Computing

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