University College London, UK.
University College London, UK; Imperial College Healthcare NHS Trust, UK.
Health Informatics J. 2020 Mar;26(1):576-591. doi: 10.1177/1460458219839574. Epub 2019 Apr 15.
Many studies have highlighted the patient safety risks in intravenous medication administration, and various technological solutions have been proposed to mitigate those risks, including 'smart pumps' and closed-loop systems. Few studies describe these implementations in detail. In this article, we report on a sociotechnical investigation of a closed-loop documentation system linked with smart pumps for intravenous infusion administration on an intensive care unit. The smart pumps are 'mapped' to an electronic prescribing and medication administration system, allowing infusion rates, volumes and boluses of intravenous medication to be monitored in real time. Ethnographic observations were conducted over 37 h, including direct observation of infusion administration (n = 23 infusions), discussions with clinical staff and semi-structured interviews with intensive care unit managers (n = 2). Analysis was based on the Distributed Cognition for Teamwork (DiCoT) method to understand how information is processed across individuals, teams and technologies. We report on how the system works in context, and identify contributions and compromises to patient safety with new risks that need to be managed at bedside and intensive care unit level.
许多研究都强调了静脉给药中的患者安全风险，并且已经提出了各种技术解决方案来降低这些风险，包括“智能输液泵”和闭环系统。很少有研究详细描述这些实施情况。在本文中，我们报告了一项针对与智能输液泵相关联的闭环文档系统的社会技术调查，该系统用于重症监护病房的静脉输液管理。智能输液泵与电子医嘱和药物管理系统进行“映射”，允许实时监测输液速度、容量和静脉药物推注量。进行了 37 小时的人种学观察，包括直接观察输液管理（n=23 次输液）、与临床工作人员的讨论以及对重症监护病房管理人员的半结构化访谈（n=2）。分析基于团队分布式认知（DiCoT）方法，以了解信息如何在个人、团队和技术之间进行处理。我们报告了系统在上下文中的工作方式，并确定了与新风险相关的对患者安全的贡献和折衷，这些风险需要在床边和重症监护病房层面进行管理。
