Researcher will be studying how to design work process
Focus is on bar code medication use
Researchers and industrial engineers are working together on a project that could help hospital pharmacies improve patient safety through work process design.
Bar code medication administration is a great process, but problems can occur in its real life use, says Steven R. Abel, PharmD, FASHP, assistant dean for clinical programs and a Bucke professor and head of the department of pharmacy practice at Purdue University School of Pharmacy and Pharmaceutical Sciences in Indianapolis, IN.
"In health care, we do a really good job with process and are pretty good at designing process, but whenever you put a human in contact with process, he finds a way to modify that process," Abel explains.
Health care workers do this because they feel overwhelmed with too much work, he adds.
"This puts patients and ourselves at risk," Abel says.
Abel and co-investigator Vincent Duffy, PhD, received a 2008 Medication Safety Team Grant to study "A work process design strategy to reduce bar code medication administration side effects for improved patient safety" from the American Society of Health-System Pharmacists (ASHP).
"We decided that with every safety procedure reported as a gold standard, and bar code administration is one of those, it's fine if it's implemented flawlessly," Abel says. "But when humans are involved, they modify the system to make the work flow easier."
And this leads to human errors and potential safety problems, Abel adds.
Investigators will try to understand the system from the bottom where the workers use the system and identify processes that might prevent workers from trying to work around the steps that are essential for safety.
Purdue is in an ideal position to study work process design because of its combination of both pharmacy school and industrial engineering school talent, Abel says.
Industrial engineers will help investigators understand both what is being done that could modify a system and also what could create harm.
"We have several industrial engineers at Purdue who have in-depth understanding of human behavior," Abel says.
They'll start the research at U.S. Veterans Administration (VA) hospitals, which have bar code medication administration fully implemented, Abel says.
"The VAs here also have gone through a complete procedural assessment of the process and have identified internally where they think the barriers and impediments exist in their system," Abel says. "We have the advantage of using these data and validating the data with them."
Ultimately, the goal will be to identify all of the impediments in the system and any places where the system might be modified or circumvented, Abel notes.
"When that happens, that's when a patient is at risk, and we're trying to identify the ultimate risk," Abel says.
"Phase II of the study is to take observations from existing systems and basically knowing where work-arounds occur and where potential breaks in the system occur," Abel explains. "And we're going to redesign the system with the intent of putting in checks and balances that block those work-arounds."
First, investigators will assess bar code data from a VA that is new to bar coding medication administration.
"At the same time we're looking at the data, we'll also be in the institution observing the workers," Abel says. "We're casual workers who are watching the process."
The observers, who are graduate students and faculty members, know how the process should look and so can note when a worker makes modifications to the process.
"This is real time observation, and the industrial engineers are helping us," Abel says. "There's actually a multidisciplinary team observing with pharmacy, nursing, and industrial engineering."
The correct bar code medication administration process contains multiple steps that need to be done in the correct order for each patient receiving medications. But it doesn't always work out that way.
For example, a nurse might obtain all of the medications that will be administered to a patient and then access the patient's bar code, scan the bar codes, scan the medications, and then facilitate charting of the administration of medication without actually doing the medication administration at that time, Abel explains.
"It's easier to get all of the medication charting done and then go back and do administration," Abel says. "But how do you know you're giving the correct one to the patient who is supposed to get it?"
If an observer sees an administration problem that could harm a patient, he or she will intervene. "But it's not our intent to intervene," Abel says.
Also, they expect the study will have some bias because of the effect of people changing their behavior while being observed, Abel notes.
But the observers will be around enough that they won't be covered all the time, Abel says.
There is a flow chart of the process as its intended, and observers can refer to that as they record where in the process there are deviations, he says.
If all goes well, the study will be published, and the improvements suggested could be made available in a tool kit, Abel says.
"Our first piece is to do the observation and design the system, hopefully to avoid where the deviations occur," he says. "Then we'll be implementing the system and will have time for analysis after administration."
Changes might entail suggesting ways for hospitals to minimize the peaks and valleys in their workflow and the associated risks of these, Abel says.
"If a health care worker is going to make a mistake then he's more likely to make it when he's really busy or when he's not busy enough," Abel explains. "Those are the times when you lose your focus."
So the key is to look at ways to enhance pharmacy and even out the workflow over time.
Further investigations will look at compliance to the procedures and whether there continues to be inappropriate or incorrect administration of medications, Abel says.
Researchers and industrial engineers are working together on a project that could help hospital pharmacies improve patient safety through work process design.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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