Annotated Bibliography
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Feb 20, 2024
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RUNNING HEAD: Annotated Bibliography
1
Annotated Bibliography
Brittany Lovett
April 11, 2023
Annotated Bibliography
2
Annotation #1
Reference
Boonstra, A., Jonker, T. L., van Offenbeek, M. A., & Vos, J. F. (2021). Persisting workarounds in electronic health record system use: Types, risks and benefits. BMC Medical Informatics and Decision Making
, 21
(1). https://doi.org/10.1186/s12911-021-01548-0 Annotation:
Boonstra and colleagues conducted research on electronic health records and barcode scanning administration and declared, through qualitative research, eleven total nurse workarounds. The research was conducted at a Dutch hospital on the internal medicine floor. Six nurses were observed during this study and seventeen physicians, nurses, administrators, and support staff were interviewed. The workarounds were categorized into three types, in-system workflow, in-
system data, and out-of-system workarounds. Examples of in-system workflow workarounds are ignoring pop-ups and starting a patient visit before the patient arrives, which was explained by a physician as saving time if the test is pre-ordered. Examples of in-system data workarounds would be copying and pasting, using separate data fields, sharing login details, and leaving data fields empty. Out-of-system examples are using shadow systems, such as Microsoft Word and Excel, giving verbal consent for dispensing medication, and separating the scanner from the computer.
It is relevant to note that in 2019, the Dutch Data Protection Authority imposed a fine of 50,220,500, in US dollars, to the Haga Hospital after more than 80 employees were caught using workarounds.
Annotated By: Brittany Lovett
Annotated Bibliography
3
Annotation #2
Reference
Koppel, R., Wetterneck, T., Telles, J. L., & Karsh, B. T. (2008). Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety.
Journal of the American Medical Informatics Association : JAMIA
,
15
(4), 408–423. https://doi.org/10.1197/jamia.M2616
Annotation:
Koppel and the above-mentioned colleagues conducted this study in order to examine the workarounds and their errors in patient medication administration. The study was conducted at a 470-bed tertiary care hospital and in four east coast health care system hospitals. The study compounded five methods to conduct the research, observation and shadowing of staff using barcode scanning, interviews with staff and leaders involved with medication administration, participation in staff meetings, failure modes and effects analysis, and override log data reflecting over 300,000 medication administrations. The workarounds were found the be within three categories, which are, omissions of process steps, such as not scanning the medication or the patient identification bracelet, steps performed out of sequence, such as documenting giving the medication before it is given, and unauthorized process steps, such as disabling alarms. The articles listed some possible causes of the workarounds, such as task-related causes like carrying more than one patient’s medication on the cart at a time, and environmental causes, such as medication stored remotely from the scanner, to name a few.
Annotated By: Brittany Lovett
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Annotated Bibliography
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Annotation #3
Reference
Seaman, J. B., & Erlen, J. A. (2015). Workarounds in the Workplace: A Second Look.
Orthopedic nursing
,
34
(4), 235–242. https://doi.org/10.1097/NOR.0000000000000161
Annotation:
This article’s primary goal was to establish causes for workarounds in healthcare. The article was
not limited to barcode scanning in medication administration but did talk about this topic. The main reason this article cited barcode scanning workarounds was because of technical difficulties
or malfunctions with the system. According to the article, the reason for technological errors is in
relation to evidence-based practice. Evidence-based practice and technology are both ever-
changing; therefore, technology cannot take into account patient preferences or values. Because evidenced-based practice takes into account the patient’s values and preferences, nurse workarounds can be attributed to appeasing the patient in a situation such as this. The articles also mention that technology cannot take into account the workload of a nurse or the workflow of a unit which can cause nurses to use workarounds in order to stay on task. Annotated By: Brittany Lovett
Annotated Bibliography
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Annotation #4
Reference
Veen, W., Taxis, K., Wouters, H., Vermeulen, H., Bates, D. W., Bemt, P. M., Duyvendak, M., Oude Luttikhuis, K., Ros, J. J., Vasbinder, E. C., Atrafi, M., Brasse, B., & Mangelaars, I. (2020).
Factors associated with workarounds in barcode‐assisted medication administration in Hospitals. Journal of Clinical Nursing
, 29
(13-14), 2239–2250. https://doi.org/10.1111/jocn.15217 Annotation:
Veen and colleagues, professors from Universities in the Netherlands, provide research and review of medication administration workarounds nurses often use. To validate their research, current University School of Pharmacy students were trained to go undercover as observers of the nurses and their medication rounds. The observers were to watch a minimum of 3 rounds per day and a weekly minimum of 18 rounds. The rounds would be compared to a printed computer output of the medications given that day. There were multiple workarounds noted, 15 to be exact,
with attaching the patient identification bracelet to the computer and scanning multiple patients’ medication at once, and then taking the medication to the patients. The article’s purpose was to research workarounds and the occurrence of medication errors with those workarounds. Annotated By: Brittany Lovett