Abstract
Protocols combined with technology-based systems such as Barcode Medication Administration (BCMA) or Computer Prescription Order Entry were designed to embed the elements of best-practice into workflow and are now dominant in promoting healthcare quality and safety (Rack, Dudjak, & Wolf, 2012). These protocols are failing, often not addressing the root cause workflow issues that are causing quality issues.
As a result, there is increasing interest in the phenomenon of Nursing Practice Workarounds (NPWs); with a focus on patient safety and evidence-based practice (Seaman et al, 2015). Workarounds have typically been viewed as deviations from best practice that put patients at risk of poor outcomes (Alter, 2014). However, this is increasingly considered a narrow view which fails to take into consideration the multi-factorial origins of workarounds.
Through interdisciplinary work with Data Engineers based in the Digital Research and Informatics Unit (DRIVE) we have been able to find the digital evidence of workarounds. Data from the trust’s electronic patient record system (EPIC) is transformed and then stored in a data warehouse (Caboodle). Using the Data Warehouse Schema relevant data was located. Data was then extracted iteratively until the specific desired medication administration data was extracted.
Pending ethical approval, this method can provide historic quantitative measures of the prevalence of non-conformation with the BCMA workflow. Combined with testimony from critical care nurses, this could prove to be a demonstration that some NPWs are unseen and meeting or exceeding KPI’s may not accurately reflect clinical safety.
As a result, there is evidence for further investigation into the nature of NPW’s and how they are influencing patient safety. Additionally, this kind of work reflects the increasing benefits for nursing/clinical staff working with data engineers.
Acknowledgements for funding or support NIHR Great Ormond Street Hospital Biomedical Research Centre (BRC)