Jacqueline Moss

Cognitive properties of a whiteboard: a case study in a trauma centre

Distributed cognition as an approach to collaborative work holds that a work unit is cognitive system in which cognitive activities are carried out jointly by workers with the use of tools. This approach has several direct implications to the study of collaborative work In this paper, we analysed staff interactions with a large display board in a Level I trauma centre operating room unit. Coordination needs are exacerbated by the unpredictability of incoming emergency surgery patients admitted to the trauma centre as well as other contingencies (such as changes in scheduled surgery cases or staffing). The public display board has evolved into a key component for supporting collaborative work. The physical and perceptual properties of the board are exploited by the clinicians to support rapid paced, highly dynamic work. The canvas-like appearances of the display board, combined with magnetic objects attached to the board, afford its users to taylor the board as an effective coordinative tool and to invent new ways of representing information Based on the concept of display-based cognition, our analysis illustrates the role of public displays in facilitating negotiation of scheduling, joint planning, and augmenting inter-personal communication.

Improving Operating Room Coordination Communication Pattern Assessment

Objective To capture communication patterns in operating room (OR) management to characterize the information needs of OR coordination. Background Technological applications can be used to change system processes to improve communication and information access, thereby decreasing errors and adverse events. The successful design of such applications relies on an understanding of communication patterns among healthcare professionals Methods Charge nurse communication was observed and documented at four OR suites at three tertiary hospitals. The data collection tool allowed rapid coding of communication patterns in terms of duration, mode, target person, and the purpose of each communication episode. Results Most (69.24%) of the 2074 communication episodes observed occurred face to face. Coordinating equipment was the most frequently occurring purpose of communication (38.7%) in all suites. The frequency of other purposes in decreasing order were coordinating patient preparedness (25.7%), staffing (18.8%), room assignment (10.7%), and scheduling and rescheduling surgery (6.2%). Conclusion The results of this study suggest that automating aspects of preparing patients for surgery and surgical equipment management has the potential to reduce information exchange, decreasing interruptions to clinicians and diminishing the possibility of adverse events in the clinical setting.

High-reliability teams and situation awareness : Implementing a hospital emergency incident command system

To enhance disaster preparedness, hospitals are beginning to implement the Hospital Emergency Incident Command System. Although Hospital Emergency Incident Command System provides a template for disaster preparation, its successful implementation requires an understanding of situation awareness (SA) and high-reliability teams. The authors present the concept of SA and how this concept relates to team reliability in dynamic environments. Then strategies for increasing SA and team reliability through education, training, and improved communication systems are discussed.

Computerized Provider Order Entry: Strategies for Successful Implementation

An estimated 522,000 serious medication errors can be eliminated in the United States each year through the use of computerized provider order entry. However, the implementation of computerized provider order entry is being slowed down by resistance from clinicians, particularly physicians. Nurses understand the work of physicians and are in a unique position to help overcome their resistance and smoothen the transition to computerized provider order entry. The authors outline the strategies for nurses to increase organizational acceptance during the process of computerized provider order entry implementation.

Opportunities and challenges in improving surgical work flow

Safe and efficient surgical operations depend on a work environment larger than the individual operating room (OR) and on communications at different levels of the hospital organization. Extensive communication is needed before and during surgery to ensure that surgical rooms, equipment, and supplies; patients; surgeons; supporting personnel; and accompanying documentation are all ready at the appropriate times. In this article, we compile the results of three of our studies of communication activities outside ORs, with the goal of identifying opportunities and challenges in the workflow of surgery. The first study demonstrates the amount of communication work performed by OR coordinators. The second study demonstrates the potential functions of a whiteboard in communication. The third study describes an organizational learning strategy of proactive event reporting. We apply computer-supported cooperative work and organizational learning concepts to the findings and suggest ways in which information technology may improve surgical workflow.

Technological system solutions to clinical communication error.

Human beings are fallible and even the most expert practitioner is prone to error. Unfortunately, in healthcare, these errors can result in the loss of human life. The Institute of Medicine’s (IOM’s) report1 estimating that between 44,000 and 98,000 Americans die each year as the result of medical error illustrates the need for systematic approaches to error reduction. Healthcare administrators must constantly be alert to the potential for error and design system countermeasures to prevent errors, detect errors when they happen, and mitigate the effects of errors.2 In a review of 16,000 hospital deaths due to error, the leading cause of death was found to be communication errors, which resulted in twice as many deaths as did clinical inadequacy.3 A study of the verbal exchanges between nurses and physicians in an intensive care unit showed an error rate of 37%.4 Faulty communication was found to be responsible for 12% of error in emergency care.5 In other contexts, results vary from 23%6 to 30% in general practice,7 25% in pediatric surgery,8 and 91% in a study of medical residents.9

Transactive Responsibility Systems and High Reliability Teams: A Tentative Formulation

Understanding how teams perform successfully in high-risk settings can provide us with insights into the processes by which safety is created. Building upon previous field and laboratory studies, we propose a tentative formulation of a concept, transactive responsibility system, to account for the intricate, complex responsibility system emerged in team interaction. With a transactive responsibility system, a team can deal with the challenges of conflicting goals of training and performing and rapidly changing work environments found in many settings. A set of measurement proposals is made to illustrate the potential practical use of the concept. Potential impact on training is speculated.

Smart pump technology: what we have learned.

Intravenous infusion may present the greatest preventable medication administration error risk to hospitalized patients. Smart pumps can provide clinical decision support at the bedside for nurses who are administering intravenously administered medications with the potential to significantly reduce medication errors and subsequent patient harm. However, implementations of smart pumps have yielded mixed results and mixed perceptions of their ability to actually decrease error. To realize the potential of smart pumps, there must exist a clear understanding of how these devices are being integrated into healthcare organizations, specifically nursing practice. The purpose of this article was to describe current smart pump evaluation studies and to suggest areas of future evaluation focus.

Costing Nursing Care: Using the Clinical Care Classification System to Value Nursing Intervention in an Acute-care Setting

The purpose of this study was to combine an established methodology for coding nursing interventions and action types using the Clinical Care Classification System with a reliable formula (relative value units) to cost nursing services. Using a flat per-diem rate to cost nursing care greatly understates the actual costs and fails to address the high levels of variability within and across units. We observed nurses performing commonly executed nursing interventions and recorded these into an electronic database with corresponding Clinical Care Classification System codes. The duration of these observations was used to calculate intervention costs using relative value unit calculation formulas. The costs of the five most commonly executed interventions were nursing care coordination/manage-refer (

Veteran Competencies for Undergraduate Nursing Education.

2.43), nursing status report/assess-monitor (