Line Melby

Characterising cooperation in the ward: framework for producing requirements to mobile electronic healthcare records

We present a framework for characterising hospital scenarios involving the patient chart. The paper-based chart is regarded as simple, efficient, and handy for mobile use by patient-care teams. However, the chart is available in only one physical place at a time, and it needs to be manually synchronised with the electronic healthcare record (EHR). The framework presented in this paper has been developed for use in non-participatory, observational studies performed at the University Hospital of Trondheim, conducted as a part of the MOBEL (MOBile ELectronic patient chart) project at NTNU. We have developed the framework iteratively; repeatedly observing groups in the ward, characterising observations in the framework, and changing attributes and outcome values. This paper presents our latest framework, a representative choice of scenarios, and their characterisation. We conclude with a discussion of results so far, the method, and the utility in the development of the MEPC.

Early experiences with the multidose drug dispensing system – A matter of trust?

Abstract Objective. To study early experiences with multidose drug dispensing (MDD) among different groups of health personnel. Design. Qualitative study based on focus-group interviews. Setting. Primary health care, Trondheim, Norway. Main outcome. The importance of trust in the technology and in collaborating partners is actualized in the early implementation of MDD. Results. GPs, home-care nurses, pharmacists, and medical secretaries trusted the new MDD technology. The quality of the GPs’ medication records improved. However, health personnel, including the GPs themselves, would not always trust the medication records of the GPs. Checking the multidose bags arriving from the pharmacy was considered unnecessary in the written routines dealing with MDD. However, home-care nurses experienced errors and continued to manually check the bags. Nurses in the home-care service felt a loss of knowledge with regard to the patients’ medications and in turn experienced reduced ability to give medical information to patients and to observe the effects of the drugs. The home-care services’ routines for drug handling were not always trusted by the other groups of health personnel involved. Conclusion. Health personnel faced some challenges during the implementation of the MDD system, but most of them remained confident in the new system. Building trust has to be a process that runs in parallel with the introduction of new technology and the establishment of new routines for improving the quality in handling of medicines and to facilitate better cooperation and communication.

Coping with the unforeseen in surgical work

OBJECTIVEnThe purpose of this study was to investigate how staff working in the perioperative domain copes with unforeseen events and in what way, if at all; they are supported in this by formal systems such as information systems.nnnDESIGNnCase study. We conducted our study in the Department of Surgery in a large academic hospital in Norway. The department consists of eight operating rooms for planned surgery. The study included observations and interviews, in addition to one design workshop with health personnel. We focused on planned surgery.nnnRESULTSnOur observations showed that unforeseen events that cause deviations from plans are characteristic and that staff apply different coping strategies to make the plan work regardless. Support of these coping strategies by formal systems is poor.nnnDISCUSSIONnWe used the concept of high-reliability organisations as proposed by Weick and Sutcliffe, 2007, to analyse the observed coping strategies. The coping strategies can be seen as examples of the principles for managing the unexpected that Weick and Sutcliffe propose. IT support for this must include both awareness-creating systems and systems that enable workers to control the effects of unforeseen events once they have occurred.

Supporting operating nurses' collaborative work: Preventing information overload and tailoring information access

Collaboration and coordination are demanding tasks in health care, but may be supported by computer systems. In this paper we describe our initial work in a large research project (Cooperation Support Through Transparency). The aim is to provide actors with information about the course of a process, thereby facilitating informed decisions and in such way support collaboration in peri-operative processes. The focus in this paper is on operating nurses current use of information resources and their information needs. He use a combination of semi-structured interviews and participant observation. Theoretically, our analyses are informed by e.g. the concepts awareness and articulation work. The study shows that this combination of methods is most useful, offering complementary insights and drawing an attention to mismatches between what is said and what is done by nurses. Furthermore, based on the empirical material, we discuss implications for design.