Vital sign documentation in electronic records: The development of workarounds

Stevenson, Jean E; Israelsson, Johan; Nilsson, Gustav; Petersson, Göran; Bath, Peter A.

doi:10.1177/1460458216663024

Cited by 22 publications

(54 citation statements)

References 21 publications

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“…These were used when available information sources did not meet the nurses' information needs. Workarounds, seen as unconventional methods for accomplishing work, have been described in previous studies as recurring events in health care resulting from a combination of the complexity of the setting and problems with the EPR system (Stevenson, Israelsson, Nilsson, Petersson, & Bath, ). Although one can argue that not all workarounds should be applauded—for instance, it is not appropriate to take pictures of patients on private cell phones—we argue that the workarounds identified in this study were all done with the intention of providing the patient with the best possible care.…”

Section: Discussionmentioning

confidence: 99%

Nurses' information practice in municipal health care—A web‐like landscape

Østensen

Bragstad

Hardiker

et al. 2019

Journal of Clinical Nursing

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Aim To uncover the characteristics of nurses' information practice in municipal health care and to address how, when and why various pieces of information are produced, shared and managed. Background Nursing documentation in the electronic patient record has repeatedly been found unsatisfactory. Little is known about how the information practice of nurses in municipal health care actually is borne out. In order to understand why nursing documentation continues to fail at living up to the expected requirements, a better understanding of nurses' information practice is needed. Design A qualitative observational field study. The study complied with the Consolidated Criteria for Reporting Qualitative Research. Methods Empirical data were collected in three Norwegian municipalities through participant observations and individual interviews with 17 registered nurses on regular day shifts. The data were analysed through thematic content analysis. Results Nurses' information practice in municipal health care can be described as complex. The complexity is reflected in four themes that emerged from the data: (1) web of information sources, (2) knowing the patient and information redundancy, (3) asynchronous information practice and (4) compensatory workarounds. Conclusions The complex and asynchronous nature of nurses' information practice affected both how and when information was produced, recorded and shared. When available systems lacked functions the nurses wanted, they created compensatory workarounds. Although electronic patient record was an important part of their information practice, nurses in long‐term care often knew their patients well, which meant that a lot of information about the patients was in their heads, and that searching for information in the electronic patient record sometimes seemed redundant. Relevance to clinical practice This study provides contextual knowledge that might be valuable (a) in the further development of information systems tailored to meet nurses' information needs and (b) when studying patient safety in relation to nurses' information practice.

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Section: Discussionmentioning

confidence: 99%

Nurses' information practice in municipal health care—A web‐like landscape

Østensen

Bragstad

Hardiker

et al. 2019

Journal of Clinical Nursing

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“…Furthermore, research is starting to emphasize how EHR workarounds are enhancing the actual workflow of healthcare professionals and ensuring patient safetyboth of which are tangible outcomes that surpass employees' perceptions. This research contours the inadequacy of current EHR tools for healthcare providers' workplace needs and equates workarounds with frontline worker resiliency (Stevenson et al, 2016). This inadequacy is likely a product of two things: many healthcare organizations rush to adopt EHRs, conducting little research for an EHR system that accommodates their specific workplace needs (see Corrao et al, 2010), and EHR technology is still in its infancy.…”

Section: Advancing Ast and Hit Workaround Researchmentioning

confidence: 99%

Technological appropriations as workarounds

Barrett

2018

ITP

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Purpose The purpose of this paper is to further adaptive structuration theory (AST) by associating technological appropriations with health information technology workarounds. The author argues that appropriating electronic health record (EHR) technology ironically – in a way other than it is designed to be used – and divergently across an organization results in enhanced perceptions of EHR technology and its implementation. Design/methodology/approach Data were collected from 345 healthcare employees in a single healthcare organization that was switching to EHRs from paper records. Two major constructs of AST – unfaithfulness and dissension in appropriation – were operationalized and analyzed using multivariate regressions to test the relationship between the type of appropriation and perceptions of EHR technology’s relative advantage and implementation success. Findings Results reveal that both ironic (unfaithful) technological appropriation and dissension in technological appropriation across the organization predicted employees’ perceptions of EHR’s relative advantage and perceptions of EHR implementation success. Furthermore, physicians are the least likely to perceive EHR’s relative advantage or EHR implementation success. These results exemplify that EHR workarounds are taking place and reaffirm AST’s principle that employees evolve technology to better suit their working environments and preferences. Originality/value The survey and scales used in this study further demonstrate that there are meaningful statistical measures to accompany the qualitative methods frequently used in the AST literature. In addition, this paper expands AST research by exploring the positive outcomes that follow ironic and divergent technology appropriations.

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“…US-American research settings accounted for the largest share with 8 out of 17 contributions. Our assessment revealed that ten articles [12,21,32,33,[41][42][43][44][45][46] did not analyze the fit of their developed research model. Further, we depicted which of the five sources of blockages to workflows the individual papers mentioned and found references to four out of five categories.…”

Section: Descriptive Resultsmentioning

confidence: 93%

A Systematic Literature Review on Antecedents of Workarounds related to Information Systems in Hospitals

Buck¹,

Doctor²,

Eymann³

et al. 2020

WI2020 Zentrale Tracks

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The use of digital technology in the healthcare sector, and in hospitals in particular, has an impact on daily routine and on the quality of patient care. In dynamic organizations like hospitals, where urgent needs have to be met, employees develop workarounds for different reasons, which in turn can have a negative impact on the quality of patient care. While the existing literature focuses mainly on the consequences of IT mismatch to work practices in hospitals and classifications thereof, a holistic understanding of the underlying reasons for workers' deviating behavior is missing. This article begins to close this research gap with a systematic literature review on antecedents of workarounds. The structured analysis provides a valuable contribution for both research and practice, as measuring root causes for behavior enables organizations to understand and develop control mechanisms.

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Vital sign documentation in electronic records: The development of workarounds

Cited by 22 publications

References 21 publications

Nurses' information practice in municipal health care—A web‐like landscape

Nurses' information practice in municipal health care—A web‐like landscape

Technological appropriations as workarounds

A Systematic Literature Review on Antecedents of Workarounds related to Information Systems in Hospitals

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