Healthcare Setting Workarounds Essay

Pages: 8 (2547 words)  ·  Bibliography Sources: 4  ·  File: .docx  ·  Level: Master's  ·  Topic: Healthcare

Workarounds in Healthcare Industry

The following report describes how workarounds are practiced in healthcare settings in the belief that the shortcuts save time. The report is divided into six sections, each section deals with different but interrelated aspect of workarounds in healthcare. After the part one (introduction), part two highlights the description of workarounds that I am familiar with. This part also explains the commonly used time-saving workarounds used in health facilities. Part three of this paper reviews pertinent literature on issues related to workarounds. Part four and five highlight and analyze ethical/legal issues of workarounds and possible solutions to workarounds respectively. The last section of this paper will be the conclusion of this report.

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Health information technology (HIT) is an integrated framework of information systems used in healthcare facilities, hospitals, and primary & tertiary care centers. The main purposes of deploying integrated information systems (IS) in healthcare facilities are manifold. For instance, health facilities use electronic medical records (EMR) to improve healthcare efficiency and productivity, prevent errors of dosage and prescription, and reduce costs, increase collaboration and communication across different stakeholders of the system for better service delivery. Having said that, HIT is essentially multi-layered and overlapping IT infrastructure. It requires proper administration, both from IT and healthcare staff. Common errors such as failure of data applications and other issues related to command execution in HIT result in failure to perform tasks timely. To overcome this situation, healthcare staff often uses workarounds to complete care giving and administrative tasks without having to delay for error rectification.

TOPIC: Essay on Healthcare Setting Workarounds Assignment

"Workaround is a method of accomplishing an activity when the usual system/process is not working well" (Pennsylvania Patient Safety Reporting System, 2013). The main purpose is to circumvent the IT system or other processes and meet the desired goal without having to go through the full procedure. Workarounds result in improvisations, deviations, and shortcuts to accomplish the tasks within desired time or quickly (Debono, et al., 2013). No matter how efficiency-oriented workarounds may seem, they are perceived negatively and often impact the patient safety. Therefore, we need to identify common workarounds used by nurses and clinicians to accomplish care giving and administrative tasks quickly and to avoid complexity or broken-down system/process elements within their HIT infrastructure.

Workarounds in Healthcare Facilities

Debono, et al. (2013) has categorized the common workarounds used by nurses in acute care facilities. The categories identified by the authors where nurses were reported using workarounds are "barcode medication administration (BCMA) features, Computer Provider Order Entry (CPOE), electronic health record (EHR), smart pumps for intravenous infusion, equipment, test ordering and pharmacy dispensing" (Debono, et al., 2013; p. 182). Some of the individually enacted workarounds included pre-pouring the medications and scanning multiple patient ID bands before even starting the administration of medicine. In computerized physician order entry (CPOE) system, when IT systems chocked, nurses used papers and whiteboards to record surgery lists and patient information. Another most common workaround by nurses is used in barcode medication administration (BCMA) when nurses hand-typed the 7-digit barcodes rather than scanning through medication cart. This is the most common time-saving workaround used by nurses. One of the most commonly reported collective workaround was in computerized patient record system (CPRS) where doctors wrote orders on paper (although they are supposed to write them and enter in computers) and get nurses to input the orders in the IT system. Doctors later signed the nurse entered records.

Workarounds used by nurses cannot be used by them without the tacit understanding obtained from their supervisors. It is safe to assume that since patient safety and care giving is a team-based activity or process (physician, doctor, and nurse being part of that team), individual workarounds are also in the knowledge of teams. Since doctors themselves use workarounds to save time, nurses are encouraged to do the same although the impact of nurses using workarounds can be far worse than doctors' use of workarounds. Some workarounds are attributed to 'design elements' of EMRs. For instance, clinicians use hand written notes to place an order without closing the progress notes. This is because if he does close the note it would be deleted. Another important but common workaround that may compromise the privacy and security of patient medical data is the use of tablet PCs and Smartphone by clinicians and nurses to access patient records and to perform care-giving tasks. It is evident that change in computing methods and the devices used to perform computing (such as laptops, net-books, Smartphone, and Tablet PCs) have significant contribution in devising new types of workarounds. I am also familiar to several workarounds used in healthcare facilities that I have personally visited, either for self-treatment or while accompanying another patient.

A common workaround that I have often comes across is by pharmacy staff to avoid the use of computer or using alternative means of accomplishing work. Computing is performed only later when the actual task has been performed. For instance, while being in a medical facility, I observed the medical purchase officer placing purchase order from cafeteria through phone call and later confirmed the purchase order through short mobile service (SMS). Another common workaround I have observed is the access of personal email through hospital computer system when it was not authorized. This may increase potential of viruses and bugs entering the system. Another workaround that I am familiar with is writing the physician orders by the nurses while having PDAs or handheld computing devices. This is because the nurses are not confident at the use of computing devices or they are too familiar with the paper-work format. Having described some common workarounds and those I am familiar with, the next section reviews pertinent literature regarding issues related to healthcare workarounds.

Literature Review

As mentioned earlier, researchers such as Debono, et al. (2013) have reviewed workaround based on the category they relate to. For instance, common categories of workarounds are paper-based workarounds, computing workarounds, and efficiency related workarounds. Since workarounds tend to save time, there are significant chances of these workarounds turning into habitual practices in care giving. The Pennsylvania Patient Safety Reporting System (PA-PSRS) reported that consequence of only type of workaround (override of automated dispensing cabinet) resulted in several patient safety issues such as wrong dose administered, wrong-drug administration, dose administered to wrong patient, administering medication without order, and wrong frequency of medication [PA-PSRS., 2005). Other affects of using workarounds (such as preparing more than one medication at once, using estimated weight of patients rather than recording current weight, not checking for existing patient allergies to quickly process the patient visit) are overdose, under dose, incompatible drugs prescription, and incomplete discharge information (Institute for Safe Medication Practices, 2004). Some researchers have investigated this issue of workarounds specifically in context of barcode medication administration.

Koppel, Wetterneck, Telles and Karsh (2008) investigated the causes and types of workarounds that clinicians used (in barcode medication administration) and the consequences thereof. The authors conducted the study through an extensive field observation, interviews with practitioners and hospital leaders. The researchers reported that some nurses scanned medication from patient drawers without checking visually and this resulted in wrong medication or wrong dose. The result of physicians not reviewing eMAR (Electronic medical administration records) was that wrong medication or dose was administered or wrong route was used. Administering medication without scanning the patient ID resulted in administration of medication to wrong patient. Another workaround that involves disabling audio alarms on devices resulted in medication given at the wrong time. This study provides comprehensive data on cause, type, and affect of workarounds in BCMA system. The results are reliable as the researchers have used multiple methods to obtain the data i.e. observation, interviews, meeting participations, and a failure modes and effects analysis (FMEA). We come across a phenomenon that health facilities are fast deploying IT systems for crucial processes related to health service administration. Specifically in the context of the U.S. health system, IT systems are now being deployed at an increased (some may call it dangerously hurried) pace. Same is the case in Canada where hospitals have started using automatic drug dispensing machines without taking into consideration lack of adequate training.

Researchers have also investigated commonly used workarounds when manual care-giving and related activities are replaced with technology-based machines to carry out the same tasks. Automatic medication and fluid dispensers are example of such technology-based changes in pharmacies. Safety issues for patients arise when machines stop functioning due to the development of errors and the lack of guidelines or emergency backups; in case of machine failure can trigger the need to use workarounds. In the category of technology use, Cina, et al. (2006) observed 140,755 automatic medication doses in a large health facility over a period of seven months. The results, obtained through observation indicated that of the total doses being observed, 3.6% (5,075) were erroneous. Of these 5075 instances where dose… [END OF PREVIEW] . . . READ MORE

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How to Cite "Healthcare Setting Workarounds" Essay in a Bibliography:

APA Style

Healthcare Setting Workarounds.  (2013, November 15).  Retrieved September 17, 2021, from

MLA Format

"Healthcare Setting Workarounds."  15 November 2013.  Web.  17 September 2021. <>.

Chicago Style

"Healthcare Setting Workarounds."  November 15, 2013.  Accessed September 17, 2021.