Organizational, Cultural, and Psychological Determinants of Smart Infusion Pump Work Arounds: A Study of 3 U.S. Health Systems.

OBJECTIVES: We investigated nurse perceptions of smart infusion medication pumps to provide evidence-based insights on how to help reduce work around and improve compliance with patient safety policies. Specifically, we investigated the following 3 research questions: (1) What are nurses' current attitudes about smart infusion pumps? (2) What do nurses think are the causes of smart infusion pump work arounds? and (3) To whom do nurses turn for smart infusion pump training and troubleshooting? METHODS: We surveyed a large number of nurses (N = 818) in 3 U.S.-based health care systems to address the research questions above. We assessed nurses' opinions about smart infusion pumps, organizational perceptions, and the reasons for work arounds using a voluntary and anonymous Web-based survey. Using qualitative research methods, we coded open-ended responses to questions about the reasons for work arounds to organize responses into useful categories. RESULTS: The nurses reported widespread satisfaction with smart infusion pumps. However, they reported numerous organizational, cultural, and psychological causes of smart pump work arounds. Of 1029 open-ended responses to the question "why do smart pump work arounds occur?" approximately 44% of the causes were technology related, 47% were organization related, and 9% were related to individual factors. Finally, an overwhelming majority of nurses reported seeking solutions to smart pump problems from coworkers and being trained primarily on the job. DISCUSSION AND CONCLUSIONS: Hospitals may significantly improve adherence to smart pump safety features by addressing the nontechnical causes of work arounds and by providing more leadership and formalized training for resolving smart pump-related problems.

Taking Another View: How Nurses Perceive Infusion Pumps as Demanding for Both Themselves and Their Patients.

Based on an organization theory perspective, this study proposes that nurses not only consider how infusion pumps place demands on themselves but also consider how infusion pumps place demands on patients. Results from a sample of nurses in a large, public authority, nonprofit teaching hospital located in the midwestern United States indicate that "demanding formalization for nurses" and "demanding formalization for patients" are 2 empirically distinct constructs. Demanding formalization for patients was a stronger predictor of infusion pump-related attitudes, in addition to trust and pay satisfaction. Demanding formalization for nurses was a stronger predictor of job satisfaction, turnover intention, and burnout.

The opioid abuse and misuse epidemic: implications for pharmacists in hospitals and health systems.

PURPOSE: The current epidemic of prescription opioid abuse and misuse in the United States is discussed, with an emphasis on the pharmacist's role in ensuring safe and effective opioid use. SUMMARY: U.S. sales of prescription opioids increased fourfold from 1999 to 2010, with an alarming rise in deaths and emergency department visits associated with the use of fentanyl, hydrocodone, oxycodone, and other opioid medications. Signs and symptoms of opioid toxicity may include altered mental status, hypoventilation, decreased bowel motility, central nervous system and respiratory depression, peripheral vasodilation, pulmonary edema, hypotension, bradycardia, and seizures. In patients receiving long-term opioid therapy for chronic pain, urine drug testing is an important tool for monitoring and assessment of therapy; knowledge of opioid metabolic pathways and assay limitations is essential for appropriate use and interpretation of screening and confirmatory tests. In recent years, there has been an increase in federal enforcement actions against pharmacies and prescription drug wholesalers involved in improper opioid distribution, as well as increased reliance on state-level prescription drug monitoring programs to track patterns of opioid use and improper sales. Pharmacies are urged to implement or promote appropriate guidelines on opioid therapy, including the use of pain management agreement plans; policies to ensure adequate oversight of opioid prescribing, dispensing, and waste disposal; and educational initiatives targeting patients as well as hospital and pharmacy staff. CONCLUSION: Pharmacists in hospitals and health systems can play a key role in recognizing the various forms of opioid toxicity and in preventing inappropriate prescribing and diversion of opioids.