Comprehensive Evaluation of the Integrated Smart Pump-EHR Technology in Eight Adult Acute and Intensive Care Units: A Mixed Method Study
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 659
- 试验地点
- 1
- 主要终点
- Pump adoption rate
研究概览
简要总结
This study looks at the effects of using "smart pumps" that connect with the Electronic Health Record (EHR) in 8 adult ICU units.
We will interview nurses and healthcare team members to learn about any challenges with this technology.
All nurses in these units will be invited to complete a survey on how easy the technology is to use.
Some nurses will practice giving medications to "mannequins" in a simulation lab to see how they work with the pumps.
We will also look at existing data to find out how many nurses use the technology and what types of alerts or errors come up.
Finally, we will review patient charts to see if using the technology has increased or decreased errors in recording IV medication amounts.
详细描述
This mixed-methods design study focuses on understanding the complexity and consequences of implementing the integrated smart pumps-EHR technology in 8 adult acute and intensive care units (ICUs) using a comprehensive evaluation approach. The evaluation will include (1) analyzing use manifestations in terms of nurse adoption, alarms, alerts, and error messages associated with technology use, (2) examining the usability of the integrated technology, and (3) identifying influential factors that facilitate or hinder technology adoption.
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Other
入排标准
- 年龄范围
- 20 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Research Aims 1 (adoption rate) and 2 (frequency and types of alerts and programming error ). We will include all IV medications and fluids delivered via smart infusion pumps within the past 6 months. We anticipate the dataset to include more than 180,000 of medications and fluid administration events.
- •Research Aim 3 (documentation errors ). We will select 200 IV medications that were administered with solutions using chart audit. To be included, the selected IV medications should be diluted with at least 100 ml solution. The choice of the 100 ml cutoff point was based on it being the minimum volume for the majority of IV medication administrations.
- •Research Aims 4, 5, 6, and 7 (usability of the technology, nurse perception, predictors of nurse perception, nurse experience with technology). Eligibility criteria will be confined to registered nurses with at least an associate degree in nursing.
- •Research Aim 8 (multidisciplinary team experience with technology). The inclusion criteria for the group of multidisciplinary representatives encompass participation in pump implementation and pumps-related quality improvement initiatives.
排除标准
- •Research Aims 1 and
- •Bolus medications will be excluded due to the distinct workflow associated with their administration.
- •Research Aim
- •Medications with solution volumes lower than 100 ml will be excluded.
- •Research Aims 4, 5, 6, and
- •Licensed vocational nurses (LVN) and licensed practical nurses (LPN) will be excluded due to their non-involvement in IV medication administration. Additionally, and for Research Aim # 7, the group of 48 nurses who will engage in the usability testing will not be part of the focus group interviews to ensure a broader participation among nurses.
- •Research Aim 8: Stakeholders from the different hospital's departments and councils (e.g., nursing, biomedical engineering, pharmacy, risk and management, technology committees, etc.) who were not part of the implementation process of infusion pumps in 2018 and 2020 or are not involved in continuous quality initiatives related to infusion pump adoption and quality measures tracking will be excluded.
研究组 & 干预措施
Nurses in ICU or Acute Care who administer medications using Smart infusion pumps
(A) Nurses from 8 acute and intensive care units (659 nurses total) will be invited to complete a survey about using the pumps.
(B) Of these 659 nurses, 48 will join focus groups to share detailed thoughts on pump use.
(C) Another 48 nurses will practice using the pumps in a simulation setting.
The study will also review 200 patient records to check for any differences in documentation errors of IV medication volumes when using pump-EHR integration versus manually programming the pumps. Additionally, the study will analyze pump data from the last 6 months to see how often the technology is used and what types of alerts and programming errors occur. Furthermore, 20 healthcare team members will participate in interviews to understand the barriers and facilitators of technology use.
结局指标
主要结局
Pump adoption rate
时间窗: 6 months
Data from the pumps over the past 6 months will be reviewed and analyzed to understand how often nurses use the integrated pump-EHR (or electronic health record) technology versus manually programming the pumps when administering medications. Z-test will be used to test the difference in percentage in adoption rate.
Alerts messages
时间窗: 6 months
Data from the pumps over the past 6 months will be reviewed to examine the difference in frequency of alert messages (including programming error messages) generated when manually programming the pump versus using the pump-EHR integrated technology. Data will be analyzed using chi-square.
Errors in documenting the volume of IV medications
时间窗: 4 months
200 patient charts will be reviewed to compare documentation errors in IV medication volumes when using pump-EHR integration versus manual pump programming.
次要结局
- Usability of the Pumps(9 months)
- Nurse perception of the usability of the integrated smart pump technology(6 months)
- Factors that facilitate or hinder technology adoption(11 months)