Exploring how nurses make sense of the safety features of smart infusion pump technology

Smart infusion pump technology (SIPT) was designed to enhance safety with intravenous medication administration, but has introduced new patient safety risks and harm when nurses initiate workarounds that bypass SIPT safety features. This study sought to develop a grounded theory explaining nurses' experiences with SIPT, their perceptions of safety features, the rules and resources used in response to safety features, the actions taken in response to SIPT workflow blocks, and conditions contributing to nurse-initiated workarounds. Corbin and Strauss's (2008) grounded theory approach guided this study. Semi-structured interviews were conducted with 28 nurses who used SIPT across 13 adult patient care areas in a single Midwest teaching hospital.

The grounded theory Nurse-Technology Interplay was developed through constant comparison analysis of transcribed interview data. The four categories of interacting with SIPT, making meaning, taking action, and consequences, were linked through relational statements and theoretically integrated to develop the grounded theory. The grounded theory explicates the continual interplay that occurs as nurses interact with SIPT, and the cognitive and physical processes used to resolve workflow blocks in the context of care delivery. Interacting with SIPT reflected the learning curves faced by nurses, the context of patient-care unit characteristics, and encountered workflow blocks. Making meaning reflected the cognitive processes used by nurses as they encountered workflow blocks with SIPT, and was influenced by individual perspectives, as well as shared learning. Taking action often occurred simultaneously with making meaning, and represented processes of doing, such as rechecking programming activities, seeking assistance, or engaging in workarounds. Consequences of using SIPT included patient outcomes with medication administration and the impact on practice as nurses experienced disruptions in care delivery, dependency on SIPT, a loss of calculation skills, and alarm overload.

The grounded theory of Nurse-Technology Interplay provides an understanding of how nurses make sense of, and respond to, workflow blocks with SIPT safety features. The study yielded valuable insights into the complexity of SIPT implementation and the challenges nurses face while providing safe, effective, patient-centered care in the midst of juggling competing priorities. The findings have implications for nursing practice and nurse leaders. Critical to moving forward is a more purposeful approach to SIPT education and training within a patient safety framework, a systematic evaluation of organizational processes that impact SIPT, optimization the SIPT drug library to facilitate nurses' work, and promotion of a learning organization that capitalizes on the lessons that can be learned from workarounds.