University of Wisconsin–Madison

Nursing, Technologies, and Medication Management

  • Overview: Funded by the Robert Wood Johnson Foundation (RWJ), this project is part of the Interdisciplinary Nursing Quality Research Initiative (INQRI) program.

    The goals of this project inlude:

    • understanding nursing care processes, the nursing workforce and environment, and the impact of technology on the quality of patient care; and
    • identifying, developing and testing new measures to advance quality nursing research in the target area of medication management.

    Building on an existing interdisciplinary research network, this project examines how nurses in Intensive Care Units contribute to the quality of medication management when using health information technology (IT). The application aims to develop measures of nursing contributions to medication management.

    Aim #1: Determine how nurses contribute to the quality of medication management when using health IT;

    Aim #2: Determine if and how nurse contributions to medication management change when health IT is used;

    Aim #3: Develop new measures of nursing contributions to medication management; and

    Aim #4: Determine the cost of nurse contributions to medication management.

    Methods:

    • Work system analysis consists of observing a nurse over several hours and taking detailed notes on the tasks he/she performs. These data help in understanding ICU nurses’ work in the context of the Electronic Health Record (EHR) implementation. It also provides data later used in the interviews.
    • Job task analysis consists of observing nurses and recording the tasks on a tablet PC using software that keeps track of time. Each task is time-stamped and produces accurate data about the time nurses spend on specific tasks. These data help determine the percent of time nurses spend on tasks related to medication management pre- and post-EHR implementation.
    • Interviews based on the observation data and input from the nursing researcher, the research team created scenarios of medication management. Nurses were then interviewed to determine how he/she makes decisions when facing different scenarios. Nurses were also asked open-ended questions about their perceptions of medication management and their role in medication management.
    • Proactive Risk Assessment is a Human Factors method for determining vulnerabilities in processes and, how people involved in the processes can contribute to or recover from breakdowns or failure modes.

    Funding: Robert Wood Johnson Foundation (RWJ)

  • A multidisciplinary team from the University of Wisconsin-Madison, St Mary’s Hospital and Children’s Hospital of Wisconsin are collaborating on this RWJ funded project.

    UW-Madison Research Team Members

    Pascale Carayon, PhD
    Procter & Gamble Bascom Professor in Total Quality
    Department of Industrial and Systems Engineering
    Director, Center for Quality and Productivity Improvement
    University of Wisconsin-Madison

    Ben-Tzion Karsh, PhD
    Department of Industrial and Systems Engineering
    University of Wisconsin-Madison

    Hélène Faye, PhD
    Former Post-doctoral Research Associate
    Center for Quality and Productivity Improvement
    University of Wisconsin-Madison

    Mary Ellen Hagenauer, BA
    Research coordinator at the Macro Ergonomics Safety and Health Laboratory
    University of Wisconsin-Madison

    UWHC School of Nursing Research Team Member

    Mary Ellen Murray, PhD, MSN
    Associate Dean for Academic Affairs and Professor
    University of Wisconsin-Madison

    St Mary’s Hospital Research Team Members

    Christine Baker, PhD
    Quality Assurance Director
    St Mary’s Hospital, Madison, WI

    Denise Cole-Ouzounian, MS, APN, CCRN
    Director of the Cardiovascular Intensive Care Unit
    St Mary’s Hospital, Madison, WI

    Children’s Hospital of Wisconsin Research Team Members

    Kathy Murkowski, RRT, CCRC
    Research Manager
    Pediatric Critical Care
    Medical College of Wisconsin

    Matt Scanlon, MD
    Associate Professor of Pediatrics, Medical College of Wisconsin
    Associate Medical Director of IS, Children’s Hospital of Wisconsin

    Doctoral Student

    Joy Rivera, PhD

  • Rivera-Rodriguez, A.J. (2013). A socio-technical systems approach to studying interruptions: Understanding the interrupter’s perspective. Applied Ergonomics, 45 (3), 747-756. PMID: 24103213

    Carayon, P., Faye, H., Hundt, A.S., Karsh, B-T., Wetterneck, T.B. (2010). Patient safety and proactive risk assessment. In Yuehwen (Ed.), Handbook of Healthcare Delivery Systems, 12, (pp. 1-15). Taylor & Francis: London.

    Faye, H., Rivera-Rodriguez, A.J., Karsh, B.-T., Hundt, A.S., Baker, C., & Carayon, P. (2010). Involving ICU nurses in a proactive risk assessment of the medication management process. Joint Commission Journal of Quality and Safety,36 (8), 376-384. PMCID: PMC3039839

    Faye, H., Rivera, A. J., Karsh, B.-T., Murray, M. E., Baker, C., & Carayon, P. (2009). Nurses’ perceptions of medication management. Poster presented at the 21st Annual Conference for Teachers of Nursing Practice, Madison, WI.

    Faye, H., Carayon, P., Karsh, B.-T., Rivera, A. J., Murray, M. E., Scanlon, M., et al. (2008). ICU nurse medication management: Decision-making in a complex environment. Paper presented at the Healthcare Ergonomics Systems and Patient Safety (HEPS) Conference, Strasbourg, France.

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