Technology implementation and workarounds in the nursing home

Document Type


Peer Reviewed


Publication Date


NLM Title Abbreviation

J Am Med Inform Assoc

Journal/Book/Conference Title

Journal of the American Medical Informatics Association

PubMed ID


DOI of Published Version


Start Page


End Page



OBJECTIVE: This study sought to explore the relationship of workarounds related to the implementation of an electronic medication administration record and medication safety practices in five Midwestern nursing homes. DESIGN: As a part of a larger study, this qualitative evaluation was conducted to identify workarounds associated with the implementation of an electronic medication administration record. Data were collected using multimethods including direct observation, process mapping, key informant interviews, and review of field notes from medication safety team meetings. MEASUREMENTS: Open and axial coding techniques were used to identify and categorize types of workarounds in relation to work flow blocks. RESULTS: Workarounds presented in two distinct patterns, those related to work flow blocks introduced by technology and those related to organizational processes not reengineered to effectively integrate with the technology. Workarounds such as safety alert overrides and shortcuts to documentation resulted from first-order problem solving of immediate blocks. Nursing home staff as individuals frequently used first-order problem solving instead of the more sophisticated second-order problem solving approach used by the medication safety team. CONCLUSION: This study provides important practical examples of how nursing home staff work around work flow blocks encountered during the implementation of technology. Understanding these workarounds as a means of first-order problem solving is an important consideration to understanding risk to medication safety.


Health Plan Implementation, Human Engineering, Humans, Medical Order Entry Systems/organization & administration, Medication Errors/prevention & control, Medication Systems/organization & administration, Nursing Homes/manpower/organization & administration, Nursing Staff, Pharmaceutical Preparations/administration & dosage, Problem Solving, Qualitative Research, Work Simplification

Published Article/Book Citation

Journal of the American Medical Informatics Association, 15:1 (2008) pp.114-119. DOI:10.1197/jamia.M2378.

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