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Abstract
<p class="first" id="d75816e75">Many studies have highlighted the patient safety risks
in intravenous medication administration,
and various technological solutions have been proposed to mitigate those risks, including
'smart pumps' and closed-loop systems. Few studies describe these implementations
in detail. In this article, we report on a sociotechnical investigation of a closed-loop
documentation system linked with smart pumps for intravenous infusion administration
on an intensive care unit. The smart pumps are 'mapped' to an electronic prescribing
and medication administration system, allowing infusion rates, volumes and boluses
of intravenous medication to be monitored in real time. Ethnographic observations
were conducted over 37 h, including direct observation of infusion administration
(n = 23 infusions), discussions with clinical staff and semi-structured interviews
with intensive care unit managers (n = 2). Analysis was based on the Distributed Cognition
for Teamwork (DiCoT) method to understand how information is processed across individuals,
teams and technologies. We report on how the system works in context, and identify
contributions and compromises to patient safety with new risks that need to be managed
at bedside and intensive care unit level.
</p>