Information technology as an infrastructure for patient safety: nursing research needs

Abstract

This article describes the process utilized to create research questions which promote technology as an infrastructure to enable safe nursing practice. Beginning with scenarios of safety problems related to nursing practice, the team identified information technology including hardware, software, and organizational and operational components to help improve the safety aspects addressed in the scenarios. Further discussed are characteristics of technology necessary at each step in the nursing process and finally recommendations are presented for various research questions that would be needed to enable research on the use of the proposed technologies.

Introduction

Ensuring patient safety has always been a concern of nurses and other healthcare professionals. Three reports in particular have called attention in the United States to creating processes to prevent errors in the practices surrounding healthcare delivery. The Institute of Medicine of the National Academies published, “To Err is Human” (2000), “Crossing the Quality Chasm” (2001), and, “Health Professions Education: A Bridge to Quality” (2003) [1], [2], [3]. The reports document problems with patient safety – highlighting medication administration – and discuss process failure instead of people failure in committing errors.

Each of these publications has included suggestions for steps that can be taken to improve patient safety, often including the potential role of technology. “To Err is Human” [1] noted the importance of patient safety leadership and research as well as the need for generally raising expectations around patient safety and creating organizational systems that promote safe care. The same report commented that technology can augment human cognitive functions to improve patient safety, but appropriately noted and cautioned that poorly designed or overly complex technology can lead to increased error. “Crossing the Quality Chasm” [2] identified the gap between what is known about high quality care and what is the current state of practice. The report indicated that safety is one aspect of quality. To improve matters, the report called for improved communication among members of the care team, increased coordination of care, redesigned care processes, improved knowledge and skills training, as well as more the efficient use of information technology. The third in the series [3] focuses on the educational reform recommended for all healthcare professionals in this ever changing system to enhance patient care quality and safety, clearly an area that must accompany technological approaches to improved safety.

Although there is a general consensus that technology can improve safety, many complex questions must be answered en route to this goal, and little has been written about what should be the directions of research in this area. “Improving Patient Safety with Technology” was the theme of NI2003—eighth International Congress in Nursing Informatics invitational post conference held in June 2003 near Rio de Janeiro, Brazil. Thirty nine healthcare representatives from thirteen countries met to assume leadership in promoting the use of technology to improve safety and to define what should be a nursing research agenda in this domain.

This paper reports the findings of one of the meeting’s subgroups whose goal was to focus on the ways that technology could serve as an infrastructure to enable safe nursing practice and identify important domains of research that could advance understanding of this area. Our approach was (1) to define key terms, (2) to identify some example scenarios to illustrate ways in which current nursing practice is unsafe and might be amenable to improvement with technology, (3) to identify ways in which information technology could potentially be used to improve safety, and (4) to identify important areas in which research is needed before the promise of technology to improve patient safety can fully be realized.