Page - 83 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

Figure 2. (a) An example of a simple social network where the general practitioner is seen as the central hub for patient information with only one other specialist; (b) An example of a complex social network where the patient is the central hub within fragmented healthcare services involving various doctors in secondary care and other specialists. 3.2. Use case 2: A problem between alarm design and barrier nursing One of the most striking findings for safety around infusion devices on the haematology ward was a tension between the design of the infusion pump alarms and the procedures for barrier nursing [18]. The infusion pumps were designed to alarm ten minutes before the infusion was due to complete (a ‘pre-alarm’). This was standard across the hospital and was intended to alert nurses so they could prepare for when it finished, e.g. prepare the next infusion. However, the haematology ward used many infusions and every patient needed barrier nursing to prevent spread of infection, requiring nurses to wash their hands and put on gloves, gown and mask before entering the patient’s room. Reaching the pump to silence the alarm was therefore costly in terms of time. Once the nurse had silenced the pre-alarm they could not wait in the patient’s room for ten minutes so they would go out and try to do something else before being called back for the actual alarm on completion of the infusion. The physical layout of the ward also meant that it was difficult to hear pumps alarming from the corridor, partly because there was an ante-room between the main corridor and each patient’s room. So, nurses were effectively relying on the pump alerting the patient, the patient pressing the call bell, and the nurse reacting to the call bell. Some patients expressed frustration at this process. One patient did not want to disturb the nurses, knowing how busy they are, so she sat next to the pre-alarm beeping for ten minutes before calling the nurse to attend to the pump. A downstream consequence of the frustrations for staff and patients caused by the pre-alarm was that nurses would sometimes break with protocol and coach patients on how to silence the alarms. However, this would depend on the nurse and patient, e.g. patients who were not deemed competent would be discouraged from interacting with their infusion pump even if they tried to do it themselves. It was suggested by one D.Furniss etal. /DistributedCognition:UnderstandingComplexSociotechnical Informatics 83