The fellow completed the first two years of the MindSElS research (2018-2019) at the Australian Institute of Health Innovation (AIHI, Macquarie University) in Sydney, Australia, and the third year in Europe in 2020 working remotely with UCL School of Pharmacy, in compliance with COVID-19 pandemic restrictions. In Australia, the fellow joined the local research team on an ongoing research project on the impact of electronic medication management systems on medication safety in a children hospital in Sydney [1]. She contributed to this project and developed her research on the effects of electronic medication management systems on individual and collective mindfulness among hospital clinicians, with two studies, one in paediatric oncology and one in a paediatric intensive care unit.
Overall, the project identified opportunities and challenges for collective mindfulness in hospitals in the use of technology for medication safety. A particular area of concern appeared to be the embedded automation. We found [2] that electronic medication systems, with embedded automated decision support and workflow management rules, may contribute to medication safety by facilitating strategies typical of the ‘ultra-safe’ model of safety (typically, standardization) and by operating ‘safety by design’ (e.g. embedded rules and constraints). However, we also found [3] that systems’ automated behaviours conceal issues with software, and contribute to clinicians’ frustrations and ‘incorrect use’ of the system. Thus, we concluded [2], for the system to be operated safely, clinicians must show a collective mindfulness with the technology - its limitations, and the embedded automation -, in addition to mindfulness with the patient situation and the context of work. We also found that different electronic medication systems pose different challenges to clinicians’ collective mindfulness. For example, in using electronic prescribing systems the challenge is to maintain a ‘sensitivity to operations’ - an awareness of the interdependencies in workflows, in a patient treatment, and within the wider hospital organization. Instead, in using an automated dispensing cabinet for example, the challenges is for the nurses not to rely on automation, as this risks a ‘drift into failure’ (as we argue in [4]). The challenge is for nurses to maintain a preoccupation with the potential for medication errors, despite the technology usually dispensing the medication correctly.
Studies results and theoretical and methodological reflections have been published in 5 journal papers, a book chapter and 3 chapters in conference proceedings. They have also been presented at local and international conferences/events. A conference paper has been accepted, and 3 more journal papers have been submitted (under review), when the fellowship ended in December 2020. The research is continuing beyond the end of the fellowship, with collaborations in the UK, the EU and Australia. AIHI granted the fellow an honorary position for her to continue collaborations with the Institute in the future.
References
1. Westbrook, et al., BMJ Open, 2016. 6(10).
2. Lichtner et al.. BMC Medical Informatics and Decision Making, 2020. 20(1):193.
3. Lichtner, et al. Eur J Cancer Care, 2019. 28(6):e13152.
4. Lichtner. Researching the drift into medication errors with automated dispensing cabinets: reflections from a study of a paediatric ICU (Accepted for publication) NI2020 International Congress on Nursing Informatics (now 2021)
