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Physical and information workflow mapping of vancomycin therapeutic drug management: A single site case study revealing potential gaps in the process

  • Implementation Science & Operations Management
  • Published:
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Abstract

Vancomycin is one of the most prescribed antibiotics in pediatric intensive care units (PICU) in US hospitals. However, a detailed understanding of workflow and information flow among various stakeholders regarding vancomycin treatment processes in clinical settings is lacking. We conducted direct observations and informant interviews to develop the mapping of key processes and information flow for vancomycin treatment, with an emphasis on therapeutic drug monitoring (TDM) dose adjustment decision-making. A health information technology (HIT) sociotechnical framework was used to identify EHR related safety concerns. A total of 27 vancomycin treatment activities were observed over a 60-h duration including infusion administration, infusion completion, trough concentration blood draw and therapeutic decision making processes. Workflow and information flow mappings revealed (1) deviations between the documented timestamp used for TDM decision making and the actual time the tasks executed and (2) the lack of information flow regarding infusion completion and interruption. Missing features, insufficient usability and lack of integration with workflow and communication in the EHR were deemed safety gaps that may affect the accuracy of therapeutic decisions. Our case study identified gaps in information flow among clinical team members via EHR in TDM processes to provide insights for the improvement of the EHR system for antibiotic treatment purposes. In particular, the potential harm of the missing, uncertain, and inaccurate documented TDM task times warrant further investigations.

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Funding

This study was supported in part by College of Engineering and the Regenstrief Center for Healthcare Engineering at Purdue University.

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Authors and Affiliations

  1. School of Industrial Engineering, Purdue University, West Lafayette, IN, USA

    Tsan-Hua Tung & Yuehwern Yih

  2. Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA

    Poching DeLaurentis & Yuehwern Yih

  3. Children’s Wisconsin, Milwaukee, WI, USA

    Jeffrey A. Sinner

  4. Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA

    Matthew C. Scanlon

Authors
  1. Tsan-Hua Tung
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  2. Poching DeLaurentis
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  3. Jeffrey A. Sinner
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  4. Matthew C. Scanlon
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  5. Yuehwern Yih
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Corresponding author

Correspondence to Tsan-Hua Tung.

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This study did not constitute Human Subjects Research, thus submission of an IRB application was not required.

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The authors declare that they have no conflicts of interest.

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This article is part of the Topical Collection on Implementation Science & Operations Management

Appendix

Appendix

Fig. 3
figure 3

Process of the completion of an infusion

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Fig. 4
figure 4

Process of vancomycin blood sample order and collection. (note: PEVCO is the tube system that ships samples from the floor to the lab)

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Tung, TH., DeLaurentis, P., Sinner, J.A. et al. Physical and information workflow mapping of vancomycin therapeutic drug management: A single site case study revealing potential gaps in the process. J Med Syst 45, 104 (2021). https://doi.org/10.1007/s10916-021-01784-x

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  • DOI: https://doi.org/10.1007/s10916-021-01784-x

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