Carry on PumpingFranny GantUX Architect

Haematology Nurses &

Digital Infusion Pumps

HCI MSc UCL

CHI+MED

I have a Social Anthropology bachelors degree andI’m drawn to this type of research because of

- The social aspect - And looking at the whole workspace and technology within it

there’s a lot going on “the messy details” of the workplace

Need to focus research on the right things

Something cool that came out of California in the 80s

Distributed Cognition Framework

understand group work situations using ethnographic research techniques

Distributed CognitionHutchins et al

DCog looks at cognitive processing of the whole workplace system Extending on models of individual cognition to LARGER UNIT

It adds a social aspect

Understand normal work practices better... helps design technology to support work rather than disrupt it

Distributed Cognition Perspective

DiCoT methodology (drawing from... CI & GT)To structure observations and analysis.

Paying attention to physical layoutartefactsinformation flowsocial structures

Distributed Cognition for Teamworking

(DiCoT)UCLiC

Contextual Inquiry

Grounded Theory

Challenges of fieldwork in healthcare settings:- focus on pumps, not people- Vetted by hospital – background check, blood tests – because of vulnerable people- Emotionally charged environment – sensitivity needed

ChallengesEthical clearanceGaining accessSerious illness

Open jotting of notes brings up some issues People can feel uncomfortable They got used to me being there

Kitchen Stories is a good film… even if you’re not an ethnographer

Kitchen Stories Bent Hamer

2003

Open jotting

Important to build trust and rapport with people

INTRODUCE-I put this notice up in shared spacesEmail sent round

EXPLAIN-“I’m here to study the how the devices fit with your work, not auditing you”.

Introducing myself

Consent gained from everyone followed (don’t follow people who decline)

Permission from each patient (nurses help)

One nurse who sternly questioned me became a key informant

Getting consent

Spent 28 hours total on two haematology wards

all times of day and night over 4 weeks Thought there might be some major contrast between night and day work

Night & Day?

•I found there was a continuous flow to the work that carried on around the clock.

Round-the-clock

Pumps used all the time in haematology

accurate delivery of drugs

‘high risk’ devices - A mis-entered number...

support the nurses’ cognitive work of giving treatments:

...nurses said things like... “the pump backs up my maths”... “it reminds you... and gives you a few minutes to go and get the new drug”

Pumps

infusions can last up to 36 hours

“Line space” is a limited resource depending on time.

nurses use the pumps as reminders to save time between end of one infusion and start of the next a workaround not designed for by the manufacturer

“It’s about safety and speed... we’re giving so much fluid. We normally give a drug, flush it through, give another, flush it through...”

I shadowed nurses in their work. unstructured ad hoc questions when I could. semi-structured interviews to check understanding

Noted things they said and did Letter coding system for later analysis (thanks Atish Rajkomar)

Data collection

a “web of artefacts” is used in their workThese process information and - communicate status of the ward system

Written notes Drug charts Whiteboards Drug labels

Web of artefacts

In Dcog – pay attention to physical space Horizons of observation

Side rooms that have closed doors to control infection. Nurses can’t see the status of pumps behind the doors (and sometimes, can’t hear them alarming).

Physical layout

Flow of information …nurses rely on patients as part of the communication loop with the pumps

If a patient is asleep, nurses may not get called

breakdown in communication which can lead to delays

Flow of information

My study highlights that...

Pump technology needs to be designed for use over long periods of time.- Nurses are using pumps in non-prescribed ways as reminders to save time

On wards with side rooms...Nurses are reliant on patients to communicate pump alerts - need to enable pumps to communicate directly with ward staff

OutcomesTechnology design for- continuous use contexts- communication from side rooms

Tips: Best times – when they will be doing what you want to see Right people – doing the work; with an overview; supportive of the research I took camera, voice recorder, note book -- spare pens & batteries. Reflect on method and own biases.

Best timesRight peopleEquipmentReflection

How I would like to do it differently…

Research in two phases one without domain knowledge (see more details) one with

Interesting to follow the events with one pump for a day and one nurse for a shift

Be able to look at the patient experience of the pumps –they have a direct relationship with the technology.

“Needs further investigation…”

Pros & Cons Ethnographic studies can take time. Gives - in depth knowledge of activities that need to be seen in the wild.

DCog & DiCoT is a great way of looking at the coordinated action of teamwork how technology can support, not disrupt it  Combining qualitative studies with quantitive – to see what’s happening at key stroke level – build complete picture. Can take this domain knowledge and use it in other research.

Time =

Behind closed doors – a distributed cognition study of infusion pump use in round-the-clock haematology treatment http://bit.ly/gant2011ucl

Look ups…

University College London Interaction Centre – UCLiC http://www.ucl.ac.uk/uclic

CHI+MED http://www.chi-med.ac.uk/

DiCoT – Furniss, Blandford, et al

Distributed Cognition – Hutchins

Contextual Design – Beyer and Holtzblatt

Grounded Theory – Charmaz

Type of pump – BBraun Infusomat Space

Kitchen Stories, Bent Hamer 2003