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This study demonstrates a series of systematic methods for mapping medication administration processes and for elaborating violations of work standards at two rural hospitals. Thirty-four observational periods were conducted to capture the details of clinical activities, and hierarchical task analysis (HTA) was used to demonstrate the current medication administration process. Facility nurse managers in five units across the two facilities participated in focus group discussions to validate the observational data and to generate a reliable context-appropriate medication administration process. The potential errors or misconduct when passing the drugs were identified, such as unsafe storage and transportation of drugs from room to room. Those hazards would cause drug contamination, loss, or access by unauthorized individuals. Hospitals without 24-hour pharmacy coverage and other interruptions would hinder the medication administration process. Preparing drugs for more than one patient at a time would increase the risk of passing the drugs to the wrong patient. This study shows the use of observation and focus groups to describe and identify violations in the medication administration process. A clear road map for continuous clinical process improvement obtained from the current study could be used to help future health information technology implementation., (Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.)

Background: One mechanism to increase participation in research is to solicit potential research participants' general willingness to be recruited into clinical trials. Such research permissions and consents typically are collected on paper upon patient registration. We describe a novel method of capturing this information electronically., Purpose: The objective is to enable the collection of research permissions and informed consent data electronically to permit tracking of potential research participants' interest in current and future research involvement and to provide a foundation for facilitating the research workflow., Methods: The project involved systematic analysis focused on key areas, including existing business practices, registration processes, and permission collection workflows, and ascertaining best practices for presenting consent information to users via tablet technology and capturing permissions data. Analysis was followed by an iterative software development cycle with feedback from subject matter experts and users., Results: An initial version of the software was piloted at one institution in South Carolina for a period of 1 year, during which consents and permission were collected during 2524 registrations of patients. The captured research permission data were transmitted to a clinical data warehouse. The software was later released as an open-source package that can be adopted for use by other institutions., Limitations: There are significant ethical, legal, and informatics challenges that must be addressed at an institution to deploy such a system. We have not yet assessed the long-term impact of the system on recruitment of patients to clinical trials., Conclusions: We propose that by improving the ability to track willing potential research participants, we can improve recruitment into clinical trials and, in the process, improve patient education by introducing multimedia to informed consent documents.