Illustrative examples of quality implications
| Quality domain | Example | Paper |
| Effective | This study explored intravenous infusion practices. ‘We identified several examples where nurses consciously worked around policies that were perceived to be inefficient or un-workable with the aim of supporting effective and timely patient care. For example, although verbal orders were not permitted, staff often acknowledged that practice deviated from policy in this respect. ‘Our medicines policy is perhaps a bit naïve in saying we should not do verbal orders. Which is fundamentally what it says at the moment. And then perhaps we do need to go back to revisit where verbal orders are taken, which would be additional, you know.’’ (Site D) | 52 |
| Efficient | This study explored medication dispensing practices. ‘Pharmacists themselves were observed missing some sub-tasks to improve efficiency. While checks to prevent fraud, non-financially efficient prescribing, or cheaper alternatives, were all included in the WAI (work as imagined) forms of the task, these were not observed to be completed in practice. Pharmacists commented that they would rarely come across prescriptions that would fail any of these checks, and so they would regularly skip them to improve processing time.’ (Examples removed) | 29 |
| Timely | The study captured examples where nurses omitted steps in established processes for checking and documenting medications because, ‘this represented the only way to ‘get things done’ and achieve the goal of timely medication administration.’ | 37 |
| Patient centred | The study described how doctors and nurses worked around electronic health records (EHR). ‘The nurse perceived EHR use impeded her ability to be nonverbally present with her patients; thus, she chose to violate EHR protocol to put her patients first.’ | 31 |
| Equitable | The study described adaptions from the policy for reviewing test results in a GP practice. ‘Participants expressed a trade-off between better management of results by a clinician who knew the patient or who had ordered the test and the speed with which results were managed including an equitable distribution of work between clinicians.’ | 35 |
| Safe | The study described e-prescription system workarounds. ‘Pharmacists were observed, though, to resort to partial processing of an order, after identifying potential adverse drug interactions, or detecting that prescribed drugs are out of the physician’s specialty…pharmacists performing this workaround think that they have to control not only the quantity of the prescribed drugs, but also the suitability of the order.’ | 49 |
GP, general practitioner.