Objective To explore the relationship of workarounds related to the implementation of an electronic medication administration record and medication safety practices in five Midwestern nursing homes.

Design As a part of a larger study, this qualitative evaluation was conducted to identify workarounds associated with the implementation of an electronic medication administration record. Data were collected using multi-methods including direct observation, process mapping, key informant interviews, and review of field notes from medication safety team meetings.

Measurements Open and axial coding techniques were used to identify and categorize types of workarounds in relation to workflow blocks.

Results Workarounds presented in two distinct patterns; those related to workflow blocks introduced by technology and those related to organizational processes not reengineered to effectively integrate with the technology. Workarounds such as safety alert overrides and short cuts to documentation resulted from first order problem solving of immediate blocks. Nursing home staff as individuals frequently used first order problem solving instead of the more sophisticated second order problem solving approach used by the medication safety team.

Conclusion This study provides important practical examples of how nursing home staff work around workflow blocks encountered during the implementation of technology. Understanding these workarounds as a means of first order problem solving is an important consideration to understanding risk to medication safety.