Navigating complexity of the medication management system within the home setting-a functional resonance analysis method (FRAM) analysis of people with dementia and their carers' experiences

BACKGROUND

There is a strong imperative to support people with dementia to live independently in their homes for as long as possible. A starting point is to understand how they manage medications on a daily basis.

AIM

To understand how people with dementia and their informal carers manage medications within the home setting to inform the identification of opportunities to improve medication management.

METHODS

A qualitative study using the Functional Resonance Analysis Method (FRAM). Interview data with people with dementia and informal carers were analysed to (i) Identify and describe key functions, (ii) identify and describe variability in performing key functions, and its potential consequences and (iii) map performance variability to Resilient Healthcare capacities.

RESULTS AND DISCUSSION

A FRAM model was developed and consisted of 14 interdependent key functions. The interdependent nature of functions, and the different nature and sources of variability in how each key function was performed highlighted the level of complexity of the medication management system within the home setting. The medication system was managed almost entirely by the person with dementia and/or their informal carers. This shows the lack of system-level controls to support the safe functioning of the medication management system in the home setting.

CONCLUSION

Future work will develop a comprehensive FRAM model that includes the perspectives of health and social care professionals and those from the third sectors to underpin the development of a range of system recommendations to strengthen resilience in the medication management system within the home setting.

Exploring the relationships between safety and maintenance in the cold generation process: insights from the functional resonance analysis method

Industrial refrigeration systems typically use ammonia as a refrigerant gas, which is a toxic gas so leaks can be catastrophic. This study aimed to identify how to improve robustness in a cold generation process using the functional resonance analysis method (FRAM). A case study was conducted through interviews and direct observations to develop three FRAM models: one focusing on operation and maintenance functions; another focusing on functions related to the provision of occupational health and safety (OHS) measures; and a third overlapping the first two models. Results revealed that the management of OHS is restricted to the legislation applied to piping under pressure, and the company did not consider a more comprehensive safety approach for the ammonia storage stage. This study also highlighted the need for action, such as non-destructive and penetrating liquid tests, in one of the process steps considered critical for operation and maintenance, but not for OHS.

An IoE and Big Multimedia Data Approach for Urban Transport System Resilience Management in Smart Cities

Today, the complexity of urban systems combined with existing and emerging threats constrains administrations to consider smart technologies and related huge amounts of data generated as a means to take timely and informed decisions. The smart city needs to be prepared for both expected and unexpected situations, and the possibility to mitigate the effect of the uncertainty behind the causes of disruptions through the analysis of all the possible data generated by the city open new possibility for resilience operationalization. This article aims at introducing a new conceptualization for resilience and presenting an innovative full stack solution to exploit Internet of Everything (IoE) and big multimedia data in smart cities to manage resilience of urban transport systems (UTS), which is one of the most critical infrastructures of the city. The approach is based on a novel data driven approach to resilience engineering and functional resonance analysis method (FRAM), to understand and model an UTS in the context of smart cities and to support evidence driven decision making. The paper proposes an architecture taking into account: (a) different kinds of available data generated in the smart city, (b) big data collection and semantic aggregation and enrichment; (c) data sense-making process composed by analytics of different data sources like social media, communication networks, IoT, user behavior; (d) tools for knowledge driven decisions able to combine different information generated by analytics, experience, and structural information of the city into a comprehensive and evidence driven decision model. The solution has been applied in Florence metropolitan city in the context of RESOLUTE H2020 research project of the European Commission.

Co-administration of multiple intravenous medicines: Intensive care nurses' views and perspectives

BACKGROUND

Co-administration of multiple intravenous (IV) medicines down the same lumen of an IV catheter is often necessary in the intensive care unit (ICU) while ensuring medicine compatibility.

AIMS AND OBJECTIVES

This study explores ICU nurses' views on the everyday practice surrounding co-administration of multiple IV medicines down the same lumen.

DESIGN

Qualitative study using focus group interviews.

METHODS

Three focus groups were conducted with 20 ICU nurses across two hospitals in the Thames Valley Critical Care Network, England. Participants' experience of co-administration down the same lumen and means of assessing compatibility were explored. All focus groups were recorded, transcribed verbatim, and analysed using thematic analysis. Functional Resonance Analysis Method was used to provide a visual representation of the co-administration process.

RESULTS

Two key themes were identified as essential during the process of co-administration, namely, venous access and resources. Most nurses described insufficient venous access and lack of compatibility data for commonly used medicines (eg, analgesics and antibiotics) as particular challenges. Strategies such as obtaining additional venous access, prioritizing infusions, and swapping line of infusion were used to manage IV administration problems where medicines were incompatible, or of unknown or variable compatibility.

CONCLUSIONS

Nurses use several workarounds to manage commonly encountered medication compatibility problems that may lead to delays in therapy. Organizations should review and tailor compatibility resources towards commonly administered medicines using an interdisciplinary approach. Developing a clinical decision-making pathway to minimise variability while promoting safe co-administration practice should be prioritised.

RELEVANCE TO CLINICAL PRACTICE

This study highlights several ways ICU nurses are able to manage challenges associated with co-administration and the need for the development of a more robust and comprehensive compatibility resource that is relevant to everyday practice through collaboration between nurses and pharmacists.