Repair Work in Electronic Medication Management

Abstract

High-quality hospital care requires careful medication management. The infrastructure in place to avert errors in medication management involves formal work procedures, elaborate electronic systems, and, we argue, continual repair work. Repair is the work required to restore things to working order after a breakdown. In this study, we analyze the repair work performed by the healthcare professionals tasked with two electronically supported medication-management processes at hospitals in Norway: medication reconciliation and closed-loop medication management. On the basis of interviews and supplementary material, we find that the repair work involved in these two activities is collaborative, continuous, and critical. It is collaborative in that it is performed by physicians, pharmacists, and nurses and, thereby, neither assigned to a single person nor to a group of designated repairers. It is continuous because the repairs do not fix the causes of the breakdowns but merely restore the individual instance of medication management to working order. It is critical in the double sense that repair work is a requirement for quality medication management and that quality repair work is also a requirement. We discuss the implications of the repair work, including the consequences of variation in the achieved level of repairedness.