Systems contradictions present challenges that need to be effectively managed, e.g. due to conflicting rules and advice, goal conflicts, and mismatches between demand and capacity. We apply FRAM (Functional Resonance Analysis Method) to intravenous infusion practices in an intensive care unit (ICU) to explore how tensions and contradictions are managed by people. A multi-disciplinary team including individuals from nursing, medical, pharmacy, safety, IT and human factors backgrounds contributed to this analysis. A FRAM model investigation resulting in seven functional areas are described. A tabular analysis highlights significant areas of performance variability, e.g. administering medication before a prescription, prioritising drugs, different degrees of double checking and using sites showing early signs of infection for intravenous access. Our FRAM analysis has been non-normative: performance variability is not necessarily wanted or unwanted, it is merely necessary where system contradictions cannot be easily resolved and so adaptive capacity is required to cope.

中文翻译：

---

使用FRAM探索ICU静脉输液管理中性能差异的来源：系统矛盾的非规范方法。

系统矛盾带来了需要有效管理的挑战，例如，由于规则和建议冲突，目标冲突以及需求与能力之间的不匹配。我们将FRAM（功能共振分析方法）应用于重症监护病房（ICU）的静脉输液实践，以探索人们如何处理紧张局势和矛盾。一个由来自护理，医疗，药学，安全，IT和人为因素背景的个人组成的跨学科团队对此分析做出了贡献。描述了导致七个功能区域的FRAM模型调查。表格分析突出显示了性能差异的重要方面，例如在开处方前服用药物，对药物进行优先排序，不同程度的重复检查以及将显示感染早期迹象的部位用于静脉内通路。