Public interest in the quality and safety of health care has spurred examination of specific organizational routines believed to yield risk in health care work. Medication administration routines, in particular, have been the subject of numerous improvement projects involving information technology development, and other forms of research and regulation. This study draws from ethnographic observation to examine how the common routine of medication administration intersects with other organizational routines, and why understanding such intersections is important. We present three cases describing intersections between medication administration and other routines, including a pharmacy routine, medication administration on the next shift and management reporting. We found that each intersection had ostensive and performative dimensions; and furthermore, that IT-enabled changes to one routine led to unintended consequences in its intersection with others, resulting in misalignment of ostensive and performative aspects of the intersection. Our analysis focused on the activities of a group of nurses who provide technology use mediation (TUM) before and after the rollout of a new health IT system. This research offers new insights on the intersection of organizational routines, demonstrates the value of analyzing TUM activities to better understand the relationship between IT introduction and changes in routines, and has practical implications for the implementation of technology in complex practice settings.

This paper employs a longitudinal perspective to examine continued system use (CSU) by individuals in utilitarian, volitional contexts when alternative systems are present . We focus on two key behavioural antecedents of CSU - habit and continuance intention - and theorise how the relationships between CSU and these antecedents evolve over time. In addition, we hypothesise how the interaction effect of habit and intention on CSU evolves temporally. Our theorising differs from extant literature in two important respects: 1) In contrast to the widespread acceptance of the diminishing effect of continuance intention on CSU in the information systems (IS) literature, we hypothesise that in our context, its impact increases with time; and 2) In contrast to the negative moderation effect of habit on the relationship between intention and CSU proposed in the literature, we posit a positive interaction effect. We collect longitudinal survey data on the use of a higher education IS from students in a European university. Our results suggest that the impact of continuance intention on CSU as well as the interaction effect between habit and intention are increasing over time. We further introduce a methodological innovation - the to conduct the multi-group analysis with repeated measures - to the literature.