Implementation of a portable cholinesterase monitoring kit in a clinical setting: A Normalization Process approach

Since 2004 Washington State has maintained a cholinesterase (ChE) monitoring program for farm workers who are exposed to organophosphate (OP) and n-methyl-carbamate pesticides as part of their employment duties. This study implements the Normalization Process Model (NPM) developed by May et al. to identify factors related to work that may favor or inhibit routine embedding of a portable ChE monitoring kit into clinical practice. Surveys were conducted in an attempt to capture the perceptions of the current monitoring program in the Yakima Valley from those most involved with it: growers/employers, farm workers, and healthcare staff at an occupational medical clinic that handles the majority of ChE monitoring for the region. The survey also attempted to capture how amenable stakeholders would be to possible introduction of a new monitoring system that would include the portable ChE monitoring kit. The perception data was obtained through oral interviews and was used to characterize the constructs of the NPM theory. These constructs serve as organizational tools for assessing the potential embedding of the ChE kit within the clinic. The ultimate goal of this project is to assess how to introduce a cholinesterase monitoring kit into clinical practice in a manner that best assures the success of initial and sustainable adoption.