Nursing Time Devoted to Medication Administration in Long-Term Care: Clinical, Safety, and Resource Implications

Baycrest Centre, Toronto, Ontario, Canada.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 02/2009; 57(2):266-72. DOI: 10.1111/j.1532-5415.2008.02101.x
Source: PubMed


To quantify the time required for nurses to complete the medication administration process in long-term care (LTC).
Time-motion methods were used to time all steps in the medication administration process.
LTC units that differed according to case mix (physical support, behavioral care, dementia care, and continuing care) in a single facility in Ontario, Canada.
Regular and temporary nurses who agreed to be observed.
Seven predefined steps, interruptions, and total time required for the medication administration process were timed using a personal digital assistant.
One hundred forty-one medication rounds were observed. Total time estimates were standardized to 20 beds to facilitate comparisons. For a single medication administration process, the average total time was 62.0+/-4.9 minutes per 20 residents on physical support units, 84.0+/-4.5 minutes per 20 residents on behavioral care units, and 70.0+/-4.9 minutes per 20 residents on dementia care units. Regular nurses took an average of 68.0+/-4.9 minutes per 20 residents to complete the medication administration process, and temporary nurses took an average of 90.0+/-5.4 minutes per 20 residents. On continuing care units, which are organized differently because of the greater severity of residents' needs, the medication administration process took 9.6+/-3.2 minutes per resident. Interruptions occurred in 79% of observations and accounted for 11.5% of the medication administration process.
Time requirements for the medication administration process are substantial in LTC and are compounded when nurses are unfamiliar with residents. Interruptions are a major problem, potentially affecting the efficiency, quality, and safety of this process.

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    • "High medication incident rates in RACFs can be attributed to the high incidence of polypharmacy and changing pharmacodynamics (adjustments in medication selection and dosage in accordance with individual age related and physical changes) of residents [6]. In addition, the presence of cognitive, behavioural, or swallowing problems for some residents may complicate the act of directly administering medications [2] and increase the risk of medication incidents [7,8]. The process of adequate medication management requires appropriate prescription of drugs in accordance with the resident’s condition, communication of instructions regarding dispensing and packaging to the community pharmacy and ensuring administration of the right drugs to the right person, in the right dose, at the right time [9]. "
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    ABSTRACT: Background Medication incident reporting (MIR) is a key safety critical care process in residential aged care facilities (RACFs). Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents’ safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs’ devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs. Methods The study was undertaken in three RACFs (part of a large non-profit organisation) in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach. Results The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a) design MIR artefacts that facilitate identification of the root causes of medication incidents, b) integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c) support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs. Conclusions This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes.
    BMC Geriatrics 11/2012; 12(1):67. DOI:10.1186/1471-2318-12-67 · 1.68 Impact Factor
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    • "Other research evidence also suggests that conduct of routine, time-consuming tasks such as repeat medication rounds can lead nurses into complacency and a diminished sensitivity towards the potential for harm resulting from medication errors [53,54]. Medication rounds occupy approximately one-third of nursing time in long-term residential care [50]. In contrast, for social care staff who do not have a robust professional and educational framework or clinical training to support them [55], the sense of being 'stressed' when administering medication could reduce any complacency and increase recall of near misses. "
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    BMC Geriatrics 12/2011; 11(1):82. DOI:10.1186/1471-2318-11-82 · 1.68 Impact Factor
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    • "Prescribing is one of the most common medical interventions experienced by older people resident in care homes [3,4]. Due to multiple medical conditions and polypharmacy (defined as the use of multiple medications and/or administration of more medications than are clinically indicated [5]), in addition to age-related changes in pharmacokinetics and pharmacodynamics, care home residents are at high risk of adverse drug events (ADEs) [6-8]. "
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    BMC Geriatrics 09/2011; 11(1):56. DOI:10.1186/1471-2318-11-56 · 1.68 Impact Factor
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