Medication administration in Australian residential aged care: A time‐and‐motion study

Abstract

Rationale/aim Medication administration is a complex and time‐consuming task in residential aged care facilities (RACFs). Understanding the time associated with each administration step may help identify opportunities to optimize medication management in RACFs. This study aimed to investigate the time taken to administer medications to residents, including those with complex care needs such as cognitive impairment and swallowing difficulties. Method A time‐and‐motion study was conducted in three South Australian RACFs. A representative sample of 57 scheduled medication administration rounds in 14 units were observed by a single investigator. The rounds were sampled to include different times of day, memory support units for residents living with dementia and standard units, and medication administration by registered and enrolled nurses. Medications were administered from pre‐prepared medication strip packaging. The validated Work Observation Method By Activity Timing (WOMBAT) software was used to record observations. Results Thirty nurses were observed. The average time spent on scheduled medication administration rounds was 5.2 h/unit of average 22 residents/day. The breakfast medication round had the longest duration (1.92 h/unit). Resident preparation, medication preparation and provision, documentation, transit, communication, and cleaning took an average of 5 minutes per resident per round. Medication preparation and provision comprised 60% of overall medication round time and took significantly longer in memory support than in standard units (66 vs 49 seconds per resident per round for preparation, 79 vs 58 for provision; P < .001 for both). Almost half (42%) of tablets/capsules were crushed in memory support units. The time taken for medication administration was not significantly different among registered and enrolled nurses. Conclusions Nurses took an average of 5 minutes to administer medications per resident per medication round. Medication administration in memory support units took an additional minute per resident per round, with almost half of tablets and capsules needing to be crushed.

How Do Pharmacists Distribute Their Work Time during a Clinical Intervention Trial?—A Time and Motion Study

“…This study has several strengths, including applying the structured and validated WOMBAT methodology and ensuring exact collection of observed task time applying several observation categories simultaneously [ 24 ]. Also, the meticulously developed observation categories, the inter-rater validation, and the number and duration of the observations strengthen the internal validity of our findings [ 38 , 39 , 40 ]. The limitations include observation bias due to the Hawthorne effect, i.e., people changing their behavior when they know they are being watched.…”

Potentially Inappropriate Medication: A Pilot Study in Institutionalized Older Adults

“…Pharmacotherapeutic complexity can be assessed considering numerous factors, but the complexity index is one of the few methodologies capable of numerically quantifying this criterion [36,45,46] and is validated for Portuguese [36]. Studies from Brazil and Portugal reported similar MRCI means to the one in our data, while Australian studies found higher complexity [47][48][49][50]. The MRCI is instrumental in gauging the challenge each pharmacotherapeutic profile presents, and our findings corroborate a direct correlation between MRCI values, the number of medications, and patient age [49,51].…”

Impact of Medication Regimen Simplification on Medication Administration Times and Health Outcomes in Residential Aged Care: 12 Month Follow Up of the SIMPLER Randomized Controlled Trial

“…Medication management is a significant component of direct care activities in RACFs and reducing time spent administering medications may enable staff to shift a meaningful period of time to other care activities or spend more time on other medication safety initiatives [40]. Previous studies have identified that time spent on medication rounds by nurses varies from approximately 1 h for 20 residents, to 4.5 h for 35 residents [43][44][45]. Data from three RACFs participating in the SIMPLER study suggests nurses spend an average of five minutes administering medications per resident per round [45].…”

“…Previous studies have identified that time spent on medication rounds by nurses varies from approximately 1 h for 20 residents, to 4.5 h for 35 residents [43][44][45]. Data from three RACFs participating in the SIMPLER study suggests nurses spend an average of five minutes administering medications per resident per round [45]. Extrapolation of the reduction in the average number of administration times for regular medications observed at 4 month follow up suggests 85 h of staff time could be redistributed per month in a 100 bed RACF.…”