The effect of electronic prescribing and medication administration on nurses’ workflow and activities: an uncontrolled before and after study

Abstract

Background: Electronic prescribing and medication administration (ePMA) is purported to improve patient safety through a number of benefits including reducing medication errors and facilitating identification of prescribers. However little is known of its effect on nurses' workflow and the associated patient safety implications. Our objective was to explore differences in drug round duration, medication administration workflow and activities, interruptions, and timeliness of medication administration before and after implementation of ePMA. Methods: The study was an uncontrolled before and after study starting one month before and continuing until one month after implementation of ePMA, in a medicine for the elderly ward in a UK teaching hospital. Observation of nursing staff and documentation of workflow patterns, activities, interruptions and timeliness of medication administration during 20 scheduled drug rounds pre-ePMA and 14 rounds afterwards.

The impact of electronic prescribing systems on healthcare professionals’ working practices in the hospital setting: a systematic review and narrative synthesis

“…Of the 25 studies, seven were from the UK [10–16], four from the US [17–20], four from the Netherlands [21–24], three from France [25–27], two from Australia [28, 29], two from Saudi Arabia [30, 31] and one each from Denmark [32], Spain [33] and Iran [34]. Nineteen studied commercial systems, one a home-grown system [25], one both a commercial and a home grown [15] system and for four studies it was not possible to establish the system type [11, 30, 31, 34].…”

“…Six papers focused on the impact of eP on time taken while completing particular medication-related tasks [13, 16, 18, 19, 28, 29]; the majority adopted uncontrolled before-and-after study designs ( n = 4), one a controlled before-and-after design [29] and one was a longitudinal qualitative study [28]. Of the former, one focused on the impact of eP on nurses’ medication-related activities [16]. This study suggested that eP did not significantly affect the length of time spent on a medication administration round but altered the distribution of tasks with a doubling of the time spent on documentation [16].…”

“…Of the former, one focused on the impact of eP on nurses’ medication-related activities [16]. This study suggested that eP did not significantly affect the length of time spent on a medication administration round but altered the distribution of tasks with a doubling of the time spent on documentation [16]. The duration of the medication round appeared to decrease post-eP but data collection ceased before the reason for this change could be fully explored [16].…”

Patients’ Bedsides or Drug Trolleys: Where to Keep Paper Medication Administration Records?

“…This setup would reduce the time needed to locate MARs, and hence make the work of doctors, nurses, and pharmacists more efficient. When hospitals fully implement electronic prescribing, we may no longer have problems of searching for MARs [4,5]. Until then, we should make every effort to make paper MARs easily accessible, and not prone to being misplaced.…”

An Evaluation of the Impact of Barcode Patient and Medication Scanning on Nursing Workflow at a UK Teaching Hospital

“…Additionally, on eight drug rounds on each ward, a spaghetti diagram [18,19] was constructed detailing a floorplan of the ward along with the walking pattern of the nurse around the ward, from the time the drug round began to the time it ended. This was done for eight of ten days, as the first two days on each ward were spent creating the floorplan [18,19].…”