The impact of electronic prescribing systems on pharmacists’ time and workflow: protocol for a time-and-motion study in English NHS hospitals

Schofield, Behnaz; Cresswel, Kathrin; Westbrook, Johanna I.; Slee, Ann; Girling, Alan; Shah, Sonal; Coleman, Jamie J.; Sheikh, Aziz

doi:10.1136/bmjopen-2015-008785

Cited by 8 publications

(7 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Independent continuous observation of workflow and methods was used. This method was consistent with previous time and motion studies of health care workers in hospitals and RACFs 21‐25 . Ethics approval was granted from the Monash University Human Research Ethics Committee (project number 11054) and the study was reviewed by the participating aged care provider organization's ethical review panel.…”

Section: Methodsmentioning

confidence: 99%

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

Chen

Bell

Ilomäki

et al. 2020

Evaluation Clinical Practice

View full text Add to dashboard Cite

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.

show abstract

Section: Methodsmentioning

confidence: 99%

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

Chen

Bell

Ilomäki

et al. 2020

Evaluation Clinical Practice

View full text Add to dashboard Cite

show abstract

“…The same researcher (LH) collected data both pre- and post-ePA and carried out a series of pilot observations on the study wards to become familiar with the data collection tool, and to allow ward staff to become familiar with being observed, before starting data collection. An existing task list [ 23 ] was expanded from 11 to 20 tasks (Additional file 1 ) by further subdividing existing categories to provide greater granularity and facilitate identification of task changes that were potentially more ePA-specific. Each task was also assigned by one researcher (MM) as being either value-added or non-value-added from a patient’s perspective, based on Lean methodology, to facilitate identification of potentially ‘wasteful’ or non-value-added steps [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

The impact of implementing a hospital electronic prescribing and administration system on clinical pharmacists’ activities - a mixed methods study

McLeod

Karampatakis

Heyligen

et al. 2019

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundThe increasing adoption of hospital electronic prescribing and medication administration (ePA) systems has driven a wealth of research around the impact on patient safety. Yet relatively little research has sought to understand the effects on staff, particularly pharmacists. We aimed to investigate the effects of ePA on pharmacists’ activities, including interactions with patients and health professionals, and their perceptions of medication safety risks.MethodsA mixed methods study comprising quantitative direct observations of ward pharmacists before and after implementation of ePA in an English hospital, and semi-structured interviews post-ePA. Quantitative data comprised multi-dimensional work activity sampling to establish the proportion of time ward pharmacists spent on different tasks, with whom and where. These data were extrapolated to estimate task duration. Qualitative interviews with pharmacists explored perceived impact on (i) ward activities, (ii) interactions with patients and different health professionals, (iii) locations where tasks were carried out, and (iv) medication errors.ResultsObservations totalled 116 h and 50 min. Task duration analysis suggested screening inpatient medication increased by 16 mins per 10 patients reviewed (p = 0.002), and searching for paper drug charts or computer decreased by 2 mins per 10 patients reviewed (p = 0.001). Pharmacists mainly worked alone (58% of time pre- and 65% post-ePA, p = 0.17), with patient interactions reducing from 5 to 2% of time (p = 0.03). Seven main themes were identified from the interviews, underpinned by a core explanatory concept around the enhanced and shifting role of the ward pharmacist post-ePA. Pharmacists perceived there to be a number of valuable safety features with ePA. However, paradoxically, some of these may have also inadvertently contributed to medication errors.ConclusionThis study provides quantitative and qualitative insights into the effects of implementing ePA on ward pharmacists’ activities. Some tasks took longer while others reduced, and pharmacists may spend less time with patients with ePA. Pharmacists valued a number of safety features associated with ePA but also perceived an overall increase in medication risk. Pharmacy staff demonstrated a degree of resilience to ensure ‘business as usual’ by enhancing and adapting their role.Electronic supplementary materialThe online version of this article (10.1186/s12913-019-3986-4) contains supplementary material, which is available to authorized users.

show abstract

“…The main strength of this study is the observational category framework in combination with the WOMBAT software, enabling exact time registration of activities, similar to what has been described when measuring time distribution of physicians, nurses and pharmacists in various hospital settings [22,26,[32][33][34][35][36]. The comprehensive development of categories based on the RCT structure reflects the workflow in a multidimensional clinical study, and made measurement an easy task.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Time distribution for pharmacists conducting a randomized controlled trial—An observational time and motion study

et al. 2021

View full text Add to dashboard Cite

Introduction An expected future increase in older adults will demand changes in health care delivery, making development, implementation and evaluation of new health care models essential. The rationale for political decision-making concerning the implementation and application of interventions in health care should include cost estimations, specifically those involving clinical interventions. To provide such data knowledge of time spent on the intervention is imperative. Time and motion methodology is suitable to quantify health care personnel’s time distribution. Aim To investigate the time distribution for pharmacists conducting a randomized controlled trial (RCT) implementing a clinical intervention. Materials and methods The setting was an RCT with a 5-step pharmacist-intervention in collaboration with the interdisciplinary team in a geriatric ward. Two pharmacists were involved in the trial during the observation period. Pharmacist activities, classified as RCT-tasks (intervention or administrative), non-RCT tasks and social/breaks, were recorded applying the Work Observation Method By Activity Timing methodology, enabling recording of predefined work tasks as well as interruptions and multitasking. One observer collected data over eight weeks. Results In total, 109.1 hours were observed resulting in 110.2 hours total task time, including multitasking. RCT tasks comprised 85.4% of the total observed time, and nearly 60% of the RCT time was spent on intervention tasks. Medication reviews was the most time consuming task, accounting for 32% of the observed time. The clinical pharmacists spent 14% of the intervention time communicating verbally, mainly with patients and healthcare professionals. Conclusion During the RCT, the clinical pharmacists spent about half their time performing the actual intervention. Consequently, costs for providing such a clinical pharmacist service should reflect actual time spent; otherwise, we may risk overestimating theoretical costs.

show abstract

The impact of electronic prescribing systems on pharmacists’ time and workflow: protocol for a time-and-motion study in English NHS hospitals

Cited by 8 publications

References 24 publications

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

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

The impact of implementing a hospital electronic prescribing and administration system on clinical pharmacists’ activities - a mixed methods study

Time distribution for pharmacists conducting a randomized controlled trial—An observational time and motion study

Contact Info

Product

Resources

About