Toward ensuring care quality and safety across settings: examining time pressure in a nursing home with observational time motion study metrics based on the Omaha system

Abstract

Background Meaningful data to determine safe and efficient nursing workload are needed. Reasoning a nurse can accomplish a finite number of interventions and location changes per hour, examination of time pressure using time motion study (TMS) methods will provide a comparable indication of safe and efficient workload for an individual nurse. Methods An observer shadowed 11 nurses at a 250-bed nursing home in the Southeastern United States and recorded 160 h of observations using TimeCaT, web-based TMS data recording software. Predefined Omaha System nursing interventions (N = 57) and locations (N = 8) were embedded within TimeCaT. The time-stamped data were downloaded from TimeCaT and analyzed using descriptive and inferential statistics. Five time pressure metrics were derived from previous TMS findings in acute care settings. Results Overall, nurses spent 66 s for each intervention, performed 65 interventions per hour, stayed 130 s at each location, changed locations 28 times per hour, and multitasked for 29% of working time. Computed hourly time pressure metrics enabled visualization of variability in time pressure metrics over time, with differences in multitasking by licensure, unit/role, and observation session time. Conclusions Nursing home nurses consistently experienced a high degree of time pressure, especially multitasking for one-third of their working time. To inform staffing decision making and improve the quality of care, resident outcomes, and nurse satisfaction, it is critical to identify ways to mitigate time pressure. Additional research is needed to refine and extend the use of the time pressure metrics.

Multitasking during medication management in a nursing home: A time motion study

“…12 This high staffing ratio causes extreme time pressure, and therefore higher levels of multitasking. [13][14][15] Given that financial constraints driving these high patient to nurse ratios are likely to persist, 16,17 it is essential to understand multitasking in order to develop innovative future solutions to reduce time pressure, and alleviate cognitive burden and resulting medication errors. Furthermore, the use of clinical informatics tools and techniques in nursing homes is in its early stages, [18][19][20][21] and there is potential to apply informatics methods to both study and address this multitasking issue.…”

“…25,26,36 A prior analysis in a nursing home using TimeCaT software and Omaha System nursing interventions, revealed a higher percentage of time multitasking (29%) and prompted further investigation into their multitasking practices. 13…”

“…Observer training and reliability assessment is described elsewhere. 13,32 The nursing director identified licensed nurses from the daily schedule as candidates for observation. The external nurse observer explained the study, including a $20 gift card incentive per session, and obtained verbal consent from the nurses.…”