Making medication administration a dedicated activity free of interruptions could improve long-term care drug safety
Research Activities, August 2009, No. 348
Long-term care patients, who are often fragile and suffer from complex medical conditions, typically take multiple medications several times a day. Many also have cognitive, behavioral, or swallowing problems that further complicate the task of administering medications to them. Typically, a 20-bed unit has only one nurse per shift, who uses one-third of her shift to administer medications to patients on the unit, according to a new study. Researchers found that even more time is spent by temporary nurses who are not familiar with the patients or their medications. With few nurses available, nurses were often interrupted while doing medication rounds, which has been correlated with medication errors. Based on these findings, the researchers recommend that the medication administration process be made a dedicated activity and that nurses receive additional support to manage interruptions during these times.
The researchers used time-motion methods to time all steps in the medication administration process among long-term care units at one facility that differed according to case mix (residents needing physical support, behavioral care, dementia care, or continuing care). They observed a total of 141 medication rounds. Nurses spent a total of 62 minutes to administer a single round of medication for 20 residents on physical support units, 84 minutes on behavioral care units, and 70 minutes per 20 residents on dementia care units. Regular nurses took an average of 68 minutes per 20 residents to complete the medication administration process, while temporary nurses took an average of 90 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 minutes per resident. Interruptions occurred in 79 percent of observed medication rounds and accounted for 11.5 percent of the medication administration process. The study was supported by the Agency for Healthcare Research and Quality (HS10481 and HS15430).
More details are in "Nursing time devoted to medication administration in long-term care: Clinical, safety, and resource implications," by Mary S. Thomson, Ph.D., Andrea Gruneir, Ph.D., Monica Lee, M.Sc., and others, in the February 2009 Journal of the American Geriatric Society 57(2), pp. 266-272.