Comparative Analysis of Medication Administration Methods on Workflow

Reidinger, Gloria L.

Saturday, 29 October 2011

Zeb E. Koran, RN, MSN, DNP
Gloria L. Reidinger, EdD, RN, MS
Center for Clinical Affairs, Northwest Community Hospital, Arlington Heights, IL

Learning Objective 1: Compare nurses workflow before and after administering medication with bar coding.

Learning Objective 2: Identify 2 frequent sources of interruptions to nurses administering medications.

Background: In 1999, the Institute of Medicine (IOM) estimated that between 44,000 and 98,000 Americans die each year as a result of a medical error. To decrease the possibility of errors, various methods to improve medication safety are being employed in the healthcare environment. Sakowski et al. (2005) showed that bar-code point-of-care medication administration (BCMA) decreases medication errors but also impacts the medication administration system. While BCMA may have a positive impact of decreasing medication errors, it may also negatively impact the nurses’ workflow.

Purpose: In the past year, our community hospital has experienced the addition of a new tower and the implementation of BCMA. The purpose of this study was to measure the impact these changes had on nurses' workflow when administering medications.

Method: This was a quantitative study in which twenty nurses, 10 from each of two units, were observed while passing their 9AM medications both prior to and after the implementation of BCMA, and also after one unit moved to a new tower. The observers recorded data regarding trips, interruptions, medications, patient load, and lengths of time for these medication passes.

Results: The number of interruptions decreased for the post-surgical unit after the implementation of BCMA and decreased further after the move to the new tower. The number of interruptions increased after the implementation of BCMA on the renal unit. The number of "runs" did not significantly change.

Conclusions: A significant variation in practice between nurses and units while administering medications was noted with the observations. This study has resulted in the hospital exploring methods of standardization and safety guidelines for the nurses to follow while administering their medications. Another consideration being explored is changing the primary medication time from 9AM since many of the interruptions were the result of physicians making their morning rounds.

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