A Novel Use of Bar Code Medication Administration Data to Assess Nurse Staffing and Workload

Abstract

Objective To introduce an innovative use of bar code medication administration (BCMA) data, medication pass analysis, that allows for examination of nurse staffing and workload using data generated during regular nursing workflow Methods Using one year (October 1, 2014 to September 30, 2015) of BCMA data for 11 acute-care units in one Veterans Affairs Medical Center, we determined the peak time for scheduled medications and included medications scheduled for and administered within two hours of that time in analyses. We established for each staff member their daily peak-time medication pass characteristics (number of patients, number of peak-time scheduled medications, duration, start-time), generated unit-level descriptive statistics, examined staffing trends, and estimated linear mixed-effects models of duration and start-time. Results As the most frequent (39.7%) scheduled medication time, 9:00 was the peak-time medication pass; 98.3% of patients (87.3% of patient-days) had a 9:00 medication. Use of nursing roles and number of patients per staff varied across units and over time. Number of patients, number of medications, and unit-level factors explained significant variability in registered nurse (RN) medication pass duration (conditional R2 = 0.237; marginal R2 = 0.199; Intraclass correlation = 0.05). On average, an RN and a licensed practical nurse (LPN) with four patients, each with six medications, would be expected to take 70 and 74 minutes, respectively, to complete the medication pass. On a unit with median 10 patients per LPN, the median duration (127 minutes) represents untimely medication administration on more than half of staff days. With each additional patient assigned to a nurse, average start time was earlier by 4.2 minutes for RNs and 1.4 minutes for LPNs. Conclusion Medication pass analysis of BCMA data can provide health systems a means for assessing variations in staffing, workload, and nursing practice using data generated during routine patient care activities.

Beyond Hospital-Level Aggregated Data

“…Having unit-level data conveys more granular information, showing that within 2 facilities with similar average patient risk scores, the unit-level values can vary greatly. Another example is a study by Knox et al 24 describing how BCMA data linked to nursing units can be used to examine nurse staffing and workload. Granular, time-stamped data are an important component of longitudinal studies and allow for complex analytic models that can control for patient severity, explore the effects of daily and unit-level variation, and potentially establish causality 5 .…”

“…The Pharmacy BCMA Domain contains data collected from the administration of medications as captured by the BCMA software system developed by the VHA to electronically record medications administered to patients 23–25 . Information such as medication type, form, and administration route are linked to the receiving patient, their location, and the staff delivering the medication 24–26 .…”

“…The Pharmacy BCMA Domain contains data collected from the administration of medications as captured by the BCMA software system developed by the VHA to electronically record medications administered to patients 23–25 . Information such as medication type, form, and administration route are linked to the receiving patient, their location, and the staff delivering the medication 24–26 . The location of a patient during medication administration is recorded in the BCMA Domain as a string of characters describing the ward name, room, and bed, altogether referred to hereafter as a “BCMA location.” 27 There is not necessarily a direct link between the ward name and room/bed embedded in the BCMA location and the ward and room/bed fields from the Inpatient Domain.…”

“…[23][24][25] Information such as medication type, form, and administration route are linked to the receiving patient, their location, and the staff delivering the medication. [24][25][26] The location of a patient during medication administration is recorded in the BCMA Domain as a string of characters describing the ward name, room, and bed, altogether referred to hereafter as a "BCMA location." 27 There is not necessarily a direct link between the ward name and room/bed embedded in the BCMA location and the ward and room/bed fields from the Inpatient Domain.…”