Evaluation of Medication Administration Timing—Are We Meeting Our Goals?

Abstract

Background: Per the Centers for Medicare and Medicaid Services (CMS) Code of Federal Regulations (CFR) 482.23(c) regarding medication administration, hospital policies and procedures must identify time-critical scheduled medications which must be administered within 30 minutes either before or after the scheduled dosing time, for a total administration window of 1 hour. Objective: The general objective of this analysis was to determine whether there was a difference in meeting medication administration goals when comparing time-critical to non-time-critical scheduled medication administration in both intensive care units (ICUs) and general medical floors at a large, academic medical center. Methods: Data were collected in 6 inpatient nursing units (3 general medical units and 3 ICUs) during the month of June 2017. Electronic medical record charge data for medications were used to evaluate timeliness of medication administration. Results: In total, 69,794 medication administrations were evaluated. Of 389 administrations of time-critical scheduled medications, 268 (69%) were administered on time. Of 69,405 administrations of non-time-critical scheduled medications, 58,099 (84%) were administered on time ( P < 0.001). ICUs had a higher percentage of on-time administrations than general medical units (89% vs 77%, P < 0.001), and nurses had a higher percentage of on-time administrations than respiratory therapists (84% vs 63%, P < 0.001). Conclusions: Non-time-critical scheduled medications were more commonly administered on time compared with time-critical scheduled medications. Staff education and optimizations to the electronic health record (EHR) are interventions that may improve administration of time-critical scheduled medications.

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

“…Timing errors in medication administration are frequent but often discounted in reports of medication errors. 29,[49][50][51][52][53][54][55] The persistent presence of wrong-time errors indicates that nurses are often unable to administer all medications assigned to them in the allotted time. This has implications for non-medication patient care as well.…”

The Impact of Delayed Symptomatic Treatment Implementation in the Intensive Care Unit

“…The objective of this study was to quantify the impact of delays in single, non-recurrent medication orders in the ICU for immediate delivery in case an order was prescribed as conditional on patient health status: more critical patients are often prioritized over less critical patients and receive their medications more quickly [ 28 , 29 , 49 ]. Delays in healthcare delivery are difficult to avoid, particularly in a setting as complex and fast-paced as the ICU [ 5 , 17 , 24 , 29 ].…”

“…The intuitive way to improve healthcare delivery is to change the workflow in the hospital. However, not all intuitive solutions yield the desired outcomes [ 18 , 28 , 39 , 52 ]. Alternating nurse shift changes may help with continuity of care as adding an 11:00 a.m. to 11:00 p.m. shift eases the transition between 7:00 a.m. to 7:00 p.m. and 7:00 p.m. to 7:00 a.m. shifts.…”

“…The increased emphasis on sepsis cases in the recent literature has demonstrated that delays in antibiotics are associated with poor outcomes in these patients [ 3 , 23 , 24 , 25 , 26 , 27 ]. Similar attention is paid to peri-operative antibiotics [ 28 ]. However, there is a relative paucity of literature regarding the effect of delays in critical care medicine when the orders to execute are conditional on parameters defined by a provider in the ICU regarding the change in symptoms [ 17 ].…”