Impact of an electronic medication management system on hospital doctors' and nurses' work: a controlled pre–post, time and motion study

Abstract

ObjectiveTo quantify and compare the time doctors and nurses spent on direct patient care, medication-related tasks, and interactions before and after electronic medication management system (eMMS) introduction.MethodsControlled pre–post, time and motion study of 129 doctors and nurses for 633.2 h on four wards in a 400-bed hospital in Sydney, Australia. We measured changes in proportions of time on tasks and interactions by period, intervention/control group, and profession.ResultseMMS was associated with no significant change in proportions of time spent on direct care or medication-related tasks relative to control wards. In the post-period control ward, doctors spent 19.7% (2 h/10 h shift) of their time on direct care and 7.4% (44.4 min/10 h shift) on medication tasks, compared to intervention ward doctors (25.7% (2.6 h/shift; p=0.08) and 8.5% (51 min/shift; p=0.40), respectively). Control ward nurses in the post-period spent 22.1% (1.9 h/8.5 h shift) of their time on direct care and 23.7% on medication tasks compared to intervention ward nurses (26.1% (2.2 h/shift; p=0.23) and 22.6% (1.9 h/shift; p=0.28), respectively). We found intervention ward doctors spent less time alone (p=0.0003) and more time with other doctors (p=0.003) and patients (p=0.009). Nurses on the intervention wards spent less time with doctors following eMMS introduction (p=0.0001).ConclusionseMMS introduction did not result in redistribution of time away from direct care or towards medication tasks. Work patterns observed on these intervention wards were associated with previously reported significant reductions in prescribing error rates relative to the control wards.

The effect of electronic prescribing and medication administration on nurses’ workflow and activities: an uncontrolled before and after study

“…Our focus on scheduled drug rounds, rather than the entire working day, limits comparison with some previous studies [12]. Our findings also differ to a previous study that reported a reduction in drug administration round duration [3].…”

“…Within the UK, Barber et al [9] explored nurses' attitudes towards ePMA implementation, noting reluctance before implementation which changed to acceptance afterwards. Other international studies [10][11][12][13] suggest that ePMA may have a negative effect on communication between nurses and doctors [10] and impede work patterns [11]. Little is known about the effect on nurses' work during drug rounds.…”

“…Little is known about the effect on nurses' work during drug rounds. An Australian study suggests that nurses spent an increased proportion of time reviewing medication following introduction of ePMA, but this was offset by a decrease in nearly all other medication related tasks [12]. There is no consensus of the effects of ePMA on nurses' workflow [14]; it has also been suggested that any effects seen on work practices may be due to individual nurses' behaviour [15].…”

Impact of Computerized Provider Order Entry Systems on hospital staff pharmacist workflow productivity: A three site comparative analysis based on level of CPOE implementation

“…This trend raises questions if the amount of time pharmacists spend doing clinical activities could decrease with the depth of CPOE implementation. A similar time-and-motion study was published by Westbrook et al [24] in 2013 that measured how introduction of an electronic medication management system (eMMS) affected the amount of time doctors and nurses spent on direct patient care and medication tasks, and it was concluded that the introduction of eMMS did not redistribute time spent on medication tasks or direct patient care.…”

An Examination of the Mediating Role for a Nursing Information System

“…Moderate ease of use (Weinhara et al, 2009;Whittaker et al, 2009). Observed increased time spent on direct patient care and nursing documentation, and decreased time spent on administrative tasks (Banner & Olney, 2009) in contrast to no significant change in time spent on patient care (Westbrook et al, 2013).…”