Impact of IPMOE on nursing tasks in the medical ward: A time-motion study

Abstract

Introduction The In-patient Medication Order Entry System (IPMOE) was first implemented in the medical ward of Princess Margaret Hospital, Hong Kong. It was a local developed close-loop system including prescription, dispensing and administration modules. Evaluation on its impact on nursing tasks would be important for practice improvement and subsequent system enhancement. Objective The study was conducted to quantify the nursing times across medication-associated tasks for paper-based MAR and computer-based IPMOE, including change in the tasks and time patterns before and after IPMOE implementation. Methods This was a prospective observation study in medical wards before (Jan 2014–Jun 2014) and after (Mar 2015–Jun 2015) the implementation of IPMOE. We conducted 8-hr observation studies of individual nurses with a customized application to time various pre-categorized nursing tasks. Statistical inferences and interrupted time series analysis was performed to identify the change in the intercept and trends over time after implementation. Result The average number of medication-related tasks was significantly reduced from 61.07 to 29.81, a reduction of 31.26 episodes per duty ( P < 0.001, 95% CI 22.9–39.63). The time for the medication-related tasks was reduced from 32 min (SD = 21.57) to 26.57 min (SD = 11.35) and the medication administration time increased from 37.93 min (SD = 14.78) to 44.37 min (SD = 19.45), but there was no overall significant difference in the time spent on each duty ( P = 0.315) between the two groups. An improving trend in the delayed effect was observed ( P = 0.03), which indicated a run-in period for new application was needed in clinical setting. Conclusion Our study had shown the time motion observation could be applied to measure the impact of the IPMOE in a busy clinical setting. Through classification of activities, validation, objective measurement and longitudinal evaluation, the method could be applied in various systems as well as different clinical settings in measure efficiency.

A Systematic Review of Quantitative Methods for Evaluating Electronic Medication Administration Record and Bar-Coded Medication Administration Usability

“…One observation study out of eight measuring efficiency (12.5%) found that the average number of medication tasks reduced by 51.2% after eMAR implementation. 47…”

“…25 Two studies did not find a significant time difference using eMAR versus paper MAR. 47,48 Two articles reported a 27.4 and 42.0% respective increase in medication administration time after eMAR implementation. 36,45 One study found nursing time on medication tasks outside of drug rounds increased by 36.1% after MAT implementation.…”

Methods used to examine technology in relation to the quality of nursing work in acute care: A systematic integrative review

“…The direct observation method was used to examine a range of technologies in relation to nursing work; a persistent theme was examination of how nurses spent their time. Most common was examination of EMM or physician ordering systems (Ampt & Westbrook, ; Asaro & Boxerman, ; Dwibedi et al, , ; Leung, Chan, Wong, & Law, ; Poon et al, ; Reed et al, ; Westbrook et al, ; Yen et al, ). Next most common was examination of nurses' clinical documentation (Ballermann, Shaw, Arbeau, Mayes, & Noel Gibney, ; Banner & Olney, ; Hurst, ; Ravat et al, ; Schachner et al, ; Wong et al, ) and EMR (Chung et al, ; Hakes & Whittington, ; Korst, Eusebio‐Angeja, Chamorro, Aydin, & Gregory, ; Read‐Brown et al, ; Roumeliotis et al, ).…”

“…Speed and accuracy are critical to capture frequent short events in a reliable way. One solution was to focus data collection on a single nursing activity related to the technology, for example medication administration was a common focus (Ampt & Westbrook, ; Ballermann et al, ; Cornell et al, , ; Dwibedi et al, , ; Leung et al, ; Reed et al, ; Westbrook et al, ). But the data show this single nursing care activity can involve going to multiple locations, obtaining many types of supplies and information, and communicating with patients, their companions and other clinicians.…”

The Effectiveness of Electronic Medication Administration Record: A Systematic Review

“…The implementation of electronic medication administration records reduced treatment time. The research stated that IPMOE significantly reduced nursing time from 61.7 to 29.81 28 . The implementation of eMAR had an effect on improving patients' care and efficacy 6 .…”