Nursing time devoted to medication administration in long-term care: clinical, safety, and resource implications.

OBJECTIVES

To quantify the time required for nurses to complete the medication administration process in long-term care (LTC).

DESIGN

Time-motion methods were used to time all steps in the medication administration process.

SETTING

LTC units that differed according to case mix (physical support, behavioral care, dementia care, and continuing care) in a single facility in Ontario, Canada.

PARTICIPANTS

Regular and temporary nurses who agreed to be observed.

MEASUREMENTS

Seven predefined steps, interruptions, and total time required for the medication administration process were timed using a personal digital assistant.

RESULTS

One hundred forty-one medication rounds were observed. Total time estimates were standardized to 20 beds to facilitate comparisons. For a single medication administration process, the average total time was 62.0+/-4.9 minutes per 20 residents on physical support units, 84.0+/-4.5 minutes per 20 residents on behavioral care units, and 70.0+/-4.9 minutes per 20 residents on dementia care units. Regular nurses took an average of 68.0+/-4.9 minutes per 20 residents to complete the medication administration process, and temporary nurses took an average of 90.0+/-5.4 minutes per 20 residents. On continuing care units, which are organized differently because of the greater severity of residents' needs, the medication administration process took 9.6+/-3.2 minutes per resident. Interruptions occurred in 79% of observations and accounted for 11.5% of the medication administration process.

CONCLUSION

Time requirements for the medication administration process are substantial in LTC and are compounded when nurses are unfamiliar with residents. Interruptions are a major problem, potentially affecting the efficiency, quality, and safety of this process.