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

ABSTRACT: OBJECTIVE: To 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. METHODS: Controlled 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. RESULTS: eMMS 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). CONCLUSIONS: eMMS 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.

SUBMITTER: Westbrook JI

PROVIDER: S-EPMC3822109 | biostudies-literature | 2013 Nov-Dec

REPOSITORIES: biostudies-literature

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

Westbrook Johanna I JI Li Ling L Georgiou Andrew A Paoloni Richard R Cullen John J

Journal of the American Medical Informatics Association : JAMIA 20130528 6

<h4>Objective</h4>To 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.<h4>Methods</h4>Controlled 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.<h ...[more]

PMID: 23715803

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Project description:ObjectiveWith regard to limitation in national budget, the relevant authorities of healthcare and treatment throughout the globe are seeking the use of available resources in a way that no wastage of money or time-which is, of course, convertible to money-is acceptable. This study sought the opinions of hospital doctors and nurses on those activities at work that wasted their time.MethodsA questionnaire designed to identify activities that waste time during hospital care was completed based on the review of previous studies and including hospital wastes items. The authors designed a questionnaire, which was filled out by 209 nurses and 30 doctors in the surgery wards in hospitals affiliated to Shiraz University of Medical Sciences (SUMS). The items for time wasting activities were extracted from previous studies, and the reliability of the questionnaire was more than 0.785 using Cronbach's alpha. The response rate was more than 60%.ResultsThe mean age of the participating nurses and doctors was 30.24 ± 6.85 and 32.77 ± 7.05 years. In all aspects, more time was wasted during the morning and evening shifts in comparison with the night shifts. The activity that was thought to waste time in hospital care the most was paper-based documentation. Preventable wasted time during the shift was 16%-30% in the nurses' view and 18%-34% in the doctors' view. For both nurses and doctors, the highest-rated preventable wasted time was related to time spent waiting in ward for lab data responses, transfer of patients, or delivery of care.ConclusionHospital working environment is complex, and opportunities for improvement of the efficiency of the nurses' and doctors' workload should be analyzed, case by case, in each hospital and work group. Process change (for the decrease in the wasted time for waiting in wards), simple innovative ways (for the decrease in the wasted time for searching the needed equipment), using hospital information system technology for documentation, communication, and the better design of the wards (to decrease the wasted time due to transfer between the ward and restroom) could be helpful for improving efficiency and for a safer and acceptable delivery of care.

Project description:BACKGROUND:Presenteeism is a behavior in which an employee is physically present at work with reduced performance due to illness or other reasons. Hospital doctors and nurses are more inclined to exhibit presenteeism than other professional groups, resulting in diminished staff health, reduced team productivity and potentially higher indirect presenteeism-related medical costs than absenteeism. Robust presenteeism intervention programs and productivity costing studies are available in the manufacturing and business sectors but not the healthcare sector. This systematic review aims to 1) identify instruments measuring presenteeism and its exposures and outcomes; 2) appraise the related workplace theoretical frameworks; and 3) evaluate the association between presenteeism, its exposures and outcomes, and the financial costs of presenteeism as well as interventions designed to alleviate presenteeism amongst hospital doctors and nurses. METHODS:A systematic search was carried out in ten electronic databases from 1998 to 2017 and screened by two reviewers. Quality assessment was carried out using the Critical Appraisal Skills Program (CASP) tool. Publications meeting predefined assessment criteria were selected for data extraction. RESULTS:A total of 275 unique English publications were identified, 38 were selected for quality assessment, and 24 were retained for data extraction. Seventeen publications reported on presenteeism exposures and outcomes, four on financial costing, one on intervention program and two on economic evaluations. Eight (39%) utilized a theoretical framework, where the Job-Demands Resources (JD-R) framework was the most commonly used model. Most assessed work stressors and resources were positively and negatively associated with presenteeism respectively. Contradictory and limited comparability on findings across studies may be attributed to variability of selected scales for measuring both presenteeism and its exposures/outcomes constructs. CONCLUSION:The heterogeneity of published research and limited quality of measurement tools yielded no conclusive evidence on the association of presenteeism with hypothesized exposures, economic costs, or interventions amongst hospital healthcare workers. This review will aid researchers in developing a standardized multi-dimensional presenteeism exposures and productivity instrument to facilitate future cohort studies in search of potential cost-effective work-place intervention targets to reduce healthcare worker presenteeism and maintain a sustainable workforce.

Project description:BackgroundHospitals across Australia are implementing Clinical Information Systems, e.g. Electronic Medication Management Systems (EMMS) at a rapid pace to moderate health services. The benefits of the EMMS depend on the acceptance of the system by the clinicians. The study hospital used a unique patient-centric implementation strategy that was based on the guiding principle of "one patient, one chart" to avoid a patient being on a hybrid medication chart. This paper aims to study the factors facilitating or hindering the adoption of the EMMS as viewed by clinicians and the implementation team.MethodsFour focus groups (FG), one each for (1) doctors, (2) nurses, (3) pharmacists, and (4) implementation team, were conducted. A guide for the FG was based on the Unified Theory of Acceptance and Use of Technology (UTAUT).ResultsA total of 23 unique subthemes were identified and were grouped into five main themes (1) implementation strategy, (2) organisational outcome of EMMS, (3) individual impact of EMMS, (4) IT product, and (5) organisational culture. Clinicians reported improvement in their workflow efficiency post-EMMS implementation. They also reported some challenges in using the EMMS that centered around the area of infrastructure, technical and design issues. Additionally, the implementation team highlighted two crucial factors influencing the success of EMMS implementation, namely: (1) the patient-centric implementation strategy, and (2) the organisation readiness.ConclusionOverall, this study outlines the implementation process of the EMMS in a large healthcare facility from the clinicians' and the implementation team's perspectives using UTAUT model. The result suggests that clinicians' acceptance of the EMMS was highly influenced by the unique implementation strategy (namely, patient-centric approach and clinical leadership in the implementation team). Whereas the level of adoption of EMMS by clinicians was determined by their level of perceived and realised benefits. On the other hand, a number of barriers to the adoption of EMMS were discovered, namely, general training instead of customised training based on local needs, technical and design issues and lack of availability of computer systems. It is suggested that promptly resolving these issues can improve the adoption of the EMMS.

Project description:ObjectivesThe use of rapid point-of-care tests (POCTs) has been advocated for improving patient management and outcomes and for optimising antibiotic prescribing. However, few studies have explored healthcare workers' views about their use in febrile children. The aim of this study was to explore the perceptions of hospital-based doctors and nurses regarding the use of POCTs in England.Study designQualitative in-depth interviews with purposively selected hospital doctors and nurses. Data were analysed thematically.SettingTwo university teaching hospitals in London and Newcastle.Participants24 participants (paediatricians, emergency department doctors, trainee paediatricians and nurses).ResultsThere were diverse views about the use of POCTs in febrile children. The reported advantages included their ease of use and the rapid availability of results. They were seen to contribute to faster clinical decision-making; the targeting of antibiotic use; improvements in patient care, flow and monitoring; cohorting (ie, the physical clustering of hospitalised patients with the same infection to limit spread) and enhancing communication with parents. These advantages were less evident when the turnaround for results of laboratory tests was 1-2 hours. Factors such as clinical experience and specialty, as well as the availability of guidelines recommending POCT use, were also perceived as influential. However, in addition to their perceived inaccuracy, participants were concerned about POCTs not resolving diagnostic uncertainty or altering clinical management, leading to a commonly expressed preference for relying on clinical skills rather than test results solely.ConclusionIn this study conducted at two university teaching hospitals in England, participants expressed mixed opinions about the utility of current POCTs in the management of febrile children. Understanding the current clinical decision-making process and the specific needs and preferences of clinicians in different settings will be critical in ensuring the optimal design and deployment of current and future tests.

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

Publications

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

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