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.