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Turcato G, Zaboli A, Brigo F, Parodi M, Fulghesu F, Bertorelle L, Sibilio S, Mian M, Ferretto P, Milazzo D, Trentin M, Marchetti M. Is the National Early Warning Score able to identify nursing activity load? A prospective observational study. Int J Nurs Stud 2024; 154:104749. [PMID: 38522185 DOI: 10.1016/j.ijnurstu.2024.104749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/26/2024] [Accepted: 03/02/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND The National Early Warning Score scale correlates well with the intensity of the patient's acute condition. It could also correlate with the nursing activity load and prove useful in defining and redistributing nursing resources based on the acuity of patients. AIM To assess whether patients' National Early Warning Score at hospital admission correlates with objective nursing demands and can be used to optimize the distribution of available care resources. METHODS This single-center prospective study included patients admitted to the Department of Internal Medicine at the Civil Hospital in Altovicentino (Italy) between September 1 and December 31, 2022. Nursing activities were recorded for the first three days after admission and standardized to the daily mean as performance/5 min/patient/day. Linear regression was used to assess the correlation between nursing demands for different National Early Warning Scores. RESULTS This study included 333 patients. Their mean National Early Warning Score was 3.9 (standard deviation: 2.9), with 61 % (203/333) in the National Early Warning Score <5 category, 19.5 % (65/333) in the National Early Warning Score 5-6 category, and 19.5 % (65/333) in the National Early Warning Score >6 category. Their average daily care requirements increased from 22 (16-30) activities/5 min/patient/day in the low National Early Warning Score category to 30 (20-39) activities/5 min/patient/day in the intermediate National Early Warning Score category (p < 0.001) and 35 (23-45) activities/5 min/patient/day in the high National Early Warning Score category (p < 0.001). CONCLUSION The National Early Warning Score correlates with nursing care activities for patients with an acute condition and can be used to optimize the distribution of available care resources.
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Affiliation(s)
- Gianni Turcato
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Arian Zaboli
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy.
| | - Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Marta Parodi
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Francesca Fulghesu
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Lidia Bertorelle
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Serena Sibilio
- Universitat Basel Department Public Health, Institute of Nursing Science, Basel, BS, Switzerland
| | - Michael Mian
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy; College of Health Care-Professions Claudiana, Bozen, Italy
| | - Paolo Ferretto
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Daniela Milazzo
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Monica Trentin
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Massimo Marchetti
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
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Ross P, Howard B, Ilic D, Watterson J, Hodgson CL. Nursing workload and patient-focused outcomes in intensive care: A systematic review. Nurs Health Sci 2023; 25:497-515. [PMID: 37784243 DOI: 10.1111/nhs.13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 10/04/2023]
Abstract
The aim of this systematic review was to examine the association of nursing workload on patient outcomes in intensive care units. The primary outcome measure was patient mortality, with adverse events (AE), the secondary outcome measures. Electronic search of databases including MEDLINE, CINAHL, Cochrane, EMCARE, Scopus, and Web of Science were performed. Studies were excluded if they were in non-ICU settings, pediatric, neonatal populations, or if the abstract/full text was unavailable. Risk of bias was assessed by the ROBINS-I tool. After screening 4129 articles, 32 studies were identified as meeting inclusion criteria. The majority of included studies were assessed as having a moderate risk of bias. The nursing activities score (NAS) was the most frequently used tool to assess nursing workload. Our systematic review identified that higher nursing workload was associated with patient-focused outcomes, including increased mortality and AE in the intensive care setting. The varied approaches of measuring and reporting nursing workload make it difficult to translate the findings of the impact of nursing workload on patient outcomes in intensive care settings.
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Affiliation(s)
- Paul Ross
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bethany Howard
- Medical Education Research & Quality (MERQ), School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dragan Ilic
- Medical Education Research & Quality (MERQ), School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jason Watterson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, Victoria, Australia
| | - Carol L Hodgson
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Assessment of Clinical Reasoning While Attending Critical Care Postsimulation Reflective Learning Conversation: A Scoping Review. Dimens Crit Care Nurs 2023; 42:63-82. [PMID: 36720031 DOI: 10.1097/dcc.0000000000000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The critical care environment is characterized with a high level of workload, complexity, and risk of committing practice mistakes. To avoid clinical errors, health care professionals should be competent with effective clinical reasoning skills. To develop effective clinical reasoning skills, health care professionals should get the chance to practice and be exposed to different patient experiences. To minimize safety risks to patients and health care professionals, clinical reasoning with a focus on reflective learning conversation opportunities can be practiced in simulated settings. OBJECTIVES To explore the most valid and reliable tools to assess clinical reasoning while attending adult critical care-related simulation-based courses in which reflective learning conversations are used. METHODS A scoping review was conducted following Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews. Eight electronic databases were searched, and full-text review was completed for 26 articles. RESULTS The search resulted in no studies conducted to measure clinical reasoning while attending adult critical care-related, simulation-based courses in which the reflective learning conversation method was embedded. DISCUSSION This highlights the need to evaluate current available clinical reasoning tools or develop new tools within the context of adult critical care simulation where reflective learning forms a key part of the simulation procedures.
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Haruna J, Masuda Y, Tatsumi H, Sonoda T. Nursing Activities Score at Discharge from the Intensive Care Unit Is Associated with Unplanned Readmission to the Intensive Care Unit. J Clin Med 2022; 11:jcm11175203. [PMID: 36079134 PMCID: PMC9457354 DOI: 10.3390/jcm11175203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
This study evaluated the accuracy of predicting unplanned the intensive care unit (ICU) readmission using the Nursing Activities Score (NAS) at ICU discharge based on nursing workloads, and compared it to the accuracy of the prediction made using the Stability and Workload Index for Transfer (SWIFT) score. Patients admitted to the ICU of Sapporo Medical University Hospital between April 2014 and December 2017 were included, and unplanned ICU readmissions were retrospectively evaluated using the SWIFT score and the NAS. Patient characteristics, such as age, sex, the Charlson Comorbidity Index, and sequential organ failure assessment score at ICU admission, were used as covariates, and logistic regression analysis was performed to calculate the odds ratios for the SWIFT score and NAS. Among 599 patients, 58 (9.7%) were unexpectedly readmitted to the ICU. The area under the receiver operating characteristic curve of NAS (0.78) was higher than that of the SWIFT score (0.68), and cutoff values were 21 for the SWIFT and 53 for the NAS. Multivariate analysis showed that the NAS was an independent predictor of unplanned ICU readmission. The NAS was superior to the SWIFT in predicting unplanned ICU readmission. NAS may be an adjunctive tool to predict unplanned ICU readmission.
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Affiliation(s)
- Junpei Haruna
- Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
- Correspondence:
| | - Yoshiki Masuda
- Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Hiroomi Tatsumi
- Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Tomoko Sonoda
- Department of Nursing, Tensei University, Sapporo 065-0013, Japan
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Assis SFD, Vieira DFVB, Sousa FREGD, Pinheiro CEDO, Prado PRD. Eventos adversos em pacientes de terapia intensiva: estudo transversal. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2021-0481pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: identificar a prevalência de eventos adversos e a necessidade de cuidado do paciente crítico em uma unidade de terapia intensiva. Método: estudo transversal, realizado de janeiro a março de 2020. Os eventos adversos investigados foram: lesão por pressão, extubação orotraqueal acidental, queda, perda de acesso venoso central e infecção relacionada à assistência à saúde. O número de horas necessárias para o cuidado do paciente foi mensurado pela Nursing Activities Score. As variáveis independentes categóricas foram descritas por frequências absoluta e relativa, e as contínuas, por tendência central. A medida de magnitude foi a razão de chance e considerou-se intervalo de confiança de 95%. Resultados: dos 88 pacientes avaliados, 52,3% apresentaram eventos adversos, os quais foram associados à maior necessidade de cuidados, gravidade e ao maior tempo de internação. O Nursing Activities Score médio foi 51,01% (12 h 24 min), sendo identificado um déficit de 20% a 30% de pessoal de enfermagem na unidade. Conclusão: a prevalência dos eventos adversos na unidade é alta e o déficit de pessoal de enfermagem na unidade revelou a necessidade de dimensionamento adequado de pessoal para reduzir os danos ocasionados pelos cuidados prestados aos pacientes críticos.
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Assis SFD, Vieira DFVB, Sousa FREGD, Pinheiro CEDO, Prado PRD. Adverse events in critically ill patients: a cross-sectional study. Rev Esc Enferm USP 2022; 56:e20210481. [PMID: 35551577 PMCID: PMC10111387 DOI: 10.1590/1980-220x-reeusp-2021-0481en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/20/2022] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To identify the prevalence of adverse events and the critically ill patient’s need for care in an intensive care unit. Method: This is a cross-sectional study, carried out from January to March 2020. The adverse events investigated were pressure injury, accidental orotracheal extubation, fall, loss of central venous access, and healthcare-associated infection. The number of hours required for patient care was measured by the Nursing Activities Score. The categorical independent variables were described by absolute and relative frequencies, and the continuous ones, by central tendency. The magnitude measure was the odds ratio and a confidence interval of 95% was considered. Results: of the 88 patients evaluated, 52.3% had adverse events, which were associated with a greater need for care, severity, and longer hospital stay. The mean Nursing Activities Score was 51.01% (12 h 24 min), with a deficit of 20% to 30% of nursing staff in the unit being identified. Conclusion: The prevalence of adverse events in the unit is high and the shortage of nursing staff in the unit revealed the need for adequate staffing to reduce the damage caused by the care provided to critically ill patients.
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Silveira RRPD, Serafim CTR, Castro MCNE, Rodrigues GM, Corrente JE, Lima SAM. Nursing workload associated with neonatal mortality risk: a cross-sectional study. Rev Bras Enferm 2022; 75:e20200965. [DOI: 10.1590/0034-7167-2020-0965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 06/24/2022] [Indexed: 11/05/2022] Open
Abstract
ABSTRACT Objectives: to analyze the association between nursing workload and neonatal mortality risk in newborns admitted to the Neonatal Intensive Care Unit. Methods: this is an observational, cross-sectional study conducted from January 2019 to January 2020. Results: the sample consisted of 399 newborns, 55.4% male, Nursing Activities Score mean of 67.5%, and Score for Neonatal Acute Physiology Perinatal Extension mean of 17.7, revealed itself as a predictor of the risk of death, while gestational age, length of hospitalization, and the first-minute Apgar established a protective relationship. The correlation between workload and neonatal mortality was low (r= 0.23, p=0.0009). Conclusions: the workload of the nursing team is not associated with the risk of mortality in the Neonatal Intensive Care Unit, as measured by the Nursing Activities Score.
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Hayes GM, Bersenas AM, Mathews K, Lane WG, LaLonde-Paul DF, Steele A, Avellaneda A. A multicenter observational study investigating care errors, staffing levels, and workload in small animal intensive care units. J Vet Emerg Crit Care (San Antonio) 2020; 30:517-524. [PMID: 32918379 DOI: 10.1111/vec.12991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To investigate associations among care errors, staffing, and workload in small animal ICUs. DESIGN Multicenter observational cohort study conducted between January 2017 and September 2018. SETTING Three small animal teaching hospital ICUs. ANIMALS None. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data on patient numbers, illness severity (assesed via the acute patient physiologic and laboratory evaluation [APPLE] score), care burden, staffing levels, technician experience/education level, and care errors were collected at each study site. Care errors were categorized as major (unanticipated arrest or death; patient endangerment through IV line, arterial catheter, chest tube or other invasive device mismanagement, or errors in drug calculation/administration) or minor. Median patient:technician ratio was 4.3 (range: 1-18). Median patient illness severity was 15.1 (4.7-27.1) APPLE score units. A total of 221 major and 3,317 minor errors were observed over the study period. The odds of a major error increased by an average of 11% (odds ratio [OR] = 1.11; 95% confidence interval [CI], 1.02-1.20; P = 0.012) for each 1 patient increase in the patient:technician ratio after averaging by ICU location. The major error incident rate ratio was 2.53 (95% CI, 1.84-3.54; P < 0.001) for patient:technician ratios of >4.0 compared with ≤4.0. The odds of a major error increased by 0.5% per total unit APPLE score increase (OR = 1.005; 95% CI, 1.002-1.007; P < 0.001). The major error incident rate ratio was 1.71 (95% CI, 1.30-2.25; P < 0.001) for APPLEfast :technician ratios of >73 compared with ≤73. The odds of a major error decreased by 2% (OR = 0.98; 95% CI, 0.97-0.99; P = 0.01) for each year increase in total technician years of ICU work experience. CONCLUSIONS Substantial reductions in major care errors may be achieved by maintaining ICU patient:technician ratios at ≤4. Technician experience and total unit burden of patient illness severity are also associated with error incidence, and should be taken into consideration when scheduling staff.
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Affiliation(s)
- Galina M Hayes
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Alexa M Bersenas
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Karol Mathews
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - William G Lane
- Department of Emergency and Critical Care, Angell Animal Medical Center, Boston, Massachusetts
| | - Denise F LaLonde-Paul
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Andrea Steele
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Ana Avellaneda
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Camargo MM, Furieri LB, Lima EDFA, Lucena ADF, Fioresi M, Romero WG. Cross mapping between clinical indicators for assistance in intensive care and nursing interventions. Rev Bras Enferm 2020; 73:e20190728. [PMID: 32901752 DOI: 10.1590/0034-7167-2019-0728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/13/2020] [Indexed: 08/30/2023] Open
Abstract
OBJECTIVE Identify the main clinical indicators for assistance in the Intensive Care Unit (ICU) and map them in the nursing interventions described by the Nursing Interventions Classification (NIC). METHODS Integrative literature review study, followed by cross-mapping between clinical indicators for assistance in the ICU care and NIC nursing interventions and activities. RESULTS 36 articles were identified, which resulted in 285 clinical indicators for ICU care, with mechanical ventilatory assistance, pain, sedation, psychomotor agitation, delirium, anxiety, altered heart rate, diet by naso tube / oroenteral and diarrhea the clinical indicators for assistance in the ICU the most prevalent. These were mapped in 12 Nursing Interventions Classification interventions and 130 nursing activities. FINAL CONSIDERATIONS It is concluded that the clinical indicators for ICU care associated with Nursing Interventions Classification are concrete data that assist intensive care nurses in their clinical practice.
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Affiliation(s)
| | | | | | | | - Mirian Fioresi
- Universidade Federal do Espírito Santo. Vitória, Espírito Santo, Brazil
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Fishbein D, Nambiar S, McKenzie K, Mayorga M, Miller K, Tran K, Schubel L, Agor J, Kim T, Capan M. Objective measures of workload in healthcare: a narrative review. Int J Health Care Qual Assur 2020; 33:1-17. [PMID: 31940153 DOI: 10.1108/ijhcqa-12-2018-0288] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Workload is a critical concept in the evaluation of performance and quality in healthcare systems, but its definition relies on the perspective (e.g. individual clinician-level vs unit-level workload) and type of available metrics (e.g. objective vs subjective measures). The purpose of this paper is to provide an overview of objective measures of workload associated with direct care delivery in tertiary healthcare settings, with a focus on measures that can be obtained from electronic records to inform operationalization of workload measurement. DESIGN/METHODOLOGY/APPROACH Relevant papers published between January 2008 and July 2018 were identified through a search in Pubmed and Compendex databases using the Sample, Phenomenon of Interest, Design, Evaluation, Research Type framework. Identified measures were classified into four levels of workload: task, patient, clinician and unit. FINDINGS Of 30 papers reviewed, 9 used task-level metrics, 14 used patient-level metrics, 7 used clinician-level metrics and 20 used unit-level metrics. Key objective measures of workload include: patient turnover (n=9), volume of patients (n=6), acuity (n=6), nurse-to-patient ratios (n=5) and direct care time (n=5). Several methods for operationalization of these metrics into measurement tools were identified. ORIGINALITY/VALUE This review highlights the key objective workload measures available in electronic records that can be utilized to develop an operational approach for quantifying workload. Insights gained from this review can inform the design of processes to track workload and mitigate the effects of increased workload on patient outcomes and clinician performance.
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Affiliation(s)
- Daniela Fishbein
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Siddhartha Nambiar
- Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - Kendall McKenzie
- Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - Maria Mayorga
- Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - Kristen Miller
- National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia, USA
| | - Kevin Tran
- LeBow College of Business, Drexel University, Philadelphia, Pennsylvania, USA
| | - Laura Schubel
- National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia, USA
| | - Joseph Agor
- School of Mechanical, Industrial and Manufacturing Engineering, Oregon State University, Corvallis, Oregon, USA
| | - Tracy Kim
- National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia, USA
| | - Muge Capan
- LeBow College of Business, Drexel University, Philadelphia, Pennsylvania, USA
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Abstract
PURPOSE Exploratory study to examine inpatient medication administration patterns. METHODS Data from multiple sources were utilized for this study. The outcome was time difference between medication schedule and administration. A 3-level hierarchical linear regression approach, both unadjusted and adjusted, was considered for this study where medication administration events are nested within patients nested within nurses or units. Intraclass correlation coefficients (ICCs) were calculated and compared. RESULTS On average, medications were delayed by 12 (SD, 48.8) minutes. From the full model, patient ICCs decreased when "unit" replaced "nurse" as the 3rd level (0.541 vs 0.444). Patients who spoke Spanish had a significant 2.3- to 4.2-minute delay in medication administration. Certified nurses significantly give medications earlier compared with noncertified nurses by 1.6 minutes. DISCUSSION Optimal medication administration is a multifactorial concern with nurses playing a role. Nursing leaders should also consider patient demographics and unit conditions, such as culture, for medication administration optimization.
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