Assessment of the Nurse Medication Administration Workflow Process

Abstract

This paper presents findings of an observational study of the Registered Nurse (RN) Medication Administration Process (MAP) conducted on two comparable medical units in a large urban tertiary care medical center in Columbia, South Carolina. A total of 305 individual MAP observations were recorded over a 6-week period with an average of 5 MAP observations per RN participant for both clinical units. A key MAP variation was identified in terms of unbundled versus bundled MAP performance. In the unbundled workflow, an RN engages in the MAP by performing only MAP tasks during a care episode. In the bundled workflow, an RN completes medication administration along with other patient care responsibilities during the care episode. Using a discrete-event simulation model, this paper addresses the difference between unbundled and bundled workflow and their effects on simulated redesign interventions.

Figure 1

Screenshot of iMedTracker.

Figure 2

Unbundled MAP workflow.

Figure 3

Bundled MAP workflow.

Figure 4

Average MAP task time (error bars indicate one standard deviation).

Figure 5

Timeline belt: (a) unbundled workflow; (b) bundled workflow.

Figure 6

Graphical user interface of MAP simulation model.

Figure 7

Impact of intervention 1 on average (mean) observation duration in minutes (note: base case and scenario 2 have a mixture of unbundled and bundled observations).

Pseudocode 1

MAP computer simulation model high-level pseudocode.

Algorithm 1

Bundled workflow data input to simulation model.