medication_administration_process_IMG_2052 Ethnoworks conducted an ethnographic study of medication delivery practices for a major chain of hospitals to gain a deeper understanding of the experiences and perspectives of nurses as they interact with changes in medication administration processes. A secondary goal was to identify possible solutions and opportunities for enhanced 1) staff satisfaction; 2) quality of care and safety; and 3) efficiency. Key findings from the study fell into five major areas:

•  Efficiency and safety. Nurses generally perceive on-unit RxStations as more efficient and safe than former medication administration systems due to the ways in which the system assigns medications and tasks to patients, as well as how it controls retrieval via individual bins.

•  Trust in technology and work-style confidence. Nurse perceptions of increased efficiency and safety result in a greater sense of trust in the medications administration process, thereby bolstering nurse confidence and allowing them to better concentrate on the rhythm of their workflow.

•  Perceptions of time. Nurses and pharmacy staff hold different perceptions of time, with nurses understanding time in the context of seconds and immediate response to patient needs, and pharmacy understanding time in terms of hourly increments.

•  Concerns about exceptions. Although the on-unit RxStation is perceived as more efficient and safe overall, exceptions to standard medications administration processes have the tendency to trigger longer delays in medication administration, since system overrides and workarounds are rendered more complex.

•  Impact of interruptions Interruptions have the capacity to ‘snowball’ on nurses in a series of layered runaway interruptions that build and distract from nurse personal rhythms and workflows.