Abstract
Background Multitasking, defined as performing two or more interventions simultaneously, increases
the cognitive burden of clinicians. This may, in turn, lead to higher risk of medication
and procedural errors. Time motion study (TMS) data for nurses in nursing homes revealed
an extensive amount of multitasking while managing medications. Further investigation
of multitasked nursing interventions will provide a foundation for optimizing medication
management workflows.
Objectives Using a continuous observational TMS method, this study aimed to describe pairs of
multitasked nursing interventions associated with medication management interventions,
including preparing and administering medications, assessing medication effects, instructing
on medications, and documenting medication administration.
Methods An external nurse observer used 57 predefined Omaha System nursing interventions
embedded within TimeCaT (version 3.9), TMS data recording software to collect observation
data in a single nursing home. A total of 120 hours of time-stamped observation data
from nine nurses were downloaded from TimeCaT and analyzed using descriptive and inferential
statistics.
Results The majority (74%) of medication management interventions were multitasked, resulting
in 2,003 pairs of multitasked interventions. Of the 57 Omaha System nursing interventions,
35 were involved in these multitasking pairs. When nurses multitasked, the average
duration of medication preparation was longer (non-multitasked: 81 seconds; multitasked:
162 seconds, p < 0.05), while the average duration of medication administration record documentation
was shorter (non-multitasked: 93 seconds; multitasked: 66 seconds, p < 0.05).
Conclusion The findings reveal the complexity of medication management in nursing homes with
numerous and diverse multitasking pairs. Findings provide a platform for in-depth
study of medication management multitasking in the clinical context, and inform future
efforts to create clinical and informatics solutions to optimize medication management
workflow. This method may be also applied to examine medication management and multitasking
in other clinical settings.
Keywords
time motion study - multitasking - Omaha System - nursing home - workflow
