title: Impact of an electronic medication management system on hospital doctors' and nurses' work: a controlled pre-post, time and motion study.
abstract: OBJECTIVE
  To quantify and compare the time doctors and nurses spent on direct patient care, medication-related tasks, and interactions before and after electronic medication management system (eMMS) introduction.
  
  
  METHODS
  Controlled pre-post, time and motion study of 129 doctors and nurses for 633.2 h on four wards in a 400-bed hospital in Sydney, Australia. We measured changes in proportions of time on tasks and interactions by period, intervention/control group, and profession.
  
  
  RESULTS
  eMMS was associated with no significant change in proportions of time spent on direct care or medication-related tasks relative to control wards. In the post-period control ward, doctors spent 19.7% (2 h/10 h shift) of their time on direct care and 7.4% (44.4 min/10 h shift) on medication tasks, compared to intervention ward doctors (25.7% (2.6 h/shift; p=0.08) and 8.5% (51 min/shift; p=0.40), respectively). Control ward nurses in the post-period spent 22.1% (1.9 h/8.5 h shift) of their time on direct care and 23.7% on medication tasks compared to intervention ward nurses (26.1% (2.2 h/shift; p=0.23) and 22.6% (1.9 h/shift; p=0.28), respectively). We found intervention ward doctors spent less time alone (p=0.0003) and more time with other doctors (p=0.003) and patients (p=0.009). Nurses on the intervention wards spent less time with doctors following eMMS introduction (p=0.0001).
  
  
  CONCLUSIONS
  eMMS introduction did not result in redistribution of time away from direct care or towards medication tasks. Work patterns observed on these intervention wards were associated with previously reported significant reductions in prescribing error rates relative to the control wards.
authors.affiliation: Faculty of Medicine, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia.
authors.forename: Johanna I
authors.initials: JI
authors.lastname: Westbrook
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.forename: Andrew
authors.initials: A
authors.lastname: Georgiou
authors.forename: Richard
authors.initials: R
authors.lastname: Paoloni
authors.forename: John
authors.initials: J
authors.lastname: Cullen
mesh_terms: D055695:Electronic Prescribing; D006801:Humans; D050316:Medical Order Entry Systems; D008505:Medical Staff, Hospital; D008510:Medication Systems, Hospital; D009517:New South Wales; D009741:Nursing Staff, Hospital; D005791:Patient Care / Q000706:statistics & numerical data*; D013997:Time Factors; D013996:Time and Motion Studies
keywords: CPOE; clinical work; communication; e-prescribing; electronic medication administration record; time and motion