Copyright @ Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. JONA Volume 38, Number 1, pp 19-26 Copyright B 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins THE JOURNAL OF NURSING ADMINISTRATION Quantifying Nursing Workflow in Medication Administration Carol A. Keohane, BSN, RN Anne D. Bane, MSN, RN Erica Featherstone, BS Judy Hayes, MSN, RN Seth Woolf, BS Ann Hurley, DNSc, RN David W. Bates, MD, MSc Tejal K. Gandhi, MD, MPH Eric G. Poon, MD, MPH New medication administration systems are showing promise in improving patient safety at the point of care, but adoption of these systems requires signifi- cant changes in nursing workflow. To prepare for these changes, the authors report on a time-motion study that measured the proportion of time that nurses spend on various patient care activities, focusing on medication administrationYrelated activities. Implications of their findings are discussed. Technology is increasingly being used at the patient bedside to improve patient safety and streamline clinicians’ work. A thorough understanding of the scope of nurses’ workflow in the inpatient environ- ment is critical to the successful integration of any bedside technology. Although bedside technology such as bar coding has the potential to improve medication safety, 1 it may also have a major effect on nursing workflow. For example, if bar code technology causes nurses to take longer to administer medications, this could divert nurses from other important patient care activities, which may have a similar effect to decreasing nursing staffing ratios and lead to poorer patient outcomes. 2 In addition, the lack of sufficient time to administer medications might encourage nurses to bypass the bar code scanning step and greatly diminish the intended impact of this technology on patient safety. In fact, during the planning stages of developing our hospi- tal’s bar code/electronic medication administration record (bar code/eMAR) system, nurses voiced their concern about increasing the time spent on adminis- tering medications and decreasing time with patients. Objective data were needed about the relative amounts of time spent on the many tasks that nurses are required to complete. Therefore, we decided to perform a baseline assessment of nursing workflow to inform the development of our eMAR system. The distribution of time over various nurse ac- tivities can be studied through work sampling, con- tinuous self-reporting, or continuous time-motion observation. Work sampling involves the intermit- tent recording of nursing activities by an independent observer. Work sampling records each activity but does not capture the time spent performing the activity. Work sampling methodology is based on the laws of probability, meaning that observations taken at repeated, random times will have the same distribution. Urden and Roode 3 used work sampling methodology to determine the amount of time that JONA  Vol. 38, No. 1  January 2008 19 Authors’ Affiliations: Program Director (Ms Keohane), Divi- sion of General Internal Medicine, Brigham and Women’s Hospital, Boston; Manager of Clinical Systems Innovations (Ms Bane), Center for Nursing Excellence, Brigham and Women’s Hospital, Boston; Research Assistant (Ms Featherstone), Division of General Internal Medicine, Brigham and Women’s Hospital, Boston; Chief Nursing Officer (Ms Hayes), Nursing, Faulkner Hospital, West Roxbury; Research Assistant (Mr Woolf), Division of General Internal Medicine, Brigham and Women’s Hospital, Boston; Center for Nursing Excellence Senior Nurse Scientist, Emerita (Ms Hurley), Brigham and Women’s Hospital, Boston; Chief (Dr Bates), Division of General Internal Medicine, Brigham and Women’s Hospital, Boston; Director of Patient Safety (Dr Gandhi), Division of General Internal Medicine, Brigham and Women’s Hospital, Boston; Assistant Professor of Medicine/ Physician Scientist (Dr Poon), Division of General Internal Medi- cine, Brigham and Women’s Hospital, Boston, Massachusetts. Corresponding author: Ms Keohane, Division of General Medicine and Primary Care, Brigham and Women’s Hospital, 3/F, 1620 Tremont St, Boston, MA 02120 (ckeohane@partners.org). This work was supported by a grant from the Agency for Healthcare Research and Quality (no. HS14053-02).