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      Time spent by hospital personnel on drug changes: A time and motion study from an in-and outpatient hospital setting

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          Abstract

          Introduction

          Medicines used at Danish public hospitals are purchased through tendering. Together with drug shortage, tendering result in drug changes, known to compromise patient safety, increase medicine errors and to be resource demanding for healthcare personnel. Details on actual resources required in the clinic setting to manage drug changes are unknown. The aim of the study is to explore time spend by hospital personnel in a drug change situation when dispensing medicine to in- and outpatients in a hospital setting in the Capital Region of Denmark.

          Method

          A time and motion study, using direct observation combined with time-registration tools, such as eye-tracking, video recording and manual time tracking. Data were obtained from observing nurses and social and health care assistants with dispensing authority while dispensing or extraditing medicine before and after the implementation of drug changes in two clinical setting; a cardiology ward and a rheumatology outpatient clinic.

          Results

          Hospital personnel at the cardiology inpatient ward spent 20.5 seconds on dispensing a drug, which was increased up to 28.4 seconds by drug changes. At the rheumatology outpatient clinic, time to extradite medicine increased from 8 minutes and 6 seconds to 15 minutes and 36 seconds by drug changes due to tender. Similarly, drug changes due to drug shortage prolonged the extradition time to 16 minutes and 54 seconds. Statistical analysis reveal that drug changes impose a significant increase in time to dispense a drug for both in- and outpatients.

          Conclusion

          Clinical hospital personnel spent significantly longer time on drug change situations in the dispensing of medicine to in- and outpatients in a hospitals. This study emphasizes that implementing drug changes do require extra time, thus, the hospital management should encounter this and ensure that additional time is available for the hospital personnel to ensure a safe drug dispensing process.

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          Most cited references26

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          Comparison of Convenience Sampling and Purposive Sampling

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            Time motion studies in healthcare: what are we talking about?

            Time motion studies were first described in the early 20th century in industrial engineering, referring to a quantitative data collection method where an external observer captured detailed data on the duration and movements required to accomplish a specific task, coupled with an analysis focused on improving efficiency. Since then, they have been broadly adopted by biomedical researchers and have become a focus of attention due to the current interest in clinical workflow related factors. However, attempts to aggregate results from these studies have been difficult, resulting from a significant variability in the implementation and reporting of methods. While efforts have been made to standardize the reporting of such data and findings, a lack of common understanding on what "time motion studies" are remains, which not only hinders reviews, but could also partially explain the methodological variability in the domain literature (duration of the observations, number of tasks, multitasking, training rigor and reliability assessments) caused by an attempt to cluster dissimilar sub-techniques. A crucial milestone towards the standardization and validation of time motion studies corresponds to a common understanding, accompanied by a proper recognition of the distinct techniques it encompasses. Towards this goal, we conducted a review of the literature aiming at identifying what is being referred to as "time motion studies". We provide a detailed description of the distinct methods used in articles referenced or classified as "time motion studies", and conclude that currently it is used not only to define the original technique, but also to describe a broad spectrum of studies whose only common factor is the capture and/or analysis of the duration of one or more events. To maintain alignment with the existing broad scope of the term, we propose a disambiguation approach by preserving the expanded conception, while recommending the use of a specific qualifier "continuous observation time motion studies" to refer to variations of the original method (the use of an external observer recording data continuously). In addition, we present a more granular naming for sub-techniques within continuous observation time motion studies, expecting to reduce the methodological variability within each sub-technique and facilitate future results aggregation.
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              Reducing medication errors through naming, labeling, and packaging.

              Errors due to look-alike or sound-alike medication names are common in the United States, and are responsible for thousands of deaths and millions of dollars in cost each year. Up to 25% of all medication errors are attributed to name confusion, and 33% to packaging and/or labeling confusion. Thousands of medication name pairs have been confused based on similar appearances or sounds when written or spoken, or have been identified as having the potential for confusion. Systems and recommendations have been developed that may reduce the occurrence of such errors.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: ResourcesRole: SupervisionRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: SoftwareRole: SupervisionRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: SupervisionRole: VisualizationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                25 February 2021
                2021
                : 16
                : 2
                : e0247499
                Affiliations
                [1 ] Social and Clinical Pharmacy, University of Copenhagen, Copenhagen Ø, Denmark
                [2 ] Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources, Capital Region of Denmark, Herlev Hospital, Herlev, Denmark
                [3 ] Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
                [4 ] Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
                [5 ] Medicines Information Center, The Hospital Pharmacy, Capital Region of Denmark, Copenhagen NV, Denmark
                University of Waterloo, CANADA
                Author notes

                Competing Interests: The PhD project is co-funded by Amgros I/S, Copenhagen, Denmark. However, it is important to emphasize that Amgros had no role in the execution of the study, such as study design, data collection analysis, decision to publish, or preparation of the manuscript. In Denmark the healthcare system is primarily funded by taxes. Public hospitals purchase medicines through tendering and procurement which is a national task carried out by Amgros. Amgros I/S is a noncommercial company owned by the five Danish Regions. On behalf of the Regions, Amgros secures patients access to new and effective treatments and devices, just as a high level of security of supply is ensured and drug relates costs are restrained. The tendering and procurement of medicine takes place in close collaboration with hospital pharmacies, drug committees, the Danish Medicines Council, suppliers and heads of procurement in the Regions. This task would otherwise be maintained independently by the five regions. Therefore, Amgros plays a central role in ensuring supply of medicine and supporting patient safe drug changes in public hospitals, but has no economic interest in the present study. With this competing interest statement, I, Joo Hanne Poulsen, confirm that the co-funding from Amgros I/S to the PhD project, does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                https://orcid.org/0000-0001-5194-9978
                Article
                PONE-D-20-21353
                10.1371/journal.pone.0247499
                7906352
                33630933
                b765fa7c-ce11-4584-ab6c-9d4fd5c30a63
                © 2021 Poulsen et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 10 July 2020
                : 8 February 2021
                Page count
                Figures: 2, Tables: 4, Pages: 16
                Funding
                Funded by: Laerdal Foundation (Stavanger, Norway)
                Award Recipient :
                Funded by: Amgros I/S, Copenhagen Academy for Medical Education and Simulation (CAMES)
                Award Recipient :
                Funded by: The Hospital Pharmacy in the Capital Region of Denmark
                Award Recipient :
                Funded by: University of Copenhagen
                Award Recipient :
                JHP is doing a co-financed PhD study funded by Amgros I/S, Copenhagen Academy for Medical Education and Simulation (CAMES), The Hospital Pharmacy in the Capital Region of Denmark and the University of Copenhagen. Peter Dieckmann holds a professorship at the University of Stavanger that is funded by an unconditional grant of the Laerdal Foundation (Stavanger, Norway) to the University of Stavanger. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Cardiology
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Nurses
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Nurses
                Medicine and Health Sciences
                Rheumatology
                Medicine and Health Sciences
                Health Care
                Health Care Facilities
                Outpatient Clinics
                Medicine and Health Sciences
                Health Care
                Patients
                Outpatients
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Allied Health Care Professionals
                Medicine and Health Sciences
                Health Care
                Patients
                Inpatients
                Social Sciences
                Economics
                Economic Analysis
                Economic Impact Analysis
                Custom metadata
                All relevant data are within the manuscript and its Supporting Information files.

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