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Aims: To understand the medication administration process in residential aged care homes. Background: Understanding actual processes that nurses follow is critical to guide improvement efforts and to develop robust systems to ensure safety in medication administration. Methods: Seven nurses were observed for 12 morning medication rounds at two units of a residential aged care home in Australia. Observations were guided by an activity theoretical framework. Results: Nurses followed a common work process to administer medication. This process included actions from preparing medication trolley, locating a resident, preparing and administering medication to this person, documenting the administration, to finally checking medication charts to ensure all residents received medication. We identified 15 process deviations that may hinder safe medication administration. Electronic medication administration records appeared to be able to prevent a deviation associated with the paper‐based documentation process. Conclusions: This study elaborated the medication administration process in a residential aged care home and identified process deviations. It suggests a safety checklist that can be used to evaluate nursing practice and improve medication administration process. Implication for Nursing Management: To develop robust systems for medication safety, nursing managers need to understand the actual nursing process, identify process deviations, and investigate the context in which these deviations occur. [ABSTRACT FROM AUTHOR]

Objective. Residential aged care services are challenged by an increasing number of residents and a shortage of nursing staff. Developing strategies to overcome this challenge requires an understanding of nursing staff work patterns. The aim of the present study was to investigate the work processes followed by nursing staff and how nursing time is allocated in a residential aged care home. Methods. An observational time–motion study was conducted at two aged care units for 12 morning shifts. Seven nurses were observed, one per shift. Results. In all, there were 91 h of observation. The results showed that there was a common work process followed by all nurse participants. Medication administration, documentation and verbal communication were the most time-consuming activities and were conducted most frequently. No significant difference between the two units was found in any category of activities. The average duration of most activities was less than 1 min. There was no difference in time utilisation between the endorsed enrolled nurses and the personal carers in providing nursing care. Conclusion. Medication administration, documentation and verbal communication were the major tasks in morning shifts in a residential aged care home. Future research can investigate how verbal communication supports nursing care. [ABSTRACT FROM AUTHOR]

Aims To examine nursing time spent on administration of medications in a residential aged care ( RAC) home, and to determine factors that influence the time to medicate a resident. Background Information on nursing time spent on medication administration is useful for planning and implementation of nursing resources. Methods Nurses were observed over 12 morning medication rounds using a time-motion observational method and field notes, at two high-care units in an Australian RAC home. Results Nurses spent between 2.5 and 4.5 hours in a medication round. Administration of medication averaged 200 seconds per resident. Four factors had significant impact on medication time: number of types of medication, number of tablets taken by a resident, methods used by a nurse to prepare tablets and methods to provide tablets. Conclusion Administration of medication consumed a substantial, though variable amount of time in the RAC home. Nursing managers need to consider the factors that influenced the nursing time required for the administration of medication in their estimation of nursing workload and required resources. Implications for nursing management To ensure safe medication administration for older people, managers should regularly assess the changes in the factors influencing nursing time on the administration of medication when estimating nursing workload and required resources. [ABSTRACT FROM AUTHOR]

Objective. To examine the time, frequency and duration of each direct care activity conducted by personal carers in Australian residential aged care homes. Methods. A time-motion study was conducted to observe 46 personal carers at two high-care houses in two facilities (14 days at Site 1 and 16 days at Site 2). Twenty-three direct care activities were classified into eight categories for analysis. Results. Overall, a personal carer spent approximately 45% of their time on direct care, corresponding to 3.5 h in an 8-h daytime shift. The two sites had similar ratios of personal carers to residents, and each resident received 30 min of direct care. No significant differences between the two sites were found in the time spent on oral communication, personal hygiene and continence activities. Personal carers at Site 1 spent significantly less time on toileting and mobility activities than those at Site 2, but more time on lunch activity. Although oral communication took the longest time (2 h), it occurred concurrently with other activities (e.g. dressing) for 1.5 h. Conclusions. The findings provide information that may assist decision makers in managing the operation of high-care residential aged care facilities, such as planning for task allocation and staffing. [ABSTRACT FROM AUTHOR]

Purposes: This study aimed to compare between electronic medication administration records and paper-based records in the nursing time spent on various activities in a medication round and the medication administration processes followed by nurses in an Australian residential aged care home. It also aimed to identify the benefits and unintended adverse consequences of using the electronic medication administration records.Methods: Time-motion observation, taking of field notes, informal conversation and document review were used to collect data in two units of a residential aged care home. Each unit had one nurse administer medication. Seven nurses were observed over 12 morning shifts. Unit 1 used electronic medication administration records and Unit 2 used paper-based records.Results: No significant difference between the two units was found in the nursing time spent on various activities in a medication round, including documentation, verbal communication, medication administration, infection control and transit. Comparison of the medication administration processes between the electronic and paper-based medication administration records identified a procedural problem which violated the organization's documentation requirement. This problem was documenting before providing medication to a resident when using the paper-based records. It was not observed with the electronic medication administration records. Benefits of introducing the electronic medication administration records included improving nurses' compliance with documentation requirements, freedom from the error of signing twice, reducing the possibility of forgetting to medicate a resident, facilitating nurses to record the time of medication administration to a resident and increasing documentation space. Unintended adverse consequences of introducing the electronic medication administration records included inadequate information about residents, late addition of a new resident's medication profile in the records and nurses' forgetting to medicate a resident due to power outage of the portable device.Conclusions: The electronic medication administration records may not change nursing time spent on various activities in a medication round or substantially alter the medication administration processes, but can generate both benefits and unintended adverse consequences. Future research may investigate whether and how the adverse consequences can be prevented. [ABSTRACT FROM AUTHOR]

The article presents a study on the screening and treatment methods for urinary continence (UC) used by personal care assistants (PCAs), enrolled nurses (ENs) and registered nurses (RNs) in nursing homes in Australia. Topics discussed include the impact of UC on the psychological health, mobility and social life of older people, the use of UC screening and management tools that compose of bladder chart, bowel chart and care programs, and the need for an improved UC assessment tools.

Abstract: Purpose: To determine whether the introduction of an electronic nursing documentation system in a nursing home reduces the proportion of time nursing staff spend on documentation, and to use this information in evaluating the usefulness of the system in improving the work of nursing staff. Methods: An observational work sampling study was conducted in 2009 and 2010, 2months before, and 3, 6 and 12months after the introduction of an electronic nursing documentation system. An observer (ENM) used a work classification tool to record documentation activities being performed using paper and with a computer by nursing staff at particular times for periods of 5days. Results: Three hundred and eighty three (383) activities were recorded before implementation of the electronic system, 472 activities at 3months, 502 at 6months, and 338 at 12months after implementation. There was no significant difference between the proportion of time nursing staff spent on documentation 2months before and 3months after the implementation of the electronic system. Six months after implementation, the proportion of time on documentation increased significantly and after 12months, settled back to original levels that were recorded in the paper-based system. Over half of the proportion of time on documentation at 6 and 12months after implementation was spent on paper documentation tasks. Conclusion: Introduction of an electronic nursing documentation system did not reduce the proportion of time nursing staff spent on documentation. This may in part have been a result of the practice of documenting some information items on paper and others on a computer. To reduce the use of paper documentation or to achieve a paper-free documentation environment in this setting, an in-depth understanding of nursing staff''s information needs, and documentation workflow is necessary. [Copyright &y& Elsevier]

Abstract: Purpose: To date few studies have compared nursing home caregivers’ perceptions about the quality of information and benefits of nursing documentation in paper and electronic formats. With the increased interest in the use of information technology in nursing homes, it is important to obtain information on the benefits of newer approaches to nursing documentation so as to inform investment, organisational and care service decisions in the aged care sector. This study aims to investigate caregivers’ perceptions about the quality of information and benefits of nursing documentation before and after the introduction of an electronic documentation system in a nursing home. Methods: A self-administered questionnaire survey was conducted three months before, and then six, 18 and 31 months after the introduction of an electronic documentation system. Further evidence was obtained through informal discussions with caregivers. Results: Scores for questionnaire responses showed that the benefits of the electronic documentation system were perceived by the caregivers as provision of more accurate, legible and complete information, and reduction of repetition in data entry, with consequential managerial benefits. However, caregivers’ perceptions of relevance and reliability of information, and of their communication and decision-making abilities were perceived to be similar either using an electronic or a paper-based documentation system. Improvement in some perceptions about the quality of information and benefits of nursing documentation was evident in the measurement conducted six months after the introduction of the electronic system, but were not maintained 18 or 31 months later. Conclusions: The electronic documentation system was perceived to perform better than the paper-based system in some aspects, with subsequent benefits to management of aged care services. In other areas, perceptions of additional benefits from the electronic documentation system were not maintained. In a number of attributes, there were similar perceptions on the two types of systems. [Copyright &y& Elsevier]