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Medication Management in Municipality-Based Healthcare: A Time and Motion Study of Nurses

Holmqvist, Malin, MScPharm; Ekstedt, Mirjam, PhD; Walter, Scott R., PhD; Lehnbom, Elin C., PhD

doi: 10.1097/NHH.0000000000000671

The objective of this observational time and motion study was to increase our understanding of how nurses in home healthcare currently distribute their work time with a focus on the medication management process. The research was conducted in four municipalities in the southern part of Sweden. Participants were nurses working in home healthcare. The study measured proportion of time, comparison of proportions of time, proportion of time spent multitasking, and rate of interruptions per hour. Of total observed time, 20.4% was spent on medication management and of these tasks the highest proportion of time was spent on communications and dispensing medications. Nurses in nursing homes spent more time (23.0% vs. 17.4%, p = 0.001) on medication management than nurses in private homes. Nurses spent 47.9% of their time completing tasks with someone else, including patients, but had minimal interaction with prescribers. We observed a rate of 1.2 (95% CI 1.1-1.4) interruptions per hour on average and 30% of all interruptions occurred during medication management tasks. Nurses spent 3.7% of their time multitasking. Interruptions while performing medication-related tasks were common, as well as multitasking. Causes and consequences of the results need to be addressed in order to improve the safety of medication management for patients receiving municipality-based home care.

Malin Holmqvist, MScPharm, is a Clinical Pharmacist, County Council of Jonkoping, Sweden.

Mirjam Ekstedt, PhD, is a Professor, School of Health and Caring Sciences, Linnaeus University, Kalmar Sweden, and Researcher, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.

Scott R. Walter, PhD, is a Research Fellow in Applied Biostatistics, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.

Elin C. Lehnbom, PhD, is an Associate Professor, Department of Pharmacy, Faculty of Health Science, UiT The Arctic University of Norway, Tromsø, Norway, and Researcher, School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.

The authors want to thank pharmacists Maria Hermodsson and Berit Carlsson for the help in data collection. We also want to thank researchers Katja Hakkarainen and May Wismén and the project manager Sara Wulff for input in the study design.

The authors declare no conflicts of interest.

Address for correspondence: Malin Holmqvist, MScPharm, Clinical pharmacy, County hospital Ryhov (House E3 leval 5), 551 85 Jonkoping, Sweden (

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