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Exploring Inpatient Medication Patterns

A Big Data and Multilevel Approach

Loresto, Figaro L. Jr, PhD, RN; Welton, John, PhD, RN; Grim, Stephanie, MS; Valdez, Carolyn, MS; Eron, Kathryn, BA

JONA: The Journal of Nursing Administration: June 2019 - Volume 49 - Issue 6 - p 336–342
doi: 10.1097/NNA.0000000000000762

PURPOSE Exploratory study to examine inpatient medication administration patterns.

METHODS Data from multiple sources were utilized for this study. The outcome was time difference between medication schedule and administration. A 3-level hierarchical linear regression approach, both unadjusted and adjusted, was considered for this study where medication administration events are nested within patients nested within nurses or units. Intraclass correlation coefficients (ICCs) were calculated and compared.

RESULTS On average, medications were delayed by 12 (SD, 48.8) minutes. From the full model, patient ICCs decreased when “unit” replaced “nurse” as the 3rd level (0.541 vs 0.444). Patients who spoke Spanish had a significant 2.3- to 4.2-minute delay in medication administration. Certified nurses significantly give medications earlier compared with noncertified nurses by 1.6 minutes.

DISCUSSION Optimal medication administration is a multifactorial concern with nurses playing a role. Nursing leaders should also consider patient demographics and unit conditions, such as culture, for medication administration optimization.

Author Affiliations: Nurse Quality Research Specialist (Dr Loresto), Denver Health and Hospital Authority, Colorado; Professor (Dr Welton), University of Colorado College of Nursing; and Senior Data Reporting Analyst (Ms Grim), Children's Hospital Colorado, Aurora; and Biostatistician (Ms Valdez) and Research Assistant (Ms Eron), Denver Health and Hospital Authority, Colorado.

The authors declare no conflicts of interest.

Correspondence: Dr Loresto, Denver Health and Hospital Authority, 777 Bannock St, Denver, CO 80204 (

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