Medication Administration Time Research Articles

Evaluating the Impact of Electronic Prescribing on Medication Administration

Aims: With the introduction of electronic prescribing (EP) to an older adult inpatient psychiatric ward after many years of paper charts, it was anticipated that unfamiliarity with the system would disrupt medication administration. This study sought to quantify that. The measure of disruption was defined as the deviation between the time of prescribed administration and the time medication was actually given.Methods: A sample of ten patients was analysed across four dates. The first day of using EP was explored, followed by the final weekday of this week. The remaining dates were at week three and five of use. Data collected included the total number of drugs, doses and any deviation in the time administered from the time in the prescription (a delayed administration was recorded as a positive figure, and a premature administration was recorded as a negative figure, both in minutes). Using the time taken per dose and number of doses, the average time taken per patient was calculated for each date. This considered any changes made to treatment regimes, focussing primarily on timing of medication administration per dose.Results: On the first day of using EP, a mean deviation of +10.6-minutes was seen across all patients (i.e. delay). By the end of week one, this dropped to a −11.5-minute deviation from the prescribed time (i.e. administered earlier). At week three, the mean was −9.7-minutes. By week five that fell to −5.3-minutes. The first day of using EP showed the longest mean delay seen for a single patient at 28.2 minutes. This dropped to 15 minutes by the end of the week, and further to 13.1 minutes at week three. The highest mean delay in a single patient however increased to 21.7 minutes by week five. In terms of individual doses, the number administered earlier than their prescribed time was lowest with initial use of EP, at 32 doses. By the end of the week, this more than doubled (75). The increased number of premature administrations dropped slightly in week three to 71 doses. At week five, it further fell to 66 doses.Conclusion: There is no consistent evidence to suggest that the introduction of EP produces a sustained impact on the administration of medications. An understandable impact was noted on day one, however subsequent dates do not suggest any ongoing pattern. There is also no evidence to suggest that continued use improved adherence to prescribed times thereafter, with significant variability persisting.

Termination of early pregnancy in Ireland: Review of the first four years of inpatient service at a tertiary maternity unit

Background: In 2019, a termination of pregnancy (TOP) service was established in Ireland following a landmark change to the constitution. Under Section 12 of the Health Act, TOP is permitted without restriction until 12 + 0 weeks’ gestation. Methods: Retrospective review of inpatient medical TOP under Section 12 between 1 January 2019 to 31 December 2022 in a single tertiary maternity hospital in Ireland. Anonymised data from eligible cases was obtained from electronic healthcare records. Results: The final cohort included 149 individuals. Gestational age (>9 + 0 weeks’) was the primary indication for hospital TOP (81.2%) with over 44% of the cohort at >11 + 0 weeks’ gestation. Misoprostol was administered within the recommended 24–48 h from mifepristone in 75.2% of cases. After one course of the medication regime, 9.4% of individuals required additional doses of misoprostol to complete the termination. Haemorrhage with blood loss >500 ml occurred in 4.2% of cases, with no other major/significant complications reported. Conclusion: This is the first reported review of the efficacy and complications of the newly established Irish TOP service. Findings highlight the importance of timely access to care given the strict legal gestational cut-off. Variations in practice, specifically in timing of medication administration, were also shown.

Antihypertensive Medication Timing and Cardiovascular Events and Death

Whether administration of blood pressure medications at bedtime instead of in the morning reduces cardiovascular risk is unknown, as findings from large clinical trials have not been consistent. There is also concern that bedtime antihypertensive use could induce glaucoma-related visual loss or other hypotensive/ischemic adverse effects. To determine the effect of bedtime vs morning administration of antihypertensive medications on major cardiovascular events and death. Multicenter, open-label, pragmatic randomized clinical trial with blinded end-point assessment and recruitment via 436 primary care clinicians across 5 Canadian provinces inviting their community-dwelling adult patients with hypertension taking at least 1 once-daily antihypertensive medication. Participants were recruited from March 31, 2017, to May 26, 2022, with final follow-up on December 22, 2023. Participants were randomized in a 1:1 ratio to using all once-daily antihypertensive medications either at bedtime (intervention group; n = 1677) or in the morning (control group; n = 1680). The primary outcome was time to first occurrence of all-cause death or hospitalization/emergency department (ED) visit for stroke, acute coronary syndrome, or heart failure. All-cause unplanned hospitalizations/ED visits, and visual, cognitive, and fall- and/or fracture-related safety outcomes were also assessed. A total of 3357 adults (56.4% female; median age, 67 years; 53.7% taking monotherapy) were randomized and followed up for a median of 4.6 years in each treatment group. The composite primary outcome event occurred at a rate of 2.3 per 100 patient-years in the bedtime group and 2.4 per 100 patient-years in the morning group (adjusted hazard ratio, 0.96; 95% CI, 0.77-1.19; P = .70). Individual components of the primary outcome, all-cause hospitalizations/ED visits, and safety outcomes did not differ between groups. In particular, there was no difference in falls or fractures, new glaucoma diagnoses, or 18-month cognitive decline. Among adults with hypertension in primary care, bedtime administration of antihypertensive medications was safe but did not reduce cardiovascular risk. Antihypertensive medication administration time did not affect the risks and benefits of blood pressure-lowering medication and instead should be guided by patient preferences. ClinicalTrials.gov Identifier: NCT02990663.

Chronotherapy for Hypertension: A Meta-Analysis and Systematic Review of RCTs.

The aim of this study was to evaluate the efficacy of chronotherapy for patients with essential hypertension with a range of clinical characteristics. We searched the PubMed, EMBASE, and Cochrane Library databases for randomized controlled trials of antihypertensive therapies in which patients were randomized to morning or evening administration. The primary outcomes of the included studies were ambulatory blood pressure (BP) parameters and patient characteristics, including age, body mass index, percentage of female participants, and drug ingestion, which were described in subgroup analyses. In total, 56 studies were included in the analyses. Meta-analyses and subgroup analyses revealed that specific populations of patients benefited more from bedtime dosing than from morning dosing in both 24-h or 48-h ambulatory systolic BP (SBP) and nighttime SBP, including (1) groups aged < 60 years, (2) those with body mass index ≥ 30 kg/m2, (3) studies with ≥ 50% female participants, and (4) patients receiving antihypertensive calcium channel blockers. However, when controversial data by Hermida et al. were omitted, the effects of BP controls were observed in patients with overweight, particularly obesity. Furthermore, calcium channel blockers contributed to an obvious reduction in nighttime SBP with chronotherapy. Chronotherapy for hypertension may not be completely ineffective, and the clinical program and timing of medication administration can be selected according to the patient's clinical characteristics. Registration PROSPERO identifier number CRD42021292795.

A multicenter mixed-methods study on the effects of intermittent fasting in patients with immune thrombocytopenia receiving thrombopoietin receptor agonists.

In recent years, significant advances have been made in the treatment of immune thrombocytopenia (ITP) with the development of thrombopoietin receptor agonists (TPO-RAs). TPO-RAs are often used following the failure of prior therapies or when bleeding episodes persist despite glucocorticoid use. In Muslim countries, where religious observance includes 16/8 intermittent fasting, the timing of medication administration may be affected. This study is the first to evaluate the impact of Ramadan fasting on patients receiving different TPO-RAs. A multicenter mixed-design study was performed in which Muslim patients who fasted during Ramadan while receiving TPO-RAs were interviewed between 2015 and 2023. Patient responses before, during, and after Ramadan were evaluated retrospectively. The bleeding tendency was assessed as (1) no bleeding, (2) minor cutaneous/mucosal bleeding, or (3) severe bleeding that involves major organs. The present study included 100 patients from three Muslim countries, including Qatar, Kuwait, and Saudi Arabia, across four tertiary centers. A complete response was observed in 63% of patients on ROM, 46% on ELT and 37% on AVA. For AVA, the mean platelet (PLT) count before Ramadan was estimated at [146.11 ± 111.76], while during Ramadan, it dropped to [131.7 ± 107.6]. For patients on ELT, the mean PLT count before Ramadan was estimated at [120.02 ± 59.7], while during Ramadan, it dropped to [100.8 ± 68.16] (p = 0.016). For patients on ROM, the mean platelet count before Ramadan was estimated at [122.68 ± 80.57], while during Ramadan, it was [130.94 ± 84.96]. Only 3% (3 patients on ELT) experienced bleeding episodes. This study supports the feasibility of Ramadan fasting for ITP patients receiving TPO-RAs. Further studies with a larger sample size are recommended to investigate the impact of other types of fasting on the efficacy and safety of TPO-RAs.

Bullying Behaviors in Clinical Settings: Potentially Harmful Distractions.

Nursing students exposed to bullying behaviors are at risk for making medication errors. For a quasi-experimental study, 15 prelicensure nursing students at a Midwestern university were exposed to simulated bullying behaviors or common distractions while administering medications in a laboratory setting. Data were analyzed using Kruskal-Wallis tests. There was no significant difference in medication administration rubric score ( H [2] = 1.489, p = .475) or time spent in room ( H [2] = 1.778, p = .411) between groups. Bullying behaviors and other interruptions distracted nursing students from successfully completing the medication administration simulation.

Evaluation and comparison of infusion reactions related to prophylactic medication timing for taxane administration.

Taxane medications, paclitaxel, and docetaxel, are chemotherapy agents that have a higher incidence of reported hypersensitivity and infusion reactions. To help classify these reactions, the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) is utilized. Prophylactic medications have been used to decrease the incidence and severity of these events. At our institution, medications that patients can receive prior to the initiation of a taxane infusion are a histamine 1 receptor antagonist (H1RA), histamine 2 receptor antagonist (H2RA), a steroid or a combination of these medications. The purpose of this retrospective review was to compare the rates and severity of infusion reactions based on the timing of prophylactic medication administration in the first and second doses of taxane infusions. Patients who received paclitaxel or docetaxel from January 30th, 2022, through January 30th, 2023, were included in the analysis. To assist in the identification of a reaction, taxane administrations were flagged for review if a rescue medication was administered after the start of a paclitaxel or docetaxel infusion. The rates and severity of infusion reactions were analyzed based on the timing of prophylactic medication administration. A sub-group analysis comparing infusion reaction characteristics between taxanes given, was performed. Of the 1486 taxane infusions that were completed within the year, 249 infusion reactions were confirmed and graded utilizing the NCI CTCAE. When examining the first and second doses of a taxane (N = 536), we identified 222 infusions reactions. The odds of a patient having an infusion reaction, during the first and second doses, was found to be less likely for patients given a prophylactic medication 30 min prior to receiving a taxane compared to those who did not receive a pre-medication (p = 0.037). This multisite retrospective study showed that administration of prophylactic medications 30 to 80 min prior to the first and second infusion of a taxane was the optimal timing to decrease the likelihood of patients having an infusion reaction. No difference in the severity of the reaction was seen. Most patients were able to complete the entire infusion, regardless of what rescue medications were used following the infusion reaction.

Barcode medication administration system use and safety implications: a data-driven longitudinal study supported by clinical observation

ObjectivesBarcode medication administration (BCMA) systems may improve patient safety with successful integration and use. This study aimed to explore the barriers and enablers for the successful use of a BCMA...

An Advanced Neonatal Resuscitation Educational Program in a Surgical Neonatal Intensive Care Unit: Development, Implementation and Audit from 2014 to 2023.

The design, implementation and audit of a multidisciplinary advanced neonatal resuscitation education initiative for "in unit" events in a quaternary NICU over a 9-year period, divided into 3-year epochs of "pre", "implementation" and "maintenance" is described. A didactic and simulation quality improvement initiative focused on teaching and reinforcing specific algorithms endorsed by the American Heart Association (AHA) to target resuscitation needs of older neonates including surgical and cardiac conditions. Qualitative and quantitative data pre and post implementation was audited. Post education implementation, team members performed quicker hemodynamic assessments and applied CPR and/or bolus epinephrine correctly in higher proportions during acute events. During supraventricular tachycardia, vagal maneuver use and medication administration time improved. Advanced neonatal resuscitation education and reinforcement targeted for event etiology, allow for AHA algorithms to be successfully taught and performed within a quaternary NICU with improvement in hemodynamic assessments and AHA algorithm implementation.

Statement on medication simplification in long-term care facilities by the Japanese Society of Geriatric Pharmacy: English translation of the Japanese article.

Many older adults who are certified for long-term care services live or stay in long-term care facilities (LTCFs), where they receive medical and nursing care. These individuals often encounter medication-related problems, such as polypharmacy and complex medication regimens, including frequent administration schedules. Although considerable attention has been paid to polypharmacy in the context of optimizing medication use in older adults, little emphasis has been placed on simplifying these regimens. Recently, the Japanese Society of Geriatric Pharmacy issued statements on medication simplification in LTCFs based on a scoping review of the literature and expert opinions. In these statements, medication simplification is defined as the process of reducing the number of medication administration times, ideally to once during lunchtime. The statements outline principles and processes to achieve medication simplification through interprofessional collaboration, including consolidating and reducing the number of medication administration times a day to minimize the risk of medication errors and ensure medical safety. Medication simplification will play a substantial role in alleviating the burden of medication intake for residents, and in reducing and equalizing the workload of medication administration for staff members throughout the day in LTCFs. These statements suggest that administering medication during lunchtime is beneficial when an adequate number of staff members are available in LTCFs. We hope that these statements will help ensure patient safety, and facilitate successful medication optimization for all medical, nursing and social care professionals working in LTCFs. Geriatr Gerontol Int 2025; 25: 14-24.

Optimizing Chronotherapy in Psychiatric Care: The Impact of Circadian Rhythms on Medication Timing and Efficacy.

In many medical settings, medications are typically administered in the morning or evening, aligning with patients' daily routines. This practice does not stem from chronotherapy, which involves scheduling drug administration to enhance its effectiveness, but rather from the way clinical operations are structured. The timing of drug administration can significantly affect a medication's effectiveness and side effects, with the impact varying by up to ten times based on circadian rhythms. Disorders such as major depression, bipolar disorder, and schizophrenia are linked to disruptions in these rhythms. Recent studies have found that circadian dysfunctions, including genetic and neurohumoral changes, underlie many psychiatric conditions. Issues such as an altered glucocorticoid rhythm due to impaired HPA axis function, disturbed melatonin balance, and sleep disturbances have been noted in psychotic disorders. Furthermore, mood disorders have been associated with changes in the expression of circadian rhythm genes such as Clock, Bmal1, and Per. Considering that the absorption, biodistribution, effects on target organs, half-life, metabolism, and elimination of drugs are all influenced by the body's circadian rhythms, this narrative review explores the optimal timing of medication administration to maximize efficacy and minimize side effects in the treatment of psychiatric disorders. By closely monitoring circadian variations in cortisol, melatonin, and key clock genes, as well as by deepening our understanding of the metabolisms and pharmacokinetics of antipsychotic medications, we propose a chronotherapy approach for psychiatric patients that could significantly enhance patient care.

Comparing Emergency Department and Infusion Clinic Outcomes Among Individuals with Sickle Cell Disease Seeking Care for Vaso-Occlusive Crises

Comparing Emergency Department and Infusion Clinic Outcomes Among Individuals with Sickle Cell Disease Seeking Care for Vaso-Occlusive Crises

Evaluating the Efficiency and Staff Satisfaction of the Point-of-Care IV Activated System Versus Traditional Piggyback in Administering IV Antibiotics at a Saudi Tertiary Hospital

Background: This study aims to compare resource utilization and staff satisfaction between the point-of-care (POC) activated system and the traditional intravenous piggyback (PB) system in hospital pharmacy settings. Methods: Employing a pre-post quasi-experimental design from November 2019 to April 2020, the study assessed resource requirements for both the POC activated system and the traditional PB system. Additionally, a staff satisfaction survey was conducted, focusing on staff experiences related to the pharmacy preparation process and the subsequent activation of the system by nurses. Results: The POC activated system required significantly fewer full-time equivalents (FTEs) per month compared to the PB system (0.36 ± 0.05 vs. 1.56 ± 0.07; p < 0.0001). Using POC in automated dispensing cabinets (ADCs) reduced medication administration time and returns (6.41% vs. 1.75%; p < 0.0001). The staff satisfaction survey revealed greater satisfaction with the POC activated system. A subsequent analysis showed the POC activated system had a low expiration rate of 0.1% and a cost of 39 Saudi riyal, while the traditional system had higher expiration rates and cost of 46,260 SR. Conclusions: The POC activated system reduced FTEs, decreased returned medications, and enhanced staff satisfaction compared to the PB system.

Exposición laboral a citostáticos en el equipo de enfermería de atención primaria

Exposición laboral a citostáticos en el equipo de enfermería de atención primaria

Improving Medication Management for Inpatients with a Secondary Diagnosis of Parkinson Disease.

Patients who have Parkinson disease require individualized medication regimens to optimize care. A review of the medication management of patients admitted to a tertiary care hospital with a secondary diagnosis of Parkinson disease found significant departures from the patients' home regimen. Medication regimens are often altered by health care teams unfamiliar with Parkinson disease-specific care in order to conform to standard hospital medication orders and administration times, potentially resulting in increased patient falls, delirium, and mortality.A nurse-led multidisciplinary team consisting of pharmacy, nursing, informatics, neurology, and quality personnel implemented a quality improvement (QI) project between July 2020 and July 2022 to identify patients with Parkinson disease, including those with a secondary diagnosis and those undergoing deep brain stimulation, and customize medication management in order to reduce length of stay, mortality, falls, falls with harm, and 30-day readmissions. The QI project team also evaluated patient satisfaction with medication management.Among patients with a secondary diagnosis of Parkinson disease, the proportion who had medication histories conducted by a pharmacy staff member increased from a baseline of 53% to more than 75% per month. For all patients with Parkinson disease, those whose medication history was taken by a pharmacy staff member had orders matching their home regimen 89% of the time, whereas those who did not had orders matching the home regimen only 40% of the time. Among patients with a secondary diagnosis of Parkinson disease, the length-of-stay index decreased from a baseline of 1 to 0.94 and observed-to-expected mortality decreased from 1.03 to 0.78. The proportion of patients experiencing a fall decreased from an average of 5% to 4.08% per quarter, while the proportion of patients experiencing a fall with harm decreased from an average of 1% to 0.75% per quarter. The rate of 30-day readmissions decreased from 10.81% to 4.53% per quarter. Patient satisfaction scores were 1.95 points higher for patients who had medication histories taken by pharmacy than for those who did not (5 versus 3.05).

Medication incidents associated with the provision of medication assistance by non-medical care staff in residential care facilities

The shift towards community-based care in Japan has led to increased medication assistance for older people by non-medical care staff. These staff members help take pre-packaged medications, apply patches, and administer eye drops. This study assessed the risks associated with such assistance by reviewing medication-related incidents across 106 residential care facilities between April 1, 2015, and March 31, 2016. An analysis of incident reports showed that all incidents were minor, with no serious outcomes. The incidents were categorized into four types: dropped drugs, misdelivery/misuse of medicines, forgetting to take medicines, and loss of medicines, with dropped drugs being the most frequent. Most incidents occurred in the morning and primarily involved residents with intermediate nursing care needs. These findings indicate a low risk of serious incidents because of medication assistance from non-medical staff. However, the frequency and nature of the incidents were influenced by the timing of medication administration and the care needs of the residents. These insights highlight the need for customized approaches to medication assistance, considering the residents' care levels and potentially optimizing medication administration times to improve safety in residential care settings.

Evaluation of a Pharmacist-Led Implementation of Standardized Medication Administration Times for Inpatients Receiving Hemodialysis.

Missed medication doses are a common and often preventable medication-related error that have been associated with an increased length of stay and mortality. Hemodialysis is a common, relatively predictable reason that patients are unavailable, resulting in missed doses. To evaluate the implications of a pharmacist-led intervention to standardize the medication administration times for patients requiring hemodialysis who were prescribed antihypertensives, antiepileptics, apixaban, and/or antimicrobials. A retrospective preanalysis and postanalysis of a pharmacist-led intervention were performed at a single-center, safety net hospital. Patients receiving dialysis and prescribed one of the targeted medications were included. The primary endpoint was the composite of missed and delayed doses. A total of 25 patients receiving 126 dialysis sessions in the preintervention group and 29 patients receiving 80 dialysis sessions in the postintervention group were included for analysis. For the primary endpoint, 118 (18%) versus 57 (9.3%) doses were missed or delayed in the preintervention versus postintervention group, respectively (P < 0.001). The primary endpoint was driven by fewer delayed doses in the postgroup. The number of antimicrobials given on a correct schedule increased in the postintervention group (98.3% vs 99.1%, P = 0.044). A pharmacist-led intervention for standard medication administration times in patients requiring hemodialysis increased the number of prescribed medication doses given and given on time. The intervention also led to more antimicrobials administered at appropriate times relative to dialysis sessions.

Timing of diuretic administration effects on urine volume in hospitalized patients.

Importance: Some medications have effects that depend on the time of day they are given. Current knowledge of the time-of-day effects of specific medications in hospitalized patients with cardiovascular disease is very limited. In hospitalized patients, increased medication efficiency might reduce dose (and associated side effects) and/or the length of time in the Intensive Care Unit (ICU) or hospital-potentially improving patient outcomes and patient and family quality of life and reducing financial costs. We studied whether the time of day or night patients in Cardiac or Intensive Care Units receive a diuretic affects urine volume. Methods: In this observational study, data were collected from 7,685 patients (63% male, 18 to 98 years old) admitted to one hospital's Acute Care Cardiac units, Cardiac ICUs, Cardiac Surgery ICUs, and/or Non-cardiac ICUs who received intravenous furosemide (a diuretic), had measurements of urine volume, were hospitalized for ≥3days between January 2016 to July 2021 and were older than 18years. The outcomes of interest were urine volume normalized by the most recent (not older than 24h) weight or body mass index (BMI), (i) in the hour after the time of diuretic administration, and (ii) when no diuretics were administered for the previous 3h. Results: We identified diuretic medication administration time 23:00-04:59 as a predictor of higher urine volume response. For patients without recent diuretic medication, higher urine volume was predicted 11:00-16:59 and 17:00-22:59. Other factors that affected urine volume response to the diuretic were sex, age, medication dose, creatinine concentration, diagnoses, and hospital unit. Discussion: Time-of-day of medication administration may be a factor associated with increased medication efficiency. Randomized controlled trials should be conducted to quantify the relative effect of modifiable factors, such as time of medication administration, that may affect short- and longer-term outcomes.

Parkinson’s disease medications in hospital: A retrospective audit of prescribing and administration errors

Background: Managing Parkinson’s disease (PD) medications in the acute hospital setting is complex. Mismanagement of PD medications such as inaccurate medication administration time and prescribing errors is common which can lead to the worsening of PD symptoms. Aim and Objectives: The aim of the study was to identify the extent of PD medication prescribing and administration errors in adult inpatients and pharmacists’ impact across a Victorian metropolitan hospital. Materials and Methods: A retrospective review analyzed a sample of 30 patients admitted between January and April 2022. PD medication orders (PDMO) and medication administration records (MAR) were reviewed; charting errors were identified based on reconciliation of PDMO with the pharmacist-led best-possible medication history (p-BPMH). Administration errors were identified through a review of MAR and PDMO charted time or p-BPMH documented administration time for each PD medication. Results: A total of 60 PDMO and 469 administration instances were reviewed. About 83.3% (50) of PDMOs had at least one instance of delay or omission in administration. 45.0% (27) of PDMO charting errors led to delays or omissions in administration. The timing of administration was the most common charting error accounting for 18.3% (11) of PDMOs. Documentation of p-BPMH within 24 h of admission led to a reduction of charting errors (52.9% vs. 76.9%, respectively). PD medications that were administered on time compared to p-BPMH documented time and PDMO charted time were 48.6% (228/469) and 53.7% (252/469), respectively. Conclusion: This study identified a high degree of PDMO charting and administration errors for patients with PD. Strategies to improve PD medication management are warranted.

Decreasing Nonemergent Nurse Interruptions During Peak Medication Administration Time Utilizing "The Golden Hour".

Decreasing Nonemergent Nurse Interruptions During Peak Medication Administration Time Utilizing "The Golden Hour".