Time and Motion Study of Influenza Diagnostic Testing in a Community Pharmacy

Background: It has been shown that use of rapid diagnostic tests (RDTs) is able to reduce costs and improve the prescribing practice of antivirals (i.e. oseltamivir) among patients with influenza-like illnesses (ILIs). Using existing Clinical Laboratory Improvement Amendment (CLIA)-waived RDTs and collaborative practice agreements, similar to those used to allow pharmacists to administer vaccines, it is possible for patients to seek point-of-care treatment for influenza or flu-like symptoms at a local pharmacy. Following a review of the patient's symptoms by a trained pharmacist, the qualified patient is offered an RDT to determine if the influenza virus is the cause of the symptoms. Based on the results of the RDT, the patient is provided with the appropriate treatment as defined by an approved practice agreement. Objective: The aim of this study was to evaluate the feasibility of incorporating an RDT for influenza into community pharmacy practice. Methods: This time and motion study was conducted at three community pharmacy locations, and a total of eight simulated patient visits were completed utilizing a standardized patient. In addition to determining a total time of the encounter, each simulation was divided into nine timed sub-categories. For data analysis, the time spent in each of the nine sub-categories was assigned to the pharmacist, pharmacy technician, or patient. Time and motion methodologies were used to estimate the total time required to provide the RDT service, to determine the amount of active time required of the pharmacist and pharmacy technician, and to evaluate the ability of the staff to provide the service within its existing workflow. Results: The average total time to complete the entire patient encounter for an influenza assessment utilizing an RDT was 35.5 minutes (± 3.1 minutes). On average, the pharmacist spent 9.4 minutes (± 3 minutes) per encounter or about 26.5% of the entire encounter. When the pharmacy technician collected the vital signs, the pharmacist-required time was reduced to 4.95 minutes (± 2.7 minutes), which was about a 48% reduction. Conclusions: The results indicate that an RDT program for influenza assessment required no more than a modest amount of pharmacist time and could be successfully incorporated into regular workflow with little to no disruption of other activities. As such, this approach to influenza management may be a feasible service for community pharmacies to offer patients. This was especially true if the pharmacy had well-trained technicians on staff that could support the service with collection of patient histories and vital signs. Type: Original Research

Download Full-text

Pharmacist-Provided Pharmacogenetic Point-of-Care Testing Consultation Service: A Time and Motion Study

Journal of Pharmacy Technology ◽

10.1177/8755122518756651 ◽

2018 ◽

Vol 34 (4) ◽

pp. 139-143 ◽

Cited By ~ 3

Author(s):

David R. Bright ◽

Michael E. Klepser ◽

Logan Murry ◽

Donald G. Klepser

Keyword(s):

Community Pharmacy ◽

Point Of Care ◽

Pharmacy Practice ◽

Point Of Care Testing ◽

Pharmacy Staff ◽

Pharmacy Technician ◽

Time And Motion Study ◽

Time And Motion ◽

Motion Study ◽

Pharmacy Setting

Background: With recent advances in pharmacogenomics (PGx) comes the potential to customize medication use based on genetic data. Support for PGx has found practical limitations in terms of workflow and turnaround time of a test. However, with the expansion of point-of-care testing (POCT) in pharmacy practice models comes opportunity for PGx testing in the pharmacy setting. Objective: The purpose of this study is to quantify the amount of time spent during each step of a PGx POCT encounter in a community pharmacy setting. Methods: A time and motion study was conducted using a mock community pharmacy space for a simulated PGx-focused encounter to manage antiplatelet therapy following hospital discharge. PGx POCT was conducted using the Spartan RX instrument. Simulated patient encounters were divided into 7 categories. Time spent in each step, as well as total time spent, was tracked. Results: A total of 54 simulated PGx POCT encounters took place with an average time of 9.49 minutes (SD ± 1.38 minutes). Instrument run time adds 60 minutes to the total time required to obtain a result. Duties that could be performed by an appropriately trained pharmacy technician totaled 6.86 minutes. Conclusions: PGx POCT would require 9.49 minutes of pharmacy staff hands-on time for the encounter, which could be reduced to 2.64 minutes of pharmacist time with appropriate pharmacy technician involvement. Time requirements for PGx POCT are similar to that of community pharmacy–based immunizations. Future studies could explore how practice could change if PGx testing were routinely performed in the pharmacy.

Download Full-text

Time Savings with Once-Monthly C.E.R.A.: A Time and Motion Study Conducted in 13 Haemodialysis Centres in Italy

Blood Purification ◽

10.1159/000437133 ◽

2015 ◽

Vol 40 (2) ◽

pp. 173-179 ◽

Cited By ~ 4

Author(s):

Erwin De Cock ◽

Persefoni Kritikou ◽

Simona Ravera ◽

Armando Filippini

Keyword(s):

Health Care Professionals ◽

Renal Anaemia ◽

Time And Motion Study ◽

Time And Motion ◽

Motion Study ◽

Receptor Activator ◽

Anaemia Management ◽

Time Savings ◽

Time Required ◽

Annual Time

Background: We sought to document the time required by health care professionals to administer erythropoiesis-stimulating agents (ESAs) and continuous erythropoiesis receptor activator (C.E.R.A.) in the management of renal anaemia. Methods: A Time and Motion study was conducted in 13 centres in Italy. The time spent on preparation, distribution, and injection for both ESA and C.E.R.A. groups was measured. A multilevel model was run to account for the centre-clustering effect. Results: The average number of ESA injections/patient/year was 89. The average uptake of C.E.R.A. was 26%. The average time per session was 1.54 min for ESA (95% CI 1.21-1.86) vs. 1.64 min for C.E.R.A. (95% CI 1.31-1.97). Estimated time/patient/year was 137 min for ESA and 20 min for C.E.R.A. Assuming a 100% uptake of C.E.R.A., annual time savings/centre would be 84% (194 h). Conclusions: Substantial annual time savings on frequent anaemia management-related tasks were found when a switchover was made from ESAs to C.E.R.A.

Download Full-text

Considering pharmacy workflow in the context of Australian community pharmacy: A pilot time and motion study

Research in Social and Administrative Pharmacy ◽

10.1016/j.sapharm.2018.01.003 ◽

2018 ◽

Vol 14 (12) ◽

pp. 1157-1162 ◽

Cited By ~ 2

Author(s):

Diana Cavaye ◽

Elin C. Lehnbom ◽

Tracey-Lea Laba ◽

Elise El-Boustani ◽

Rohina Joshi ◽

...

Keyword(s):

Community Pharmacy ◽

Time And Motion Study ◽

Time And Motion ◽

Motion Study ◽

Australian Community

Download Full-text

The Community Pharmacy Technician’s Role in the Changing Pharmacy Practice Space

INNOVATIONS in pharmacy ◽

10.24926/iip.v11i2.3325 ◽

2020 ◽

Vol 11 (2) ◽

pp. 11

Author(s):

Brooke Taylor ◽

Bella Mehta

Keyword(s):

Community Pharmacy ◽

Clinical Laboratory ◽

Pharmacy Practice ◽

Pharmacy Technician ◽

Medication Therapy ◽

Medication Information ◽

Article Type ◽

Pharmacy Technicians ◽

Clinical Laboratory Improvement Amendments

Purpose: The practice of pharmacy and role of pharmacists has evolved over the decades but markedly since the introduction of the Affordable Care Act (ACA) in 2010. The ACA allowed patients to have increased access to community pharmacy services, such as medication therapy management, leading to an increase in the clinical services provided by pharmacists. This expansion of pharmacist’s roles has led to pharmacists to feel an increase in workload which negatively impacts the time spent with patients. One way for this shift to occur without continuing to increase the pharmacist’s workload is by using technicians as pharmacist extenders to take on more technical tasks. Summary: The role of pharmacy technicians has been slow to expand from fear of public safety due to the lack of required education and training. Today, state requirements to practice as a pharmacy technician have become stricter with state requiring licensing, registration or certification. This increase in requirements as led to the expansion of pharmacy technician duties. Studies show that pharmacy technicians are able to perform technician accuracy checking, provide immunization and perform Clinical Laboratory Improvement Amendments (CLIA)-waived screenings. In addition to these duties, pharmacy technicians are being utilized in more novel ways such as collecting medication information in primary care and telepharmacy settings. Conclusion: In order for pharmacy to continue to grow as a profession, pharmacists need to use pharmacy technicians as extenders. As pharmacy technicians begin to take on more of the technical duties, pharmacists are able to increase the time spent with patients. Article Type: Commentary

Download Full-text

How long do nursing staff take to measure and record patients’ vital signs observations in hospital? A time-and-motion study

International Journal of Nursing Studies ◽

10.1016/j.ijnurstu.2021.103921 ◽

2021 ◽

Vol 118 ◽

pp. 103921

Author(s):

Chiara Dall'Ora ◽

Peter Griffiths ◽

Joanna Hope ◽

Jim Briggs ◽

Jones Jeremy ◽

...

Keyword(s):

Nursing Staff ◽

Vital Signs ◽

Time And Motion Study ◽

Time And Motion ◽

Motion Study

Download Full-text

Advancing Community Pharmacy Practice – A Technician Product Verification Pilot to Optimize Care

INNOVATIONS in pharmacy ◽

10.24926/iip.v11i2.2340 ◽

2020 ◽

Vol 11 (2) ◽

pp. 14

Author(s):

Michael Andreski ◽

Erica Martin ◽

Victoria Valentine Brouner ◽

Sarah Sorum

Keyword(s):

Community Pharmacy ◽

Patient Care ◽

Error Rate ◽

Pharmacy Practice ◽

Direct Patient Care ◽

Utilization Review ◽

Original Research ◽

Pharmacy Technician ◽

Pharmacy Technicians ◽

Product Verification

Elevating the technical role of pharmacy technicians to perform Technician Product Verification (TPV) is one strategy that has shown promise to optimize pharmacy practice models. This is done by better positioning pharmacists to provide clinical care, in line with their education and expertise. TPV permits a Validated Pharmacy Technician, as defined by the Wisconsin Pharmacy Examining Board, to verify the accuracy of a product filled by another technician. The pharmacist maintains responsibility for assessing the clinical appropriateness of the prescription, including drug utilization review, data entry, and patient counseling. During the study period, 12,891 pharmacist-verified prescriptions (baseline) and 27,447 Validated Pharmacy Technician-verified prescriptions were audited for accuracy. The aggregate verification error rate for pharmacist-verified prescriptions was 0.16% and 0.01% for Validated Pharmacy Technician-verified prescriptions. The mean error rate was significantly less for Validated Pharmacy Technician-verified prescriptions than for pharmacist-verified prescriptions (0.19 ± 0.174 % vs 0.03 ± 0.089 %, p=0.020) (Figure 3). This suggests TPV in the community pharmacy setting maintained patient safety. In this study, Validated Pharmacy Technicians were shown to be more accurate than pharmacists at performing product verification. The ability to delegate the product verification task holds the potential to free up pharmacist time for increased direct patient care. Increasing direct patient care by pharmacists in community pharmacies may have significant implications for improving patient outcomes and pharmacy quality. Article Type: Original Research

Download Full-text

How long do nursing staff take to measure and record patients’ vital signs observations in hospital? A time-and-motion study

10.1101/2020.12.09.20246355 ◽

2020 ◽

Author(s):

Chiara Dall’Ora ◽

Peter Griffiths ◽

Joanna Hope ◽

Jim Briggs ◽

Jeremy Jones ◽

...

Keyword(s):

Nursing Staff ◽

Vital Signs ◽

Standard Operating Procedure ◽

Nursing Workload ◽

Safe Patient Care ◽

Time And Motion Study ◽

Time And Motion ◽

Motion Study ◽

Monitoring Protocols ◽

The Impact

ABSTRACTIntroductionMonitoring vital signs in hospital is an important part of safe patient care. However, there are no robust estimates of the workload it generates for nursing staff. This makes it difficult to plan adequate staffing to ensure current monitoring protocols can be delivered.ObjectiveTo estimate the time taken to measure and record one set of patient’s vital signs observations; and to identify factors associated with time to measure and record one set of patient’s vital signs observations.MethodsWe undertook a time-and-motion study of 16 acute medical or surgical wards across four hospitals in England. One hospital recorded vital signs on paper, while three recorded measurements on electronic devices. Two trained observers followed a standard operating procedure to record the time taken to measure and record vital sign observations. We used mixed-effects models to estimate the mean time using whole observation rounds, which included preparation time, or time spent taking observations at the bedside. We tested whether our estimates were influenced by nurse, ward and hospital factors.ResultsAfter excluding non-vital signs related interruptions, dividing the length of an observation round by the number of observations in that round yielded an estimated time per observation set of 5 minutes and 1 second (95% Confidence Interval (CI) = 4:39-5:24). If interruptions within the round were included, the estimated time was 6:26 (95% CI = 6:01-6:50). If only time taking each patient’s observations at the bedside was considered, after excluding non-vital signs related interruptions the estimated time was 3:45 (95% CI = 3:32-3:58). We found no substantial differences by hospital, ward or nurse characteristics, despite different systems for recording observations being used across the hospitals.DiscussionThe time taken to observe and record a patient’s vital signs is considerable, so changes to recommended observation frequency could have major workload implications. Variation in estimates derived from previous studies may, in part, arise from a lack of clarity about what was included in the reported times. We found no evidence that nurses save time when using electronic vital signs recording, or that the grade of staff taking the observation influenced the time taken.ConclusionsTaking and recording vital signs observations is time consuming and the impact of interruptions and preparation away from the bedside is considerable. When considering the nursing workload around vital signs observations, no assumption of relative efficiency should be made if different technologies or staff groups are deployed.

Download Full-text