Electronic drug monitoring in rheumatology

Description, aims, design & method

Project main description

Medication monitoring for chronic rheumatology disease patients is time consuming and complex.  It involves communication between patients, doctors, nurses and laboratories and the use of multiple information systems – both manual and electronic - to ensure patients are appropriately monitored with blood tests and timely follow-up of abnormal test results.  Information technology has the potential to improve the process for patients on long-term immunosuppressive rheumatology medications.

Aims

The aim of the study was to evaluate the impact of an electronic drug monitoring system (eDMS) used for ambulatory rheumatology patients on time nurses spent on, and the process of, drug monitoring.

Design and method

Sample:

Nurses working in the Rheumatology Department of one large metropolitan hospital (3 registered nurses and 1 clinical nurse specialist).

Intervention:

The Electronic Drug Monitoring System (eDMS) was developed in-house as a module of the Hospital Clinical Information System.  It provides an electronic auditable, legible trail of actions related to drug monitoring.

Data collection:

We used a time-and-motion work measurement tool (Figure 1) to collect timing data before and after the implementation of the eDMS relating to:

• time spent on specific nursing activities;
• who nurses spent time with; and
• format and location of documentation monitoring;.Interviews, observations and video recording of drug monitoring work tasks were undertaken to ascertain nurses’ perceptions of whether the eDMS changed their monitoring activities.

Timing data were collected for approximately 80 hours by one researcher for a two week period before and a two week period after implementation of the eDMS.

Findings

• Nurses spent significantly less time on medication monitoring tasks (33.1% to 26.4%)
• Nurses spent significantly more time on patient care (6.5% to 18.1%)
• Nurses spent significantly more time with patients (7.7% to 19.8%) and with relatives (0.4% to 3.7%)
• The eDMS made the medication monitoring process much simpler, more standardized and less time-consuming.  There was less transcribing of patient data between systems
• Time saved by nurses meant they could undertake more nurse-led clinics (two nurse-led clinics prior to the eDMS increased to four after the system was implemented) resulting in an increase in patients seen by nurses in the nurse-led clinics from 34 for a six month period prior to implementation to 99 for a six month period after implementation.

This study showed that the work of nurses changed after implementation of the electronic medication monitoring system with drug monitoring activities being more standardised and taking less time. This allowed nurses to spend more time on patient care related activities and to increase the number of nurse directed clinics.

Resources

Can technology change the work of nurses? Evaluation of an electronic drug monitoring system used in an ambulatory rheumatology setting