Original study
Nursing Home Medication Administration Cost Minimization Analysis

https://doi.org/10.1016/j.jamda.2006.10.002Get rights and content

Objectives

To assess the time it takes nurses to administer medications in the nursing home setting, to calculate nursing cost of medication administration, and to determine whether using extended-release products are justified by decreasing nursing costs.

Design

Cost-minimization analysis using observational data from a time-motion analysis.

Setting

Two 150-bed nursing homes in rural eastern North Carolina.

Participants

Nurses working during first and second shifts.

Measurements

Nurses were timed as they each administered medications to 12 patients. The mean time required to administer each dosage form was calculated. The cost of nursing time was based on the average nursing staff salary of $20.45 per hour as reported by the directors of nursing. Time and cost to dispense one more medication during an existing medication pass and an additional medication pass are calculated.

Results

The time to administer an additional dose of an oral medication to one patient was 45.01 seconds during an already scheduled medication pass and 63.05 seconds during a new medication pass. The cost of adding an oral medication once a day for a patient will cost $7.67 per month if administered at the same time as other medications or $10.74 per month if a new medication pass is required. The administration of other dosage forms, such as crushed, percutaneous enteroscopic gastrostomy, injection, and patch was more time involved and, thus, costlier. Formulas are provided to calculate medication administration cost based on local salary.

Conclusions

Nursing time and costs for medication administration in the nursing home are great and should be considered when selecting a product. This may justify the selection of higher cost extended-release products.

Section snippets

Methods

This is a cost minimization analysis using observational data from a time-motion analysis of nurses administering medications. The analysis identifies the cost of administering different dosage forms and regimens of medications, allowing for calculation of product administration costs. The Institutional Review Boards of Campbell University and East Carolina University approved this study.

Results

At each facility the 5 observed nurses administered medications to a total of 51 residents. Of those, we analyzed 41 residents at each facility. Each nurse administered medications to an average of 10.4 ± 1.4 residents per medication pass. Each resident received an average of 7.3 ± 3.7 medications during the observed medication pass. Nursing experience averaged 9.6 years with a range of 2 to 21 years. The average number of years the nurses had administered medications was 6.3 years with a range

Discussion

This is the first study that takes into consideration the cost of administering different dosage forms and the cost when additional medication passes are added for a resident. The reader can calculate the medication pass cost using our data results in conjunction with local nurses’ salaries with benefits (Figure 1).

Compared to a previous study,5 the time to administer a crushed medication was longer (80.3 versus 124.0 seconds in our study) but the time to administer an oral medication was

Conclusion

The cost of medication administration is important to consider in nursing home residents since it requires nursing time and salary. Frequency of dosing should be considered when choosing between otherwise equivalent medications or dosage forms. If extended release products are equally or only slightly more expensive than the immediate release products, then choosing the extended release product would be less costly by saving medication administration costs. The cost differential is dependent on

References (12)

  • L. Frank et al.

    Time and economic cost of constipation care in nursing homes

    J Am Med Dir Assoc

    (2002)
  • Population Division, DESA, United Nations. World’s Population Ageing 1950–2050....
  • National Center for Health Statistics. Health, United States, 2005 With Chartbook on Trends in the Health of Americans....
  • J.A. Doshi et al.

    National estimates of medication use in nursing homes: Findings from the 1997 Medicare current beneficiary survey and the 1996 medical expenditure survey

    J Am Geriatr Soc

    (2005)
  • D.V. Liebel et al.

    Consolidating medication passes: It can lead to more time with patients

    Am J Nurs

    (2005)
  • E.R. Gonzalez et al.

    Cost analysis of solid oral medication distribution and administration: Applicants for chonic nitrate therapy

    Consult Pharm

    (1997)
There are more references available in the full text version of this article.

Cited by (16)

  • Transitioning from insulin to dipeptidyl-peptidase 4 (DPP-4) inhibitors for type 2 diabetes

    2022, Geriatric Nursing
    Citation Excerpt :

    Transitioning from Insulin to DPP-4 inhibitors would be advantageous to the nursing profession because of the retrieval of time with medication administration. During medication administration, injecting insulin four times per day equates to 63.05 seconds (s) x 4 = 252.2 s, or 4.2 minutes (m) compared to the administration of one daily pill equates to 45.01s, for a difference of 207.19s or 3.45m per patient per day.2 Added to that is the time and cost of finger stick blood glucose (FSBS) checks and hypoglycemia management that are eliminated in DPP-4 inhibitors, which do not cause hypoglycemia.

  • Reducing the Burden of Complex Medication Regimens: SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) Cluster Randomized Controlled Trial

    2020, Journal of the American Medical Directors Association
    Citation Excerpt :

    By extrapolation, a reduction in the average number of medication administration times for regular medications from 4 to 3.66 times per day could therefore free up 51 minutes of staff time per resident per month, or 85 hours of staff time per month in a 100-bed RACF. Similarly, a United States study estimated that reducing the number of administration times from 3 times per day to once per day could save 63 minutes of staff time per resident every month.39 However, time estimates may differ based on country of residence, resident care needs, local medication administration practices, the total number of residents included in the medication round, polypharmacy, time of day, and use of dose administration aids.

  • Reducing Cost by Reducing Polypharmacy: The Polypharmacy Outcomes Project

    2012, Journal of the American Medical Directors Association
    Citation Excerpt :

    Medication costs were compared using paired t tests, with separate analyses for overall, scheduled, and PRN medication costs. The overall administration time was calculated by multiplying the number of doses of discontinued medications by the average nursing time required to administer medications, previously reported to be 45 seconds per medication.24 The nursing costs for medication administration were estimated based on nursing staff average hourly wage of $23.10 using publicly available labor statistics25 and registered nurse/licensed practical nurse staffing ratios at this facility.

  • Outcomes of Polypharmacy in Nursing Home Residents

    2012, Clinics in Geriatric Medicine
    Citation Excerpt :

    Nursing time for medication administration was estimated at 45 seconds for each oral medication pass.69 The cost of adding an oral medication once a day for a patient was between $7 and $10 depending on timing of administration, and the cost of adding an oral crushed medication once a day was between $21 and $31, depending on whether the medication was given at an existing medication pass or a new medication pass needed to be added.69 Nursing medication administration times also differed, depending on type of nursing home unit (62 minutes per 20 residents on physical support units, vs 84 minutes per 20 residents on behavioral care units).

View all citing articles on Scopus
View full text