Table 1. Characteristics of study wards and summary of data collected.
| Study wards | Staffing | Medication systems and administration processes | Observations |
|---|---|---|---|
| Site A: 27-bed vascular/ cardiology ward in an acute NHS trust | 24 nurses. Observed nurse to patient ratio 1:8 on both day shift and night shift. Nurse participants reported fewer staff than usual during the data collection period | Paper drug prescription and administration chart; four drug trolleys; RFID controlled electronic bedside medication cabinets; nurses administered drugs to patients they were looking after; patient’s own drugs from home were permitted to be used during their inpatient stay. | 26 March to 3 April 2012; 14 nurses (includes 2 bank/agency) a (13 female; 1 male); 18 drug rounds (three at 6am and five each at 12pm, 6pm and 10pm); total 27 hours of observation, of which 15 hours 20 min were during drug rounds; 11 hours 40 min were before and after drug rounds. |
| Site B: 28-bed adult elective surgical ward in an acute hospital of a foundation NHS trust | 16 nurses. Observed nurse to patient ratio 1:6 on both day shift and night shift. Nurse participants reported fewer patients than usual during the data collection period | Trust-wide EPMA system since 2008; EPMA access: two desktop computers, three tablet devices, and one COW; two drug trolleys; RFID controlled bedside medication cabinets; nurses administered drugs to patients they were looking after; patient’s own drugs from home were permitted to be used during their inpatient stay. | 20–31 August 2012; 13 nurses (includes 2 bank/agency) a (12 female; 1 male); 20 drug rounds (four at 6am, five at 12pm, six at 6pm, and five at 10pm); total 29 hours of observation, of which 14 hours 13 min were during drug rounds; 14 hours 47 min were before and after drug rounds. |
| Site C: 18-bed adult neurological rehabilitation ward in an acute hospital of a foundation NHS trust | 15 nurses. Observed nurse to patient ratio 1:9 on both day shift and night shift. Nurse participants reported fewer staff than normal during the data collection period | EPMA system since July 2012, trust-wide roll out in progress at time of data collection; EPMA access: one desktop computer, one laptop attached to the drug trolley, and two COWs; one large drug trolley; conventional metal bedside medication lockers; two nurses administered drugs to all patients together; ‘opt-out’ patient self-administration policy; patients’ own drugs from home were permitted to be used during their inpatient stay; HCAs helped patients to take their medications after the nurse had prepared the doses. | 12–19 November 2012; 16 nurses (includes 3 bank/agency) a (13 female; 3 male); 18 drug rounds (two at 6am, four at 8am, four at 12pm, five at 6pm, and three at 10pm); total 29 hours of observation, of which 20 hours 35 min were during drug rounds; 8 hours 25 min were before and after drug rounds; no IV doses were prescribed (patients on this ward do not usually require IVs). |
Abbreviations: COW, computer on wheels; EPMA, electronic prescribing and medication administration system; HCA, health care assistant; IV, intravenous; NHS, National Health Service; RFID, radio frequency identification.
aBank nurses were employees of the hospital trust who may also be a regular staff member of the study ward. Agency nurses were employees of an external company who were contracted by the hospital trust to provide nursing staff cover to wards for specific work shifts.