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Developing indicators of workflow efficiency in electronic medication administration

Authors: Benita Idowu, RN

Primary Advisor: Dean F. Sittig, PhD

Committee Members: Jorge Herskovic, MD PhD

Masters thesis, The University of Texas School of Biomedical Informatics at Houston.



To develop measurable indicators of workflow efficiency in electronic medication administration.

Materials and Methods

Direct staff observations and informal staff interviews were used to model the series of tasks involved in electronic medication in a medical intensive care unit. The tasks were divided by computer physician order entry (CPOE), automated medication dispenser (AMD), and electronic medication administration (eMAR) barcode technology. Tasks were then examined for possible hindrances and expediters to clinician workflow. Such factors were used to determine the indicators of workflow efficiency in electronic medication administration. AMD reports, logged nursing activities, and clinician scorecards were used to collect numerical data for selected indicators.


Electronic medication administration involved 14 basic tasks related to CPOE, AMD, and eMAR. 20 measurable efficiency indicators were drawn from these tasks.  Indicators included: ratio of fingerprint attempts to fingerprint acceptances when using AMD; percent of orders requiring pharmacist clarification; and time from electronic medication request to medication receipt.


All developed indicators were measurable by direct observation or record retrieval, and several indicators had the potential for improvement through system enhancements and/or staff education.


Several workflow efficiency indicators in electronic medication administration system are available Many can be adjusted to improve the use of CPOE, AMD, and eMAR barcode technology.