‘Tabs versus Jabs’ time and motion study involving experiential learning student pharmacists: how long to prepare intravenous versus oral antibiotics?
Authors: MacDonald C Y , Lobban A , Rose R , Stephen L , Lynas G , Aslam A , McCormick S , Brown A 
Published: November 2024

Abstract

Introduction
Approximately one-third of inpatients in Scotland are prescribed antibiotics1. Patients prescribed IV antibiotics should be reviewed regularly and switched to oral therapy when clinically appropriate. Optimising IV to oral switch (IVOST) is often perceived as challenging2 and risks associated with IV access and patient comfort benefits to IVOST are well known. Workforce time required to administer IV medicines compared to oral equivalents is rarely considered in the risk-benefit assessment to IVOST2. To quantify this difference, a medicines administration time and motion study was undertaken.

Aim
To conduct a time and motion study to explore antibiotic administration in NHS Lanarkshire (NHSL) district general hospitals: University Hospitals Hairmyres, Wishaw, and Monklands.

Objectives
To measure time taken by nursing staff to prepare and administer IV/oral antibiotics.
To explore potential nursing time saved if IVOST.
To make recommendations to NHSL’s Antimicrobial Management Committee on inpatient antibiotic use.
To involve final year Student Pharmacists in a multidisciplinary (MDT) project during placement.

Methods
Data were collected by Student Pharmacists on Antimicrobial/Surgical Experiential Learning (EL) placements as a novel approach to specialist EL.
Data were collected during midday medication rounds in a surgical ward at each hospital. Nurses were observed administering antibiotics and the time taken recorded included medicine preparation; patient identification; assessment of peripheral venous catheter; and gathering IV equipment. The timer stopped when medication was administered to the patient. IV infusion duration was not included. Data were recorded in an Excel spreadsheet in HH:MM:SS.
This study did not require review by an NHS Research Ethics Committee under the updated Governance Arrangements for Research Ethics Committees (GAfREC) 2020 Edition; although local permission was sought from service leads.

Results
Mean nursing time to prepare IV antibiotic administration was 11 minutes 55 seconds (n=20). Mean nursing time for oral administration was 1 minute 59 seconds (n=10).
Nursing staff take 6 times longer to prepare IV compared to oral antibiotics for patient administration. Potential nursing time saved per individual IVOST is approximately 10 minutes.

Discussion/Conclusion
Results suggest IVOST would reduce nursing time involved in medicines administration, with IVOST for one patient taking antibiotics three times daily potentially saving 30 minutes of nursing time alone.
Some antibiotics have excellent oral bioavailability and this project highlights the need to educate clinical teams on selecting oral route for high bioavailability antibiotics when safe and clinically appropriate.
Student pharmacists observed that nurses managed multiple interruptions and spent time looking for IV equipment, commenting that IV antibiotics produced more waste (single use plastics, syringes, packaging). Student pharmacists had a better understanding of medicines administration and nursing roles following involvement in the study.

Limitations
Small sample size, time constraints, data did not include infusion durations or administrations outside drug rounds.
Benefits of IVOST are well known and the results of this study are comparable to similar studies in the UK. NHSL’s Antimicrobial Team are disseminating key information from this study in line with local and national guidelines. Student Pharmacists effectively contributed to a novel EL placement project and this improved their understanding of nursing roles within the MDT.

References
1. Hospital Antibiotic Review Programme (HARP) [Internet]. Scottish Antimicrobial Prescribing Group (SAPG); 2021 [cited 2024 June 6]. Available from: https://www.sapg.scot/guidance-qi-tools/quality-improvement-tools/hospital-antibiotic-review-programme-harp/
2. Jenkins, A., & Agravedi, N. (2023, April). Jabs to tabs: A time and motion study investigating medicines administration [ECCMID 2023 Conference Presentation]. University Hospitals Birmingham.