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Implementation of an Electronic Medication Management System in 41 Residential Care Homes in Hong Kong, China: A Pre–Post Interventional Study
ABSTRACT
Background:
The medication management process in Resident Care Homes for the Elderly (RCHEs) is complex and can be labor intensive. However, its safety and time efficiency can be enhanced with the appropriate use of information technology. In 2019, a non-government organization led by pharmacists with special interest in informatics developed the SafeMed Medication Management System (SMMS®), which is a digital web-based system that integrates electronic medical profiles and medication profiles to revamp the traditional manual medication management process in RCHEs in Hong Kong, China.
Objective:
The aims of this study were to assess the effectiveness of the SMMS® in improving RCHE staff’s time efficiency and competencies in the medication management process and how this could potentially reduce manpower costs after its implementation.
Methods:
This was a pre–post interventional study conducted from September 2022 to August 2024. Time efficiency was evaluated using time–motion analysis. The time spent on each process – preparing the medication doses, checking the prepared doses and administering the doses to residents – was evaluated in 10-minute blocks. The mean numbers of doses prepared, checked, and administered were calculated for each block. A three-way analysis of variance was used to compare the doses before and after the system implementation. Staff competencies and perceived acceptance of the system were evaluated using a structured survey adapted from the technology acceptance model. The Mann–Whitney test was performed to identify the individual and organizational factors associated with staff’s perceived competency and acceptance of the system.
Results:
Forty-one RCHEs implemented the SMMS®, serving a total of 3,911 residents. The time–motion analysis (n = 6 RCHEs) revealed that the mean number of doses significantly increased in 10-minute blocks after the system implementation (medication preparation: 25 ± 14 to 49 ± 15 doses; medication checking: 21 ± 6 to 85 ± 33 doses, medication administration: 9 ± 1 to 16 ± 6 doses). The overall mean number of doses handled across all processes combined was significantly higher after implementation (18.9 vs 51.9 doses, P = 0.022). RCHE staff (n = 392) reported significantly improved competencies in entering and accessing residents’ records and preparing, checking, and administering medications after the system implementation (all P < 0.001). The estimated cost of managing one dose of medication dropped substantially from HKD 2.00 (USD 0.25) before to HKD 0.74 (USD 0.09) after system implementation. If fully implemented in all RCHEs across Hong Kong, the daily manpower cost associated with the medication management process could be reduced from HKD 2,574,000 (USD 330,000) to HKD 952,380 (USD 122,100).
Conclusions:
The time–motion analysis and quantitative survey findings suggest that digital technology combined with automation can improve staff’s time efficiency and competencies and promote manpower cost-saving in the medication management process. Future work should evaluate the long-term impact of this system on medication safety and its cost effectiveness in RCHEs. Clinical Trial: Not applicable
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