In the hospital setting, time is a precious commodity that often seems in short supply. A team of nurses at Bayhealth Hospital in Delaware discovered that the solution to their challenges wasn’t adding more staff — it was rethinking their approach to medication administration times.
The Challenge: A Hectic Shift Change
Several nurses in the busy med-surg/intermediate care unit were struggling with a persistent time crunch immediately after change of shift. "The beginning of your shift was always rushed. The end of the shift was always rushed, and we were always having to stay later to finish documentation," said nurse Catrina Ansbach.
The nurses initially thought they needed more staff. However, through their participation in AACN CSI Academy, they identified a more fundamental issue: The two-hour window to administer medication in the morning was creating a bottleneck at the start of each shift.
"We come in at 7 a.m. and shift report typically doesn’t end until at the earliest at 7:15. So, you're already 15 minutes behind, and more often than not, it may be 7:30,” said nurse Breda Roche. With medications scheduled for early in the shift and multiple patients to care for, nurses were constantly rushing to complete everything within the required time frame.
CNS Karin Cooney-Newton, who served as the unit’s CSI coach, added: “It's especially difficult when you're a newer nurse and need that time [in the beginning of the shift] to coordinate, plan and prioritize patient care.”
The Solution: Rethinking Medication Times
The team's innovative solution was straightforward yet transformative: They collaborated with the pharmacy team to push back medication administration times.
"Just that little change that we made, changing that time of medication administration, changed everything,” said nurse Susan Singh. “It changed the entire flow of the day and just made it so much better."
The new schedule allows nurses to do the following before medication administration:
- Complete thorough patient assessments
- Review physician notes and admission information
- Respond to patient questions with better information
The team also adjusted nighttime medication schedules, moving non-critical medications from midnight or 2 a.m. to 9 p.m. or 10 p.m., reducing unnecessary sleep disruptions for patients.
Implementation: A Methodical Change
The project faced some initial resistance, especially in a healthcare setting with well-established routines.
"Change is hard for people," Roche said. "When we initially put out the idea of changing the medication administration times, there was some resistance. They didn't really see how that would improve their workflow."
The project team’s approach to overcoming this resistance was methodical: They conducted a baseline survey to document current challenges and framed the change as a trial rather than a permanent decision. They also shared results showing improvement in on-time medication administration.
“People really started realizing, ‘Wow, I’m not so rushed. My day isn’t starting in a panic,’” Roche said. “‘I know exactly what I’m doing during this time period. I have more time for my patients.’”
The nursing assistants also needed to adjust their workflow. Instead of immediately starting vital signs at shift change, they could now spend time addressing patients’ comfort needs first and taking vital signs later, when the information would best inform medication administration.
Measuring Success
Within the first year of the change, on-time medication administration improved from about 70% to over 90%. Nurses reported feeling less rushed and having more time for patient care.
What began as a single-unit initiative quickly spread throughout the Sussex campus and eventually to the northern, Kent campus of the Bayhealth system. As floating nurses experienced the new workflow, they advocated for implementing it on their home units.
"Initially it was just supposed to stay on our unit for a certain period of time," Singh explained. "But word spread so quickly."
Only the pediatric floor voiced a concern. However, when they reviewed the plan, the pediatric nurses agreed that they would administer earlier in the time-window rather than later to accommodate younger patients' sleep schedules.
Lessons to Share
The Bayhealth team offers the following advice for others considering similar workflow improvements:
- Start with data: Conduct a survey to learn about the unit’s needs. The team used AACN’s Healthy Work Environment Assessment Tool (HWEAT), which is a free survey.
- Secure leadership support: Get management and clinical coordinators on board to provide support and buy-in.
- Persist through initial resistance: Don't give up just because there may be some resistance in the first few months of the trial. In time, others will see the change and feel it. But it takes time.
- Share visible results: Regularly share metrics showing improvement, which will help build momentum and convince any skeptics.
The Bayhealth team's experience demonstrates that sometimes the most effective solutions don't require additional resources — just a thoughtful reassessment of existing processes. By addressing the specific problem with a simple, targeted intervention, they transformed medication administration and the entire rhythm of patient care in their units.
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