Effective method of multidimensional work sampling in nursing homes

Sep 4 2006

A study to develop an effective method of multidimensional work sampling (MDWS) in nursing homes has found that, initially, the proportion of time pharmacists spend in non-professional or semi-professional activities compared with professional activities is 3:1.

The results of the study, undertaken by Queen's University, Belfast, were launched at the British Pharmaceutical Conference in Manchester today.

Multidimensional work sampling is a methodology that is increasingly used in the healthcare setting to calculate the costs involved in the provision of complex healthcare services and is a useful tool for quantifying the work of a pharmacist.

This research calculated the change in healthcare resource usage in two nursing homes in Northern Ireland as a result of implementing a pharmaceutical care model previously used in a nursing home study in North Carolina, U.S.A.

The Fleetwood model is a holistic approach to structured pharmaceutical care in the nursing home setting, which was adapted for use in the UK.

Key Methodology

• A prescribing support pharmacist visited each home to provide a pharmaceutical care service according to a protocol.
• Three preliminary dimensions which described the pharmacist's activity, location (nursing home, travelling etc.) and contact (with nurse, GP etc.) were developed.
• An independent researcher observed the pharmacist's activities, location and contact while delivering the service to both nursing homes during the first visits. The time in minutes was measured continuously.
• Activities were classified into 15 main categories (which were further sub-categorised into 63 activities, 5 contacts and 6 locations) representing a range of pharmacist activities: professional, semi-professional and non-professional.

Key Results

• 25% of time was spent being professional, 30% semi-professional and 45% non-professional.
• Most time was spent collecting background information, travelling and formulating pharmaceutical care plans.
• The pharmacist spent the majority of time working alone in the nursing home (40%) or GP practice (31%).
• The large proportion of time spent in semi- or non-professional activities (3:1) was due to the need to establish working relationships and collect background data about each resident during the initial visit.

Pharmacist, Susan Patterson who led the study said that although the non-professional vs professional ratio proved to be 3:1, this proportion is likely to decrease. "It is likely that repeated pharmacist review visits would focus more n pharmaceutical care issues and we would therefore see an increase in professional activities," he said.

The method developed from this study will be used to perform a random multidimensional work sampling study which will calculate the change in healthcare resource usage as a result of the implementation of the adapted Fleetwood model for nursing home residents in Northern Ireland.