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J Nurs Adm. 2009 May;39(5):204-10. doi: 10.1097/NNA.0b013e3181a23d6d.

Medication Administration Time Study (MATS): nursing staff performance of medication administration.

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  • 1Northwestern Memorial Hospital, 251 East Huron Street, Chicago, IL 60611, USA.



The aim of this study was to develop and test a method for assessing nursing effort and workflow in the medication administration process.


Thousands of patients die each year from medication errors, and hospitals strive for error reduction. Bar-coding medication administration systems have been proposed as a solution; however, many hospitals lack the necessary pre-implementation workflow process data on medication administration processes to evaluate the effectiveness of their current systems.


A descriptive observation study of 151 nurses during 980 unique medication observations in medical-surgical units at a rural hospital, an urban community hospital, and an academic medical center was conducted.


Nurses averaged more than 15 minutes on each medication pass and were at risk of an interruption or distraction with every medication pass.


System challenges faced by nurses during the medication administration process lead to threats to patient safety, work-arounds, workflow inefficiencies, and distractions during a time when focus is most needed to prevent error.

[PubMed - indexed for MEDLINE]
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