SHM Converge Scientific Abstract ePoster Gallery-Deimplementing Deliriogenic Drug Dosing Defaults: Exploring the Feasibility of Adjusting Ehr Default Dosing Schedules to Reduce Overnight Disruptions

Deimplementing Deliriogenic Drug Dosing Defaults: Exploring the Feasibility of Adjusting Ehr Default Dosing Schedules to Reduce Overnight Disruptions

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This project explored whether changing default medication dosing times in the electronic health record could reduce both nursing workload and overnight patient sleep disruption in 11 hospitals.<br /><br />Researchers exported all standing medication doses from June 2025, excluding PRN and one-time orders, leaving 253,597 doses for analysis. In the current state, medication administration occurred during 11 possible med-pass times across the day. This created a heavy burden on day nurses, who handled 7 med passes compared with 4 for night nurses, and 74% of administrations fell to the day shift. Although 75% of doses were given during key times like breakfast, lunch, dinner, evening, and bedtime, 4.9% still occurred during sleep time, defined as 10 p.m. to 6 a.m.<br /><br />The team tested several alternative default schedules, including two AI-generated options and one human-designed option. The human-designed version performed best across all measures. Proposed changes shifted common frequencies such as daily, BID, q8h, q12h, TID, q6h, and QID to more patient-friendly times. Under the projected future state, the number of administration hours would drop from 11 to 8, day nurse med passes would decrease from 7 to 4, and administration would become more evenly distributed between day and night staff. Consolidation during key times would improve from 75% to 87%, and sleep-time dosing would fall from 4.9% to 2.2%, representing about 82,000 fewer overnight doses per year across the 11 hospitals.<br /><br />The authors conclude that optimizing default dosing times can reduce nursing burden while substantially decreasing unnecessary overnight disruptions, and they are working toward EHR implementation.

Asset Subtitle

Alan Kubey

Meta Tag

Author List Alan Kubey, Cara Martino, Charlene Eltman, Jeffrey Riggio

Category Innovations

Concept Medication Dosing Time

Concept Medication Administration

Concept Sleep Disruption

Concept Electronic Health Record

Concept Medication Frequency

Distinguished Non-Finalist

Presenter Organization Thomas Jefferson University and Mayo Clinic

Presenting Author Alan Kubey

Track Quality Improvement

Keywords

electronic health record

medication dosing times

nursing workload

overnight sleep disruption

hospital medication administration

default dosing schedule

day nurse med passes

sleep-time dosing

EHR optimization

patient-friendly dosing

Medication Dosing Time

Medication Administration

Sleep Disruption

Electronic Health Record

Medication Frequency