OBJECTIVES

Time and Motion (T&M) methodology consists of breaking down a process into its main tasks and repeatedly measuring time for those tasks. The design of a T&M study requires prior process mapping to define the time outcomes to be measured. Mapping of the paediatric hexavalent immunisation process in the United Kingdom (UK) to determine the feasibility of a real-world study is described.

METHODS

A targeted review of publicly available information on the UK paediatric hexavalent immunisation process was conducted. Subsequently, a survey was designed to elicit the chronology of immunisation-related tasks prior to and on immunisation day, estimates of active health care professional time, and the occurrence of errors and wastage. Interviews were conducted with seven practice nurses experienced in paediatric hexavalent immunisation. Descriptive statistics were generated.

RESULTS

Activities prior to immunisation day include: inventory, ordering, collect/check stock at arrival, cold-chain management and booking appointments. Mean reported time for booking one appointment was 5.4 minutes and for daily cold-chain management 7.4 minutes. Mean time per week for inventory, ordering and collecting vaccineswas 46.5 minutes. Activities on immunisation day consist of seven steps: room preparation, child check-in, consultation, vaccine preparation, vaccine administration, waste disposal and record keeping. Mean reported time per child totaled 24.4 minutes, of which 16% dedicated to vaccine administration and 16% to vaccine preparation/reconstitution. Errors and wastage were reported to not or rarely occur.

CONCLUSIONS

Detailed mapping of the paediatric hexavalent immunisation process in the UK identified clearly discernible tasks. Preliminary time estimates from interviews revealed that a switch from lyophilised to pre-mixed hexavalent vaccines could save time per immunisation. This could be spent on other patient care activities. This study confirms the feasibility of an observational T&M study to generate time data that are more precise than opinion-based estimates presented here.