This study aimed to compare between electronic medication administration records and paper-based records in the nursing time spent on various activities in a medication round and the medicationadministration processes followed by nurses in an Australian residential aged care home. It also aimedto identify the benefits and unintended adverse consequences of using the electronic medication admin-istration records.Methods: Time–motion observation, taking of field notes, informal conversation and document reviewwere used to collect data in two units of a residential aged care home. Each unit had one nurse admin-ister medication. Seven nurses were observed over 12 morning shifts. Unit 1 used electronic medicationadministration records and Unit 2 used paper-based records.Results: No significant difference between the two units was found in the nursing time spent on variousactivities in a medication round, including documentation, verbal communication, medication adminis-tration, infection control and transit.Comparison of the medication administration processes between the electronic and paper-basedmedication administration records identified a procedural problem which violated the organization’sdocumentation requirement. This problem was documenting before providing medication to a residentwhen using the paper-based records. It was not observed with the electronic medication administrationrecords.Benefits of introducing the electronic medication administration records included improving nurses’compliance with documentation requirements, freedom from the error of signing twice, reducing thepossibility of forgetting to medicate a resident, facilitating nurses to record the time of medicationadministration to a resident and increasing documentation space. Unintended adverse consequencesof introducing the electronic medication administration records included inadequate information aboutresidents, late addition of a new resident’s medication profile in the records and nurses’ forgetting tomedicate a resident due to power outage of the portable device.Conclusions: The electronic medication administration records may not change nursing time spent onvarious activities in a medication round or substantially alter the medication administration processes,but can generate both benefits and unintended adverse consequences. Future research may investigatewhether and how the adverse consequences can be prevented.