Interruptions and medication administration in critical care

Patient safety improvement in the gastroenterology department: An action research

BACKGROUND

Patient safety is a global concern. Safe and effective care can shorten hospital stays and prevent or minimize unintentional harm to patients. Therefore, it is necessary to continuously monitor and improve patient safety in all medical environments. This study is aimed at improving patient safety in gastroenterology departments.

METHODS

The study was carried out as action research. The participants were patients, nurses and doctors of the gastroenterology department of Ayatollah Taleghani Hospital in Tehran in 2021-2022. Data were collected using questionnaires (medication adherence tool, patient education effectiveness evaluation checklist, and medication evidence-based checklist), individual interviews and focus groups. The quantitative data analysis was done using SPSS (v.20) and qualitative data analysis was done through content analysis method using MAXQDA analytic pro 2022 software.

RESULTS

The majority of errors were related to medication and the patient's fault due to their lack of education and prevention strategy were active supervision, modification of clinical processes, improvement of patient education, and promotion of error reporting culture. The findings of the research showed that the presence of an active supervisor led to the identification and prevention of more errors (P<0.01). Regarding the improvement of clinical processes, elimination of reworks can increase satisfaction in nurses (P<0.01). In terms of patient education, the difference was not statistically significant (P>0.01); however, the mean medication adherence score was significantly different (P<0.01).

CONCLUSION

The improvement strategies of patient safety in Gastroenterology department included the modification of ward monitoring processes, improving/modification clinical processes, improvement of patient education, and development of error reporting culture. Identifying inappropriate processes and adjusting them based on the opinion of the stakeholders, proper patient education regarding self-care, careful monitoring using appropriate checklists, and presence of a supervisor in the departments can be effective in reducing the incidence rate. A comprehensive error reporting program provides an opportunity for employees to report errors.

Educational interventions to reduce nurse medication interruptions: A scoping review

BACKGROUND

Preventable harm from medicines is a global problem creating huge economic and social burden. Interruptions occur frequently in clinical environments causing medication episodes to take longer and having a cognitive cost on the nurse.

AIM

The aim of this scoping review is to identify and evaluate educational interventions that have been employed to reduce medication interruptions and improve medication safety.

METHODS

Six databases were searched for the scoping review (PubMed, Embase, Cochrane Library, CINAHL, Pishin and Medline) along with reference lists and grey literature searches. Articles were included if they were written in English, published between 2010 and 2020 and employed an education intervention (including bundled interventions). Databases were searched using keywords and Boolean operators.

RESULTS

Eight studies met the inclusion criteria. Seven of these studies were conducted in hospital (adults n = 6, paediatric n = 1) and one study in a university with undergraduate nurses. Four studies used a combined intervention and four exclusively employed an education intervention. Five studies found a significant decrease in the number of interruptions post intervention, but one of the studies that exclusively employed an education intervention found no significant difference. Changes in the nurses' behaviour post intervention were also cited in two studies.

IMPLICATIONS FOR FUTURE RESEARCH

There was a lack of exclusive education interventions, making it difficult to determine the effectiveness of education at reducing medication interruptions. This review highlights the necessity of some interruptions when performing tasks, for example, to make a nurse aware of a deteriorating patient. However, as the majority of studies used the number of interruptions to determine the effectiveness of the intervention, there is uncertainty as to whether this is the right outcome measure to use. In the future, a focus on outcome measures reflecting change in nurse behaviour may be more effective in determining the strength of an educational intervention.

Systematic review of interruptions in the emergency department work environment

OBJECTIVE

The purpose of this systematic review is to describe the operationalization of interruptions measurement and to synthesize the evidence on the causes and consequences of interruptions in the emergency department (ED) work environment.

METHODS

This systematic review of studies explores the causes and consequences of interruptions in the ED. Of 2836 abstract/titles screened, 137 full-text articles were reviewed, and 44 articles met inclusion criteria of measuring ED interruptions.

RESULTS

All articles reported primary data collection, and most were cohort studies (n = 30, 68%). Conceptual or operational definitions of interruptions were included in 27 articles. Direct observation was the most common approach. In half of the studies, quantitative measures of interruptions in the ED were descriptive only, without measurements of interruptions' consequences. Twenty-two studies evaluated consequences, including workload, delays, satisfaction, and errors. Overall, relationships between ED interruptions and their causes and consequences are primarily derived from direct observation within large academic hospitals using heterogeneous definitions. Collective strengths of interruptions research in the ED include structured methods of naturalistic observation and definitions of interruptions derived from concept analysis. Limitations are conflicting and complex evaluations of consequences attributed to interruptions, including the predominance of descriptive reports characterizing interruptions without direct measurements of consequences.

CONCLUSIONS

The use of standardized definitions and measurements in interruptions research could contribute to measuring the impact and influence of interruptions on clinicians' productivity and efficiency as well as patients' outcomes, and thus provide a basis for intervention research.

Interruption in the work of nursing professionals: conceptual analysis

OBJECTIVES

to analyze the concept of "interruption in the work of nursing professionals".

METHODS

conceptual study according to the method proposed by Walker and Avant through integrative literature review. The study searched the databases using the descriptors: "Attention", "Attention Bias", "Health Personnel", "Nurses", "Patient Safety" and "Medical Malpractices". The sample consisted of 36 studies.

RESULTS

the antecedents were alarms, answering phone calls, providing patient care, and lack of material/medicine. The defining attributes were pause, suspension, breakage, and intrusion. In relation to the consequences, the study highlighted the increase in frequency and severity of medication errors and change of focus.

FINAL CONSIDERATIONS

theconceptual analysis identified the attributes, antecedents, and consequences and allowed to build an operational definition for "interruption in the work of nursing professionals". It will contribute to the improvement of the work process and the creation of strategies that ensure safer care for the patient.

Nurse Cognition, Decision Support, and Barcode Medication Administration: A Conceptual Framework for Research, Practice, and Education

This article synthesizes theoretical perspectives related to nurse cognition. We present a conceptual model that can be used by multiple stakeholders to study and contemplate how nurses use clinical decision support systems, and specifically, Barcode-Assisted Medication Administration, to make decisions during the delivery of care. Theoretical perspectives integrated into the model include dual process theory, the Cognitive Continuum Theory, human factors engineering, and the Recognition-Primed Decision model. The resulting framework illustrates the process of nurse cognition during Barcode-Assisted Medication Administration. Additionally, the model includes individual or human and environmental factors that may influence nurse cognition and decision making. It is important to consider the influence of individual, human, and environmental factors on the process of nurse cognition and decision making. Specifically, it is necessary to explore the impact of heuristics and biases on clinician decision making, particularly related to the development of alarm and alert fatigue. Aided by the proposed framework, stakeholders may begin to identify heuristics and cognitive biases that influence the decision of clinicians to accept or override a clinical decision support system alert and whether heuristics and biases are associated with inappropriate alert override.

Interventions to Reduce Pediatric Prescribing Errors in Professional Healthcare Settings: A Systematic Review of the Last Decade

INTRODUCTION

Pediatric medication therapy is prone to errors due to the need for pharmacokinetic and pharmacodynamic individualization and the diverse settings in which pediatric patients are treated. Prescribing errors have been reported as the most common medication error.

OBJECTIVES

The aim of this review was to systematically identify interventions to reduce prescribing errors and corresponding patient harm in pediatric healthcare settings and to evaluate their impact.

METHODS

Four databases were systematically screened (time range November 2011 to December 2019), and experimental studies were included. Interventions to reduce prescribing errors were extracted and classified according to a 'hierarchy of controls' model.

RESULTS

Forty-five studies were included, and 70 individual interventions were identified. A bundle of interventions was more likely to reduce prescribing errors than a single intervention. Interventions classified as 'substitution or engineering controls' were more likely to reduce errors in comparison with 'administrative controls', as is expected from the hierarchy of controls model. Fourteen interventions were classified as substitution or engineering controls, including computerized physician order entry (CPOE) and clinical decision support (CDS) systems. Administrative controls, including education, expert consultations, and guidelines, were more commonly identified than higher level controls, although they may be less likely to reduce errors. Of the administrative controls, expert consultations were most likely to reduce errors.

CONCLUSIONS

Interventions to reduce pediatric prescribing errors are more likely to be successful when implemented as part of a bundle of interventions. Interventions including CPOE and CDS that substitute risks or provide engineering controls should be prioritized and implemented with appropriate administrative controls including expert consultation.

Interventions to Reduce Medication Dispensing, Administration, and Monitoring Errors in Pediatric Professional Healthcare Settings: A Systematic Review

Introduction: Pediatric patients cared for in professional healthcare settings are at high risk of medication errors. Interventions to improve patient safety often focus on prescribing; however, the subsequent stages in the medication use process (dispensing, drug administration, and monitoring) are also error-prone. This systematic review aims to identify and analyze interventions to reduce dispensing, drug administration, and monitoring errors in professional pediatric healthcare settings. Methods: Four databases were searched for experimental studies with separate control and intervention groups, published in English between 2011 and 2019. Interventions were classified for the first time in pediatric medication safety according to the "hierarchy of controls" model, which predicts that interventions at higher levels are more likely to bring about change. Higher-level interventions aim to reduce risks through elimination, substitution, or engineering controls. Examples of these include the introduction of smart pumps instead of standard pumps (a substitution control) and the introduction of mandatory barcode scanning for drug administration (an engineering control). Administrative controls such as guidelines, warning signs, and educational approaches are lower on the hierarchy and therefore predicted by this model to be less likely to be successful. Results: Twenty studies met the inclusion criteria, including 1 study of dispensing errors, 7 studies of drug administration errors, and 12 studies targeting multiple steps of the medication use process. A total of 44 interventions were identified. Eleven of these were considered higher-level controls (four substitution and seven engineering controls). The majority of interventions (n = 33) were considered "administrative controls" indicating a potential reliance on these measures. Studies that implemented higher-level controls were observed to be more likely to reduce errors, confirming that the hierarchy of controls model may be useful in this setting. Heterogeneous study methods, definitions, and outcome measures meant that a meta-analysis was not appropriate. Conclusions: When designing interventions to reduce pediatric dispensing, drug administration, and monitoring errors, the hierarchy of controls model should be considered, with a focus placed on the introduction of higher-level controls, which may be more likely to reduce errors than the administrative controls often seen in practice. Trial Registration Prospero Identifier: CRD42016047127.

Northeastern Ontario nurses' perceptions of e-learning: An interpretive description

BACKGROUND

E-learning is a common method of continuing education for nurses that supports professional competencies and learning needs. However, variations in setting, information technology, and quality of the e-learning may impact these experiences.

OBJECTIVE

To explore registered nurses' perceptions of e-learning in a hospital setting.

DESIGN

A qualitative study using an Interpretive Description methodology.

SETTING

A small urban Northeastern Ontario hospital.

PARTICIPANTS

Ten registered nursing staff from acute medical and surgical inpatient departments.

METHOD

Face-to-face semi-structured interviews were conducted to explore nurses' e-learning perceptions. Interview transcripts were analyzed for themes.

RESULTS

Three key themes were found that described the participants' perceptions of e-learning and how it related to their continuing education: Unsatisfactory, Meaningful, and Enhancing learning experiences.

CONCLUSION

E-learning can be a useful method of continuing education for registered nurses; however, there are challenges in the delivery of e-learning and an ongoing need for quality development.

Prescription for care

Nursing and midwifery practice has evolved, with many nurses and midwives now holding prescriptive authority. This paper reports on findings in relation to care which formed part of a broader qualitative study which aimed to explore the experiences of nurse and midwife prescribers in the maternity setting in Ireland. Following research ethics approval, 16 nurse/midwife prescribers participated in one-to-one audio recorded semi-structured interviews. Prescriptive authority both enhances the caring role of the nurse/midwife and supports safer care. The ways in which this happened have been illuminated though barriers have also been identified. In order for the full potential of nurses/midwives with prescriptive authority to be realised, measures such as increasing the number of prescribers and the provision on non-interruption zones need to be considered.

Patient safety incidents and medication errors during a clinical trial: experience from a pre-hospital randomized controlled trial of emergency medication administration

AIM

To assess and evaluate patient safety incidents and in particular, medication errors, during a large multi-center pre-hospital trial of emergency therapy (PARAMEDIC2), in order to inform and improve future pre-hospital medicines trials.

METHODS

The PARAMEDIC2 trial was undertaken across five NHS Ambulance Services in England and Wales with randomisation between December 2014 and October 2017. Patients with an out -of-hospital cardiac arrest unresponsive to initial resuscitation were randomly assigned to 1 mg intravenous adrenaline or matching placebo. Records were reviewed to identify trial medication errors involving documentation and/or clinical protocol errors occurring in trial participants. Causes of medication errors, including root cause analysis where available, were reviewed to identify patterns and themes contributing to these errors.

RESULTS

Eight thousand sixteen patients were enrolled, of whom 4902 received trial medication. A total of 331 patient safety incidents was reported, involving 295 patients, representing an overall rate of 3.6% of these, 166 (50.2%) were documentation errors while 165 (49.8%) were clinical protocol/medication errors. An overall rate of 0-4.5% was reported across all five ambulance services, with a mean of 2.0%. These errors had no impact on patient care or the trial and were all resolved CONCLUSION: The overall medication error rate of 1.8% primarily consisted of administration of open-label adrenaline and confusion with trial medication packs. A similar number of patients had documentation errors. This study is the first to provide data on patient safety incidents relating to medication errors encountered during a pre-hospital trial of emergency medication administration and will provide supporting data for planning future trials in this area.

Effect of Personalized Music Intervention in Mechanically Ventilated Children in the PICU: A Pilot Study

OBJECTIVES

To determine the feasibility of a personalized music intervention with mechanically ventilated patients in the PICU.

DESIGN

Pilot study with a quasi-experimental design.

SETTING

Tertiary children's hospital in China with a 40-bed PICU.

PATIENTS

Children, 1 month to 7 years, with mechanical ventilation were recruited and assigned to music group (n = 25) and control group (n = 25).

INTERVENTIONS

Children in the music group received their own favorite music and listened for 60 minutes three times a day. The control group receive routine care without music.

MEASUREMENTS AND MAIN RESULTS

Primary outcome measure was comfort measured with the COMFORT Behavior scale 5 minutes before and after the music. Secondary outcome measures were physiologic variables; heart rate, respiration, blood pressure, oxygen saturation. Mechanical ventilation time, length of stay, and sedation medication were also collected. Qualitative analysis revealed that nurses had a positive attitude in delivering the interventions and identified improvements for the main trial. Children in the music group had lower COMFORT Behavior scores (15.7 vs 17.6; p = 0.011). Children in the music group had better physiologic outcomes; heart rate (140 vs 144; p = 0.039), respiration rate (40 vs 43; p = 0.036), systolic blood pressure (93 vs 95 mm Hg; p = 0.031), oxygen saturation (96% vs 95%; p < 0.001), diastolic blood pressure was not significantly (52 vs 53 mm Hg; p = 0.11). Children in the music group had a shorter ventilation time (148.7 vs 187.6; p = 0.044) and a shorter length of stay, but not significant (11.2 vs 13.8; p = 0.071). Children in the control group had higher total amount of on-demand midazolam (29 vs 33 mg; p = 0.040).

CONCLUSIONS

Our pilot study indicates that personalized music intervention is feasible and might improve the comfort of children with mechanical ventilation. Further studies are needed to provide conclusive evidence in confirming the effectiveness of music interventions comforting critically ill children in PICUs.

Association of medication administration errors with interruption among nurses in public sector tertiary care hospitals

Objectives:

To determine the association of medication administration errors with interruption among nurses working at public sector tertiary care hospitals in Karachi, Pakistan.

Methods:

An analytical cross-sectional study was accomplished at two public sector healthcare facilities Civil Hospital, and Dow University Hospital, Karachi. The study was carried out from October 2017 to July 2018 over a period of 10 months. The sample was calculated by using OpenEpi version 3.0. By taking 56.4% of medication administration errors, 5% margin of error and 95% confidence level. The calculated sample size was 204 of both genders. The subjects both male and female nurses having a valid license from Pakistan Nursing Council and one year of clinical experience were enrolled in the study. The subjects were approached by using non-probability purposive sampling method. Validated and adapted questionnaire utilized to gather the data. Data was entered and analyzed by using SPSS version 21.0.

Results:

In this study, total 204 nurses were included, almost half (52%) of them were male. Majority of (82.3%) study participants had age between 25-35 years old. There were total 716 medications given by 204 nurses. Out of these, 295 (41.2%) were antibiotics, other common medications were acid-suppressive, analgesic and antiemetic 14.5%, 15.9% and 11.2% respectively. Among all 716 medications, 644 (89.9%) were given intravenously whereas only 6.7% drugs given orally. A significant association has been found between medication administration errors and interruption like talking with other health care personnel, patients or attendant queries, phone calls (p-value=<0.001). Nearly 91% of the study nurses who were interrupted during medication committed medication errors.

Conclusion:

It is concluded that there is a significant association between medication administration errors with interruption among nurses.

An urban medical system's exploratory study of medication errors

AIMS

This study sought to identify patterns of medication errors with respect to shifts, day of week, unit involved, severity, medication class and cause of errors and to propose possible solutions.

DESIGN

This was a retrospective explorative study using a database containing 605 medication events from two medical centres. Variables assessed include medication type, the error severity, and time the medication was ordered, the unit that the error occurred on and the day of the week of the errors.

METHODS

Simple percentages were used to report the results, and point-biserial correlation was employed to test for significant differences between the day and night shifts.

RESULTS

There were no statistically significant findings when comparing event severity against the a.m. or p.m. shifts. The medication classes with the most errors were antibiotics, and the most common reason cited for errors was dose omission. The most commonly reported severity level was a 2 which requires increased patient monitoring.

Perception of clinical deterioration cues among medical-surgical nurses

AIM

To examine medical-surgical nurses' capacity and tendency to perceive cues indicating clinical deterioration and nursing characteristics influencing deterioration cue perception.

DESIGN

Cross-sectional, explorative study design.

METHODS

Data were collected over 10 weeks between September-November 2017. Medical-surgical nurses completed an online survey consisting of a demographic questionnaire, the Occupational Fatigue, Exhaustion Recovery scale and 50 detection trials. Descriptive statistics and statistical tests were used to describe and interpret data.

FINDINGS

A significant association was found between nurses' capacity and tendency to perceive deterioration cues. As nurses' capacity to perceive deterioration cues increased, nurses were more likely to classify patient cues as indicators of deterioration. Fatigue, education, and certification were not identified as characteristics associated with deterioration cue perception. However, experience was observed to significantly influence nurses' capacity to perceive deterioration cues based on levels of skills acquisition.

CONCLUSION

Study findings imply that future research should be directed at determining whether other individual factors and organizational system dynamics influence deterioration cue perception.

IMPACT

To better understand how nurses perceive deterioration cues, this study integrated concepts from the Situation Awareness model and Signal Detection Theory. Novice, advanced beginner and competent nurses were found to have a lower capacity to perceive deterioration cues compared with proficient and expert nurses. With simulation increasingly being used as a primary teaching modality in nursing, the development of a simulation-based signal detection training intervention may be beneficial in enhancing deterioration cue perception.

The Impact of Phone Interruptions on the Quality of Simulated Medication Order Validation Using Eye Tracking: A Pilot Study

INTRODUCTION

Order validation is an important component of pharmacy services, where pharmacists review orders with a focus on error prevention. Interruptions are frequent and may contribute to a reduction in error detection, thus potential medication errors. However, studying such errors in practice is difficult. Simulation has potential to study these events.

METHODS

This was a pilot, simulation study. The primary objective was to determine the rate of medication error detection and the effect of interruptions on error detection during simulated validation. Secondary objectives included determining time to complete each prescription page. The scenario consisted of validating three handwritten medication order pages containing 12 orders and 17 errors, interrupted by three phone calls timed during one order for each page. Participants were categorized in groups: seniors and juniors (including residents). Simulation sessions were videotaped and eye tracking was used to assist in analysis.

RESULTS

Eight senior and five junior pharmacists were included in the analysis. There was a significant association between interruption and error detection (odds ratio = 0.149, 95% confidence interval = 0.042-0.525, P = 0.005). This association did not vary significantly between groups (P = 0.832). Juniors took more time to validate the first page (10 minutes 56 seconds vs. 6 minutes 42 seconds) but detected more errors (95% vs. 69%). However, all major errors were detected by all participants.

CONCLUSIONS

We observed an association between phone interruptions and a decrease in error detection during simulated validation. Simulation provides an opportunity to study order validation by pharmacists and may be a valuable teaching tool for pharmacists and pharmacy residents learning order validation.

A qualitative study of nurses' perceptions of a behavioural strategies e-learning program to reduce interruptions during medication administration

OBJECTIVES

We sought to evaluate the perceptions of nurses of an e-learning educational program to encourage the use of behavioural strategies-blocking, engaging, mediating, multitasking, and preventing-to reduce the negative effects of interruptions during medication administration.

DESIGN

A qualitative design was used to evaluate the impact of this e-learning educational intervention on nurses' behaviour.

SETTINGS

Two wards (palliative care and aged care) from two different hospitals within a large local health service within Sydney Australia, were included in the study. These wards were also involved in a cluster randomised trial to test the effectiveness of the program.

PARTICIPANTS

A purposive sample participated comprising nine registered and enrolled nurses certified to conduct medication administration, who had reviewed the educational modules.

METHODS

Two focus groups were conducted and these sessions were digitally recorded and transcribed verbatim. Thematic analysis identified seven themes.

RESULTS

The major themes identified included: perceptions of interruptions, accessing the program, content of the program, impact, maintaining good practice and facilitators and barriers to changing behaviour.

CONCLUSIONS

The use of embedded authentic images of patient interruptions and management strategies increased some nurses' perceived use of strategies to manage interruptions. Nurses varied in their perception as to whether they could change their behaviour with some describing change at the individual and ward team levels, while others described patient caseload and other health professionals as a barrier. The use of this innovative educational intervention is recommended for staff orientation, student nurses, medical officers and allied health staff. Further research is required in how this e-learning program can be used in combination with other effective interventions to reduce interruptions.

Distractions and interruptions in a surgical room: perception of nursing staff

Abstract Objective: To understand the perception of nursing staff about intraoperative distractions and interruptions. Methods: An exploratory qualitative study was performed with 16 nursing professionals of a surgical center in Minas Gerais. The data were collected through a semi-structured interview and thematic content analysis was performed. Results: When reflecting on the occurrence of distractions and interruptions of intraoperative activities, nursing professionals define, identify and value events in a heterogeneous way, but believe that distractions and interruptions negatively affect both the quality of the work environment and the safety of care provided to the surgical patient. Factors contributing to the occurrence of distractions and interruptions are related to aspects inside the operating room such as equipment failure and use of cell phones and to external factors such as verbal messages given at the operating room door. Incidents have been reported due to distractions, but there are no established actions to minimize these events. Conclusion: This study indicates the importance of implementing strategies that minimize the occurrence of distractions and interruptions of intraoperative activities in order to plan surgical care better, and prevent and mitigate harm to patients.

Predictability of Interruptions During Medication Administration With Related Behavioral Management Strategies

The aim of this qualitative study was to examine the nature of interruptions during medication administration. Focus groups were conducted with medical/surgical nurses (n = 15), critical care nurses (n = 13), and nurse managers/educators/specialists (n = 6). Most interruptions (78%) were predictable. Nurse-adopted strategies included blocking, engaging, mediating, multitasking, and preventing. Educational content was developed that relates behavioral strategies to respond to predictable and unpredictable interruptions.

Medication administration and interruptions in nursing homes: A qualitative observational study

AIMS AND OBJECTIVES

To contribute in-depth knowledge of the characteristics of medication administration and interruptions in nursing homes. The following research questions guided the study: How can the medication administration process in nursing homes be described? How can interruptions during the medication administration process in nursing homes be characterized?

BACKGROUND

Medication administration is a vital process across healthcare settings, and earlier research in nursing homes is sparse. The medication administration process is prone to interruptions that may lead to adverse drug events. On the other hand, interruptions may also have positive effects on patient safety.

DESIGN

A qualitative observational study design was applied.

METHODS

Data were collected using partial participant observations. An inductive content analysis was performed.

RESULTS

Factors that contributed to the observed complexity of medication administration in nursing homes were the high number of single tasks, varying degree of linearity, the variability of technological solutions, demands regarding documentation and staff's apparent freedom as to how and where to perform medication-related activities. Interruptions during medication administration are prevalent and can be characterised as passive (e.g., alarm and background noises), active (e.g., discussions) or technological interruptions (e.g., use of mobile applications). Most interruptions have negative outcomes, while some have positive outcomes.

CONCLUSIONS

A process of normalisation has taken place whereby staff put up with second-rate technological solutions, noise and interruptions when they are performing medication-related tasks. Before seeking to minimise interruptions during the medication administration process, it is important to understand the interconnectivity of the elements using a systems approach.

RELEVANCE TO CLINICAL PRACTICE

Staff and management need to be aware of the normalisation of interruptions. Knowledge of the complexity of medication administration may raise awareness and highlight the importance of maintaining and enhancing staff competence.

Work Interruption Experienced by Nurses during Medication Administration Process and Associated Factors, Northwest Ethiopia

BACKGROUND

During medication administration process, including preparation, administration, and documentation, there is high proportion of work interruption that results in medication administration errors that consequently affect the safety of patients. Thus, the main purpose of this study was to assess the prevalence of work interruption and associated factors during medication administration process.

METHODS

A prospective, observation-based, cross-sectional study was conducted on 278 nurses. Structure observational sheet was utilized to collect data. EPI Info version 3.5.3 and SPSS version 20 software were utilized for data entry and analysis, respectively. Binary and multivariable logistic regression were fitted to identify the associated factors using an odds ratio and 95% CI.

RESULTS

The incidence of work interruption was found to be 1,152 during medication administration process. Of this, 579 (50.3%) were major/severe work interruptions. Unit of work, day of the week, professional experience, perceived severity of work interruption, source/initiator of interruption, and secondary tasks were factors significantly associated with major work interruptions at p < 0.05.

CONCLUSION

In this study, more than half of work interruption was major/severe. Thus, the authors suggest raising the awareness of nurses regarding the severity of work interruptions, with special attention to those who have lower work experience, sources of interruption, and secondary tasks by assigning additional nurses who manage secondary tasks and supportive supervision.

A combined intervention to reduce interruptions during medication preparation and double-checking: a pilot-study evaluating the impact of staff training and safety vests

AIM

The aim was to evaluate the impact of staff training and wearing safety vests as a combined intervention on interruptions during medication preparation and double-checking.

BACKGROUND

Interruptions and errors during the medication process are common and an important issue for patient safety in the hospital setting.

METHODS

We performed a pre- and post-intervention pilot-study using direct structured observation of 26 nurses preparing and double-checking 431 medication doses (225 pre-intervention and 206 post-intervention) for 36 patients (21 pre-intervention and 15 post-intervention).

RESULTS

With staff training and the introduction of safety vests, the interruption rate during medication preparation was reduced from 36.8 to 28.3 interruptions per hour and during double-checking from 27.5 to 15 interruptions per hour.

CONCLUSION

This pilot-study showed that the frequency of interruptions decreased during the critical tasks of medication preparation and double-checking after the introduction of staff training and wearing safety vests as part of a quality improvement process.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing management should acknowledge interruptions as an important factor potentially influencing medication safety. Unnecessary interruptions can be successfully reduced by considering human and system factors and increasing both staff and nursing managers' awareness of 'interruptive communication practices' and implementing physical barriers. This is the first pilot-study specifically evaluating the impact of staff training and wearing safety vests on the reduction of interruptions during medication preparation and double-checking.

The Effectiveness of Simulation on Recognizing and Managing Clinical Deterioration: Meta-Analyses

The purpose of these meta-analyses was to quantitatively synthesize the effectiveness of simulation on student nurses’ and registered nurses’ ability to recognize and manage clinical deterioration in the acute care setting. A search of the literature resulted in 22 reports and 19 studies meeting inclusion criteria. Four random-effects analyses were conducted to examine two-group posttest and single-group pre–posttest intervention effect sizes for knowledge and performance. A total of 41 effect sizes were calculated from the data extracted. The standardized mean difference ( d) for two-group posttest knowledge was d = 0.964 ( p = .001) and for performance was d = 1.382 ( p ≤ .001). The standardized mean difference for single-group pre–posttest knowledge was d = 1.231 ( p ≤ .001) and performance was d = 1.610 ( p ≤ .001). Findings indicate that simulation-based interventions have a positive effect on knowledge and performance. As simulation is increasingly used as a teaching modality in nursing, further research should aim to test standardized simulation-based education programs.

Effectiveness of a 'Do not interrupt' bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study

Aim

To evaluate the effectiveness of a ‘Do not interrupt’ bundled intervention to reduce non-medication-related interruptions to nurses during medication administration.

Methods

A parallel eight cluster randomised controlled study was conducted in a major teaching hospital in Adelaide, Australia. Four wards were randomised to the intervention which comprised wearing a vest when administering medications; strategies for diverting interruptions; clinician and patient education; and reminders. Control wards were blinded to the intervention. Structured direct observations of medication administration processes were conducted. The primary outcome was non-medication-related interruptions during individual medication dose administrations. The secondary outcomes were total interruption and multitasking rates. A survey of nurses' experiences was administered.

Results

Over 8 weeks and 364.7 hours, 227 nurses were observed administering 4781 medications. At baseline, nurses experienced 57 interruptions/100 administrations, 87.9% were unrelated to the medication task being observed. Intervention wards experienced a significant reduction in non-medication-related interruptions from 50/100 administrations (95% CI 45 to 55) to 34/100 (95% CI 30 to 38). Controlling for clustering, ward type and medication route showed a significant reduction of 15 non-medication-related interruptions/100 administrations compared with control wards. A total of 88 nurses (38.8%) completed the poststudy survey. Intervention ward nurses reported that vests were time consuming, cumbersome and hot. Only 48% indicated that they would support the intervention becoming hospital policy.

Discussion

Nurses experienced a high rate of interruptions. Few were related to the medication task, demonstrating considerable scope to reduce unnecessary interruptions. While the intervention was associated with a statistically significant decline in non-medication-related interruptions, the magnitude of this reduction and its likely impact on error rates should be considered, relative to the effectiveness of alternate interventions, associated costs, likely acceptability and long-term sustainability of such interventions.