‘Do not interrupt’ Bundled Intervention to Reduce Medication Interruptions.

Journal Club Article: Westbrook, J. I., Li, L., Hooper, T. D., Raban, M. Z., Middleton, S., & Lehnbom, E. C. (2017). Effectiveness of a ‘Do not interrupt’ bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility studyBMJ Qual Saf, bmjqs-2016.

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

Method:parallel eight cluster randomised controlled study. Nurses were informed that the study was a direct observational study of medication administration and preparation tasks. Nursing staff were blinded to the study aim focused on interruptions and at baseline were blinded to the intervention. Only intervention ward staff were informed of the intervention subsequently.

Use of real time collected data using the Work Observational Method by Activity Timing Software (WOMBAT).

Setting: 4 wards in 1 hospital. Over 8 weeks and 364.7 hours, 227 nurses were observed administering 4781 medications.

Intervention: Wearing a vest when administering medications; strategies for diverting interruptions; clinician and patient education; and reminders.

Outcome Measures: 

  1. Primary outcome was non-medication-related interruptions during individual medication dose administrations.
  2. Secondary outcomes were total interruption and multitasking rates. A survey of nurses’ experiences was administered.

Intervention: The ‘Do not interrupt’ intervention comprised five ‘bundled’ elements:

  1. Wearing of a ‘Do not interrupt’ medication vest by nurses when preparing and administering medications,
  2. Interactive workshops with nurses regarding the purpose of the intervention to reduce non-medication-related interruptions and to identify local barriers and enablers to intervention use (eg, where to store vests),
  3. Brief standardised education sessions with clinical staff (eg, doctors, allied health),
  4. Patient information, which included why nurses were wearing a vest, and a request not to interrupt nurses during medication administration unless their concern was serious and urgent, or related to their medication. Patients were informed of other nurses and staff from whom to seek help if required,
  5. The use of reminders such as posters and stickers to inform health professionals, patients and visitors not to interrupt nurses during medication rounds for safety reasons.

Results: Baseline characteristics for control and interventions wards were similar.  Due to the observational approach of the study, the impact on influencing behaviours must be considered.

  • At baseline, nurses experienced 57 interruptions/100 administrations, 87.9% were unrelated to the medication task being observed.
  • A significant reduction of 15 non-medication-related interruptions/100 administrations compared with control wards.
  • Medication
  • The intervention more effective reducing interruptions from other nurses, no substantial impact from patient interruptions.
  • Intervention ward nurses reported that vests were time consuming, cumbersome and hot.
  • Only 48% of nurses indicated that they would support the intervention becoming hospital policy.
  •  There was reduction in multitasking rates in the intervention wards compared to control wards.

Discussion: The main aspect was the reduction of interruptions (30%) which potentially (as reduction in medication errors was not measured) translates to a reduction in medication administered errors (MAEs) of 1.8%.

This study was conducted in a paper system, so the impact of electronic medication administration records (eMARs) on reducing medication errors needs to be considered.

If visual aids such as vests are not a preference for nurses, also the infection control issue moving around the ward then educating nurses to deal with interruptions is advocated.

Resources

Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administrationJournal of Clinical Nursing24(21-22), 3063-3076.

Westbrook, J. I., Woods, A., Rob, M. I., Dunsmuir, W. T., & Day, R. O. (2010). Association of interruptions with an increased risk and severity of medication administration errorsArchives of Internal medicine170(8), 683-690.

Westbrook, J. I., & Ampt, A. (2009). Design, application and testing of the Work Observation Method by Activity Timing (WOMBAT) to measure clinicians’ patterns of work and communication. International Journal of Medical Informatics78, S25-S33.

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