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

Johanna I. Westbrook, Ling Li, Tamara D. Hooper, Magda Z. Raban, Sandy Middleton, Elin C. Lehnbom

Research output: Contribution to journalArticlepeer-review

54 Citations (Scopus)

Abstract

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 364.7hours, 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.

Original languageEnglish
Pages (from-to)734-742
Number of pages9
JournalBMJ Quality and Safety
Volume26
Issue number9
DOIs
Publication statusPublished or Issued - Sept 2017
Externally publishedYes

Keywords

  • Cluster trials
  • Interruptions
  • Medication safety
  • Nurses
  • Randomised controlled trial

ASJC Scopus subject areas

  • Health Policy

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