TY - JOUR
T1 - Effectiveness of a Do not interrupt' bundled intervention to reduce interruptions during medication administration
T2 - A cluster randomised controlled feasibility study
AU - Westbrook, Johanna I.
AU - Li, Ling
AU - Hooper, Tamara D.
AU - Raban, Magda Z.
AU - Middleton, Sandy
AU - Lehnbom, Elin C.
N1 - Publisher Copyright:
© Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
PY - 2017/9
Y1 - 2017/9
N2 - 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.
AB - 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.
KW - Cluster trials
KW - Interruptions
KW - Medication safety
KW - Nurses
KW - Randomised controlled trial
UR - http://www.scopus.com/inward/record.url?scp=85029952441&partnerID=8YFLogxK
U2 - 10.1136/bmjqs-2016-006123
DO - 10.1136/bmjqs-2016-006123
M3 - Article
C2 - 28232390
AN - SCOPUS:85029952441
SN - 2044-5415
VL - 26
SP - 734
EP - 742
JO - BMJ Quality and Safety
JF - BMJ Quality and Safety
IS - 9
ER -