Effectiveness of an improvement programme to prevent interruptions during medication administration in a paediatric hospital: a preintervention–postintervention study

Abstract

ObjectiveTo assess the effectiveness of an improvement programme to reduce the number of interruptions during the medication administration process in a paediatric hospital.Design and methodsA prestudy–post study design was used to monitor nursing interruptions during medication cycles in a paediatric hospital. Interruptions were reported on an observation sheet (MADOS-P) adapted to the paediatric context.SettingA 600-bed tertiary paediatric research hospital in Italy.InterventionThe interventions included a yellow sash worn by nurses during medication cycles, a yellow-taped floor area indicating the ‘No interruption area’, visual notices in the medication areas, education sessions for healthcare providers and families, patient and parent information material.Results225 medication cycles were observed before the intervention (T0) and 261 after the intervention (T1). The median of interruptions occurring in each cycle decreased significantly from baseline to postintervention (8.0 vs 2.0, p=0.002), as the rate ratios (interruptions/patient post–pre ratio: 0.34; interruptions/medication post–pre ratio: 0.37; interruptions/hour of medication cycle post–pre ratio: 0.53, p<0.001). During preintervention, the main causes of interruptions were ‘other patients’ (19.9%), ‘other nurses’ (17.2%) and ‘conversation’ (15.7%); during postintervention, they were ‘other nurses’ (26.1%), ‘conversation’ (18.2%) and ‘other patients’ (17.4%).ConclusionsThis bundle of interventions proved to be an effective improvement programme to prevent interruptions during medication administration in a paediatric context.

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

“…They reported four to five such interruptions an hour, mostly from patients. Interventions to reduce interruptions document varying results depending on the context in which they are implemented (Dall'Oglio et al, 2017;Lapkin, Levett-Jones, Chenoweth, & Johnson, 2016;Westbrook et al, 2017). A review of the current literature indicates a knowledge gap related to medication administration and interruptions in the nursing home context.…”

The Effectiveness of Interventions to Reduce the Nurses’ Distractions during Medication Administration: A Systematic Review

“…The majority of the included studies were conducted in hospital wards (n = 6), while one study was completed in a medical centre which was equal to a regional hospital. (Ching, Long, Williams, & Blackmore, 2013;Dall'Oglio et al, 2017;Flynn, Evanish, Fernald, Hutchinson, & Lefaiver, 2016;Pape, 2013;Tomietto, Sartor, Mazzocoli, & Palese, 2012;Westbrook et al, 2017;Williams, King, Thompson, & Champagne, 2014) The total amount of wards studied was 41, and the type of ward varied from acute care wards and medical surgical wards through to intensive care wards, medical wards and an emergency unit. (Ching et al, 2013;Dall'Oglio et al, 2017;Flynn et al, 2016;Pape, 2013;Tomietto et al, 2012;Westbrook et al, 2017;Williams et al, 2014).…”

“…The majority of the included studies (n = 6) assessed the outcomes of the interventions in terms of preventing interruptions to the nurses during medication administration. (Dall'Oglio et al, 2017;Flynn et al, 2016;Pape, 2013;Tomietto et al, 2012;Westbrook et al, 2017;Williams et al, 2014) Furthermore, four studies evaluated the outcome of interventions in terms of eliminating medication errors. (Ching et al, 2013;Flynn et al, 2016;Pape, 2013;Williams et al, 2014) Two studies specified that the aim of their research was to examine the outcome of their interventions on the prevalence of interruption experienced by the nurses and to further scrutinize the multi-tasking rates among nurses during medication administration.…”

“…(Williams et al, 2014) The outcome of interest was assessed by the Collaborative Alliance for Nursing Outcomes (CALNOC) Medication Administration Accuracy Assessment in two studies (Ching et al, 2013;Flynn et al, 2016) and three studies utilized the Medication Administration Distraction Observation Sheet (MADOS) to observe the interruption rates. (Dall'Oglio et al, 2017;Pape, 2013;Williams et al, 2014) Westbrook, et al (Westbrook et al, 2017) applied the Work Observational Method by Activity Timing (WOMBAT) Software to collect the outcome of interest in real time and the remaining studies used direct observations for the interruptions. (Tomietto et al, 2012).…”

Interruptions during intravenous medication administration: A multicentre observational study

“…Another potentially effective approach are bundled interventions, which consist of a combination of do‐not‐disturb vests, hourly medication rounds, posters in medication rooms, patient and family education, information material, no interruption zones and triage of phone calls (Dall'Oglio et al., ; Relihan, O'Brien, O'Hara, & Silke, ; Westbrook et al., ). These interventions effectively reduced the frequency of interruptions during medication administration but were not focused specifically on IV medication and did not include dealing with multitasking or setting priorities.…”