Paradoxical effects of a hospital-based, multi-intervention programme aimed at reducing medication round interruptions

Abstract

Before introducing new strategies, an evaluation of their appropriateness with regard to the culture of the patients and nurses is recommended: in the present study, patients seem to have considered the warning message worn by nurses as mainly intended for them.

How do interruptions affect clinician performance in healthcare? Negotiating fidelity, control, and potential generalizability in the search for answers

“…A recent review of studies that have tested interventions to reduce interruptions and, by implication, to reduce medication administration errors, has noted that there is only weak evidence that such interventions are effective (Raban & Westbrook, 2014). In this section we highlight a "multi-intervention" study by Tomietto, Sartor, Mazzocoli, and Palese (2012), which led to conflicting outcomes, a medication administration accuracy study by Kliger, Singer, Hoffman, and O'Neil (2012) that included minimising interruptions and distractions, and an early study of interventions by Pape (2003) to reduce interruptions. Interventions are sometimes the end-point of a sustained program of research into interruptions (Colligan, Guerlain, Steck, & Hoke, 2012;Prakash et al, 2014;Trbovich, Howell, et al, 2010) and programmatic research will be covered in a later section.…”

“…The three intervention studies described have not been motivated by theoretical accounts of how interruptions might lead to harm, but instead by the practical goal of improving the accuracy of medication administration and removing the potential for error. Indeed, given that the evidence for a causal connection between interruptions and errors is still tenuous Hopkinson & Jennings, 2013;Raban & Westbrook, 2014) and given reports of paradoxical outcomes (Tomietto et al, 2012) it is arguable that intervention studies are premature. Elsewhere we have argued that to draw a connection between interruptions and harm, we need a theory not just of the effect of interruptions on human cognition, but also of how accidents occur .…”

“…Until there is better differentiation between interruptions and distractions that are helpful communication events promoting organizational resilience vs. those that are not helpful Sasangohar et al, 2012) and better understand of the reasons that clinicians interrupt (Rivera, 2014), intervention studies will be difficult to design effectively and may lead to paradoxical results (Tomietto et al, 2012).…”

“…In the Tomietto et al (2012) study, the interventions intended to reduce interruptions included a special medication preparation room, a red tabard to be worn by the nurse doing the medication round, and general education of staff on the new changes. Although the total number of interruptions decreased after the above interventions were introduced, Tomietto et al found that interruptions by staff to the nurse actually become more frequent, but shorter, whereas interruptions by patients to the nurse became less frequent and shorter.…”

Nursing Innovations: Medication Administration Errors and Safety

“…Documentation the medication in a chart before the medication has been administered is a wrong, because of the patient may refuse to take this medication or, in some cases, forget to take them. Similarly, failing to sign when a medication has been administered creates the risk that another nurse may assume that it has not been administered, and repeat that dose [26].…”