Effectiveness of a ‘do not interrupt’ bundled intervention to reduce interruptions during medication administration : A cluster randomised controlled feasibility study
Westbrook, Johanna I., Li, Ling, Hooper, Tamara D., Raban, Magda Z., Middleton, Sandy and Lehnbom, Elin C.. (2017). Effectiveness of a ‘do not interrupt’ bundled intervention to reduce interruptions during medication administration : A cluster randomised controlled feasibility study. BMJ Quality and Safety. 26(9), pp. 734-742. https://doi.org/10.1136/bmjqs-2016-006123
|Authors||Westbrook, Johanna I., Li, Ling, Hooper, Tamara D., Raban, Magda Z., Middleton, Sandy and Lehnbom, Elin C.|
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 364.7 hours, 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.
|Journal||BMJ Quality and Safety|
|Journal citation||26 (9), pp. 734-742|
|Publisher||BMJ Publishing Group|
|Digital Object Identifier (DOI)||https://doi.org/10.1136/bmjqs-2016-006123|
|PubMed Central ID||PMC5574391|
|Open access||Published as ‘gold’ (paid) open access|
|Research or scholarly||Research|
|Funder||National Health and Medical Research Council (NHMRC)|
|Research Group||Nursing Research Institute|
File Access Level
|Online||23 Feb 2017|
|Publication process dates|
|Accepted||05 Feb 2017|
|License: CC BY-NC 4.0|
|File access level: Open|
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