Are interventions to reduce interruptions and errors during medication administration effective?: a systematic review

Abstract

BackgroundMedication administration errors are frequent and lead to patient harm. Interruptions during medication administration have been implicated as a potential contributory factor.ObjectiveTo assess evidence of the effectiveness of interventions aimed at reducing interruptions during medication administration on interruption and medication administration error rates.MethodsIn September 2012 we searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Effective Practice and Organisation of Care Group reviews, Google and Google Scholar, and hand searched references of included articles. Intervention studies reporting quantitative data based on direct observations of at least one outcome (interruptions, or medication administration errors) were included.ResultsTen studies, eight from North America and two from Europe, met the inclusion criteria. Five measured significant changes in interruption rates pre and post interventions. Four found a significant reduction and one an increase. Three studies measured changes in medication administration error rates and showed reductions, but all implemented multiple interventions beyond those targeted at reducing interruptions. No study used a controlled design pre and post. Definitions for key outcome indicators were reported in only four studies. Only one study reported κ scores for inter-rater reliability and none of the multi-ward studies accounted for clustering in their analyses.ConclusionsThere is weak evidence of the effectiveness of interventions to significantly reduce interruption rates and very limited evidence of their effectiveness to reduce medication administration errors. Policy makers should proceed with great caution in implementing such interventions until controlled trials confirm their value. Research is also required to better understand the complex relationship between interruptions and error to support intervention design.

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.…”

“…As noted by Raban and Westbrook (2014), almost all intervention studies (with the exception of Pape, 2003) have been quasi-experiments with a pre-post design. Assigning participants at random to conditions that are run in parallel with each other is impractical, due to the need to keep work practices consistent within hospital units.…”

“…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 .…”

Progressive Care Nurses Improving Patient Safety by Limiting Interruptions During Medication Administration

“…Essential aspects of the sterile cockpit concept include eliminating interruptions, prohibiting communication unrelated to critical tasks, and maximizing teamwork and coordination during high-risk activities. 21,22 The majority of published clinical initiatives to limit interruptions during medication administration are nurse-led quality improvement projects involving implementation of a set of strategies to limit interruptions ( Table 1). The goal of these initiatives is to provide nurses with time to remain focused and undisturbed while preparing and administering medications.…”

Coaching nursing students with attention deficit hyperactivity disorder in clinical settings: A case study

“…Strategies to reduce distractions, such as posting "Do Not Disturb" signs, or vests worn by nurses to indicate they are administering medications, have had mixed results. [2][3][4] Moreover, to ensure patient safety, it is undesirable to eliminate all interruptions and distractions. In their review of the subject, Hayes et al identified "the need for the development of sustainable programmes that include high quality learning experiences that teach interruption management to undergraduate nurses in a safe environment" (p. 1063).…”