Effectiveness of a ‘Do not interrupt’ bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study

Abstract

AimTo evaluate the effectiveness of a ‘Do not interrupt’ bundled intervention to reduce non-medication-related interruptions to nurses during medication administration.MethodsA 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.ResultsOver 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.DiscussionNurses 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.

Perceived contributory factors to medication administration errors (MAEs) and barriers to self-reporting among nurses working in paediatric units of selected referral hospitals in Rwanda

“…Similar to the findings from the study done in hospitals affiliated with Mashhad university of medical sciences in, Mashhad, Iran with the purpose of evaluating the medication errors among 530 nurses. 31 Another study with similar findings was conducted in Saudi Arabia and showed that 30.9% responded that the most common medication administration error is the wrong timing of medication administration. 32 Moreover, using the documentation of Pediatric mediation administration errors in Canadian pediatric center wrong time error accounted 168 cases (45.2%) among 272 cases.…”

Interruptions in medication administration: are we asking the right questions?

“…In this issue of BMJ Quality and Safety , Westbrook7 and colleagues report a cluster randomised controlled trial of a bundled intervention to reduce interruptions during medication administration in a hospital using paper-based prescribing. This well-designed feasibility study tested a bundled intervention based on ‘Do Not Disturb’ vests and the education of healthcare professionals, patients and visitors.…”

“…Taking into account these points, together with the findings of the study by Westbrook et al ,7 we therefore need to consider whether other interventions may be more appropriate, and, if so, which. Interventions may relate to reducing the risk from interruptions or to other unrelated aspects of medication administration.…”

Rigorous evaluations of evolving interventions: can we have our cake and eat it too?

“…Consider a second example, in which Westbrook and colleagues evaluated a bundled intervention to reduce nurse interruptions during medication administration using a cluster randomised controlled trial (RCT) 13. For every 100 medication administrations, nurses on intervention wards experienced 15 fewer non-medication-related interruptions compared with control wards.…”

“…Consequently, it made sense to randomise wards to a fixed intervention or to usual care and focus on evaluating the impact. That said, it obviously occurred to Westbrook et al 13 that the nurses might not like wearing the vests, since they solicited this feedback as part of their results. Thus, they might have anticipated the need for making some changes to the intervention.…”