Reducing interruptions during medication administration: the White Vest study

Abstract

The well-established Institute of Medicine report entitled To Err is Human: Building a Safer Health System highlighted the importance of preventative errors in medicine, suggesting interruptions are a contributing factor. Patient safety organisations, such as The Joint Commission, acknowledge that interruptions contribute to preventable medical errors. The aim of this research is to examine the most frequently observed interruptions experienced by nurses administering medications and evaluate an intervention designed to reduce those interruptions. The primary intervention consisted of a White Vest worn during administration stating: ‘Please do not interrupt while passing medications’. A quasi-experimental design was employed. Nurses were observed for 2 weeks during routine administration of morning medications. The vest was then introduced and worn during administration for 2 weeks for post-intervention data collection. The hospital unit, date, time, duration, and description of the interruption were recorded. Data collection was conducted in four hospital units sequentially. A content analysis revealed the most frequently observed interruptions were comments/questions by hospital staff, phone calls, and seeking supplies. As hypothesised, the overall number of interruptions during medication administration (MA) declined after implementation of the intervention. This study illustrates implications and policy changes with regards to nursing practices and MA.

Characteristics of interruptions during medication administration: An integrative review of direct observational studies

“…Some articles provided the specific reason(s) for the self‐initiated interruptions observed during MA. Gathering supplies was the most frequently reported reason for a self‐initiated interruption (Aguirre, Wilhelm, Backer, Schoenman, & Koehler, ; Craig, Clanton, & Demeter, ; Kreckler et al., ) with one study also finding that initiating conversations unrelated to the MA process as another reason (Aguirre et al., ).…”

Interruptions and nursing workload during medication administration process

“…The implementation of interventions showed a significant reduction in the number of interruptions during the medication process, of almost 87% (25) . Some of the strategies adopted by international health institutions include the use of a vest with the warning "Please, do not interrupt me" when the professional is preparing medications (26) and the provision of a secluded place without distractions and interruption sources for the preparation of medications (27)(28) .…”

Interruptions in Health Care: Assessing Their Connection With Error and Patient Harm

“…Surprisingly, many quality improvement studies show counterintuitive or unintended negative consequences from interventions, or they demonstrate that interventions are sometimes unsustainable (Raban & Westbrook, 2014). Interventions can result in more but shorter interruptions (Tomietto, Sartor, Mazzocoli, & Palese, 2012), fewer but longer interruptions (Craig, Clanton, & Demeter, 2014), more interruptions from colleagues but fewer from patients (Tomietto et al, 2012) or even an increase in both medication errors and reported interruptions (Yoder, Schadewald, & Dietrich, 2015). A recent stochastic simulation demonstrated that a combination of interventions intended to reduce interruptions actually predicted an increase in interruptions to other direct care tasks, due to the deferment of work (Myers & Parikh, 2019).…”