EBP Presentation

Patient Safety:Effectiveness of

strategies to Reduce

Distractions during med passAlaina Reese, John T. Robinson, Kristy Schwenk

PICO Question

Population: Nurses in acute care settings

Intervention: Approaches to reducing distractions

Comparison: Non-protected medication pass

Outcome: Reduced medication administration errors

PICO Question

For nurses in acute care settings, do approaches to prevent distractions during

medication pass reduce medication administration errors (MAE) versus non-

protected pass?

Literature ReviewArticles Reviewed: 17

Articles Appraised: 9

Databases Searched: CINAHL, Cochrane Library, EBSCO-Host, Google Scholar, JBI, PubMed

Keywords Used: Medication administration errors, medication errors, prevention, error reduction, tabard/vest, distractions, interruptions, acute care

Search Limits: Scholarly journals, 2002 to present, peer reviewed, English

Learning ObjectivesDescribe what a medication administration error is

Explore the negative effects of medication administration errors

Identify strategies implemented to decrease distractions and interruptions during medication administration

Acknowledge that research for this topic is understudied and implications for further research are necessary

List alternative methods that can be utilized during traditional medication pass that reduce the occurrence of medication errors

StatisticsWhile delivering nursing care, nurses perform multiple tasks 30% of the time (Tomietto, Sartor, Mazzocoli, & Palese 2012)

Medication errors contribute to more than 7,000 inpatient deaths per year in the United States (Flynn, Liang, Dickson, Xie, & Suh, 2012)

On average, a U.S. hospital patient is subjected to at least one medication error per day; making medication errors the most common cause of preventable adverse patient events (Flynn, et al., 2012)

Definition of Medication Administration Error“A medication administration error is defined as any deviation from the prescriber’s medication order as written on the patient’s chart, manufacturers’ instructions or relevant institutional policies’.”

(Keers, 2013)

Negative Effects of Medication Administration ErrorsMedication Administration Errors in acute care settings are associated with:

Increased overall healthcare costs

Decreased patient experience/satisfaction

Increased length of stay

Adverse drug events (ADE)

Toxicity, overdose, allergic reaction, etc. (Bates et al, 1995 in Allard, Carthey, Cope, Pitt, & Woodward, 2002)

(Keers, 2013)

Medication administration processStage I: Prescribing

Stage II: Transcribing

Stage III: Dispensing

Incorrect preparation, expiration, equipment failure, labeling issues

Stage IV: Administration

Wrong dose, route, patient, time, frequency, drug, noncompliance, communication error

(Allard, Carthey, Cope, Pitt, & Woodward,

2002)

Current PracticeMany institutions use articles of clothing

to indicate that a nurse is administering medications

The intended purpose of these indicators is to prevent patients and other staff members from interrupting or distracting them during the administration phase

The reviewed literature indicates inconclusiveness as to whether or not the use of tabards, vests, and sashes are effective in reducing medication errors(Allard, et al., 2002); (Choo, Johnston, & Manias, 2013); (Flynn, et al., 2012); (Nicol 2007); (Relihan, O'Brien, O'Hara, & Silke, 2010); (Tomietto, et al., 2012); (Wimpenny & Kirkpatrick, 2010)

Current Practice (continued)

Visual signage can serve as a warning, or it can be used as a safety reminder to redirect distractive behavior

Visual signage at or around areas of medication administration help to reduce the occurrence of distractions

It is inconclusive if this method of reducing distractions is effective. More research is needed to see if this is an effective method of reducing distractions

An example of visual signage (Pape, 2005)

(Pape, 2005)

Current practice (continued)

“No Interruption Zones”

A zone designated as a quiet area in which nurses can prepare medications in a safe and calm environment

A door protects the nurse from external stimuli such as noise and patient or staff activities

Signage is also utilized in areas of medication retrieval such as the Pyxis machine and the medication room door

Although this strategy allows for a more desirable environment and is effective in reducing some distraction, studies show administering the medication as close to the patient as possible allows for better patient input and decreases the occurrence of MAEs

(Tomietto, et al, 2012)

Current Practice at PennState Health - St. JosephThere is medication room dedicated to medication dispensing and preparation on each ward/unit

There is one Pyxis machine located within the medication room that dispenses medications for the entire unit

2-North currently does not utilize any other interventions previously mentioned to prevent interruptions during medication administration

ConsiderationsBecause there are numerous gaps in the literature, there is an obvious need for more in-depth research on strategies targeted at reducing distractions during medication administration

The use of clothing, signs, and “no-interruption/quiet zones” were found to be effective on several units and ineffective on others for a variety of reasons

If there are plans to implement these strategies on new units, staff and patient education, as well as readiness to learn, needs to be assessed and re-evaluated frequently(Allard, et al., 2002); (Choo, Johnston, & Manias, 2013); (Flynn, et al., 2012); (Keers, et al., 2013); (McGraw & Topping, 2010); (Nicol 2007); (Pape, et al., 2005); (Relihan, O'Brien, O'Hara, & Silke, 2010); (Tomietto, et al., 2012); (Wimpenny & Kirkpatrick, 2010)

Considerations (continued)

Generalisability is limited due to the differences in staffing patterns, severity of patients’ statuses, and cultural factors

Effectiveness of the aforementioned strategies vary within each individual unit/ward

(Allard, et al., 2002); (Choo, Johnston, & Manias, 2013); (Flynn, et al., 2012); (Keers, et al., 2013); (McGraw & Topping, 2010); (Nicol 2007); (Pape, et al., 2005); (Relihan, O'Brien, O'Hara, & Silke, 2010); (Tomietto, et al., 2012); (Wimpenny & Kirkpatrick, 2010)

Alternative MethodsAlthough methods for reducing distractions are controversial, the

following methods have been proven effective in reducing medication errors:

Fully stocked medication carts and trolleys (Wimpenny & Kirkpatrick 2010)

Patient and staff education regarding new practices and techniques being used to decrease the occurrence of distractions during medication administration (Choo, Johnston, & Manias, 2013)

Patients should be provided with information about other healthcare professionals who can help them with any concerns they have regarding their care or assistance with daily activities (Choo, et al., 2013)

A supportive work environment allows nurses to employ practices that can assist in interrupting medication errors before they reach the patient (Flynn, et al., 2012)

Support colleagues who are utilizing “no interruption/quiet zones”

Take messages, answer patient call bells, do not disrupt administering nurses unless it is necessary (Relihan, O'Brien, O'Hara & Silke 2013)

ReferencesAllard, J., Carthey, J., Cope, J., Pitt, M., & Woodward, S. (2002). Medication Errors: Causes, Prevention And Reduction. British

Journal of Haematology Br J Haematol, 116(2), 255-265.

Choo, J., Johnston, L., & Manias, E. (2013). Nurses' medication administration practices at two Singaporean acute care hospitals.

Nursing & Health Sciences Nurs Health Sci, 15(1), 101-108. Retrieved March 26, 2016.

Flynn, Linda, Yulan Liang, Geri L. Dickson, Minge Xie, and Dong-Churl Suh. "Nurses’ Practice Environments, Error Interception

Practices, and Inpatient Medication Errors." Journal of Nursing Scholarship 44.2 (2012): 180-86. Web.

Keers, Richard N., Steven D. Williams, Jonathan Cooke, and Darren M. Ashcroft. "Causes of Medication Administration Errors in

Hospitals: A Systematic Review of Quantitative and Qualitative Evidence." Drug Saf Drug Safety 36.11 (2013): 1045-067. Print.

McGraw, C., & Topping, C. (2010). The district nursing clinical error reduction programme. British Journal of Community

Nursing, 16(1).

References (continued)

Nicol, N. (2007). Case study: An interdisciplinary approach to medication error reduction. American Journal of Health-System

Pharmacy, 64(14 Supplement 9).

Pape, T., Guerra, D., Muzquiz, M., Bryant, J., Ingram, M., Schranner, B., . . . Welker, J. (2005). Innovative approaches to reducing

nurses' distractions during medication administration. The Journal of Continuing Education in Nursing, 36(3), 108-116.

Relihan, E., O'Brien, V., O'Hara, S., & Silke, B. (2010). The impact of a set of interventions to reduce interruptions and

distractions to nurses during medication administration. Quality and Safety in Health Care, 1-6.

Tomietto, M., Sartor, A., Mazzocoli, E., & Palese, A. (2012). Paradoxical effects of a hospital-based, multi-intervention

programme aimed at reducing medication round interruptions. Journal of Nursing Management, 20(3), 335-343. Retrieved March

17, 2016.

Wimpenny, Peter, and Pamela Kirkpatrick. "Roles and Systems for Routine Medication Administration to Prevent Medication

Errors in Hospital-based, Acute Care Settings: A Systematic Review." JBI Library of Systematic Reviews 8.10 (2010): 405-46.

Web.