Work Interruptions and Medication Errors

1. Work Interruptions and Medication Errors Angelia Diab, Renee Engleking, Nicole Jorgensen, Bridget Taeoalii OU College of Nursing � Career Mobility 2010

2. Why is this a problem? It is estimated that 1.3 million people are injured annually in the United States from medication errors. Many payers are adopting the concept of �no payment for never events�, which means that the health care facility will have to absorb the cost. Medication errors lead to: Poor outcomes Increased cost of care Decreased reimbursement

3. Why is this a problem? Worldwide studies estimate that about 10% of hospitalized patients are inadvertently harmed by the care they receive, and about 1 in 300 die Drug complications and errors are the third most common case of patient harm Medication errors account for annual morbidity and mortality costs surpassing $136 billion.

4. PICO Question Population of interest: RNs Intervention of interest: controlled interruptions Comparison of interest: Uncontrolled interruptions Outcome of interest: Fewer medication errors

5. PICO Question Do RNs who have an increased number of interruptions during medication preparation experience more medication errors than those who have fewer or no interruptions?

6. Factors that contribute to medication errors Interruptions and distractions Standards of practice or protocols Preoccupation Attention slips Inadequate staffing Ineffective communication

7. Evidence 1/3 of nurses reported making at least one error or near error during a 28 day period One review found that 38% of medication errors occurred during nursing administration Wrong dosage comprised 24.1% of medication errors, with interruptions and distractions during drug preparation cited as leading causes

8. Literature Review The prevalence and nature of errors and near errors reported by hospital staff nurses. Balas, M.C., Scott, L.D. and Rogers, A.E. (2004)

9. The prevalence and nature of errors and near errors reported by hospital staff nurses Study- Systematic Review Sample � randomly selected RNs who worked full-time as hospital staff nurses Procedure � RNs involved in the study answered questions in a log book including information that could relate to errors or near errors.

10. The prevalence and nature of errors and near errors reported by hospital staff nurses Findings 30% of nurses in this study reported making at least one error 33% reported at least one near error It was common for nurses to describe interruptions and distractions when preparing medications

11. Work interruptions and their contribution to medication administration errors: an evidence review Biron, A., Loiselle, C., & Lavoie-Trembly, M. (2009).

12. Work interruptions and their contribution to medication administration errors: an evidence review Study- Descriptive Study Sample � 23 studies were considered for analysis Procedure � 14 studies were reviewed Results � 6.7 work interruptions per hour was obtained Work interruptions are mostly initiated by nurses themselves

13. Medication-related errors: a literature review and antecedents Carlton, G., and Blegan, M. (2006).

14. Medication-related errors: a literature review and antecedents Study- Integrated Review Procedure � a literature review was conducted specifically focusing on medication administration errors. Findings � Nearly one of every five doses administered in their study resulted in error Complex environments coupled with increased activity represent latent conditions of time pressures, interruptions, and distractions, layering error potential.

15. Environmental elements affecting the decision-making process in nursing practice Hedberg, B., and Satturlund Larson, U. (2003)

16. Environmental elements affecting the decision-making process in nursing practice Study- Content Analysis Sample � six RNs, two from a medical ward, two from a geriatric rehabilitation ward, and two from a primary health care unit. Procedure � observation of actual situations in which nurses� decision-making occurs.

17. Environmental elements affecting the decision-making process in nursing practice Findings � The most frequent type of interruption was interruptions by persons, where patients and staff members asking questions or requesting a helping hand interrupted the nurse 62% of the interrupted activities were while the RN was performing direct patient care, which includes administering medication

18. Environmental elements affecting the decision-making process in nursing practice Findings � Interruptions can affect patient care. Environmental elements can have an effect on decision making.

19. The impact of dedicated medication nurses on the medication administration error rate. Greengold, Nancy L., Shane, Rita, Schneider, Philip, Flynn, Elizabeth, Elashoff, Janet, Hoying, Cheryl L., Barker, Kenneth & Burnes Bolton, Linda. (2003).

20. The impact of dedicated medication nurses on the medication administration error rate. Study- Randomized Controlled Trial Sample- Registered nurses with at least 1 year of acute care nursing experience and a minimum of 6 months of full-time employment at the hospital. Procedure- Comparison was made between trained medication nurses and general nurses, then medical units and surgical units.

21. The impact of dedicated medication nurses on the medication administration error rate. Findings No significant differences in total errors between medication and general nurses for hospital A medical units. Significantly lower error rate for medication nurses than for general nurses in hospital A surgical units.

22. The impact of dedicated medication nurses on the medication administration error rate. Findings Cont�d- The total error rate for medication nurses was significantly higher at hospital B vs. hospital A. Rates for general nurses were essentially the same at each site. Results suggest the use of a dedicated medication nurse doesn�t reduce medication error rates.

23. Interruptions during drug rounds: an observational study Kreckler, S., Catchpole, K., Bottomley, M., Handa, A., & McCulloch, P. (2008

24. Interruptions during drug rounds: an observational study Study- Observational Study Sample- Nurses administering medications on a 37-bed acute surgical ward at a UK teaching hospital. A total of 38 drug rounds were observed. Procedure- An observer was present during drug rounds

25. Interruptions during drug rounds: an observational study Findings- Ninety-nine interruptions were observed during the 38 drug rounds. An average 11% of each drug round was spent dealing with interruptions. No interruptions were encountered on 14 (37%) drug rounds, nearly 50% of the sample experienced two or more interruptions.

26. Interruptions during drug rounds: an observational study Findings Cont�d- The most frequent interruptions were caused by the nurses themselves who stopped to find equipment or deliver care. Doctors also frequently interrupted nurses. The longest distractions were associated with receiving telephone calls, but were infrequent.

27. Summary of Findings Balas Study: 119 of the 393 nurses (30%) in the study reported making at least one error during the 28-day data collection period Nurses reported making 2-5 errors during the 28 day period.

28. Summary of Findings Biron Study: A rate of 6.7 work interruptions an hour was documented . Carlton Study: 38% of medication errors occurred during nursing administration.

29. Summary of Findings Greengold Study: Ninety-nine interruptions were observed during 38 drug rounds. On average, 11% of each drug round was spent dealing with interruptions. Kreckler Study: Nearly 50% of the sample experienced two or more interruptions.

30. Recommended Interventions Adherence to the 5 rights of medication administration. Implementation of a safe, dependable reporting system for nurses. Interventions to minimize interruptions during medication preparation and administration: Comprehensive nurse education Quiet zones Provisions for better storage of equipment for easier access. A vest that will let others know that medication is being prepared or administered IV Smart Pump technology is also available in some facilities

31. Suggestions for further study More precise definition of the concept of work interruptions to provide for more reliable measurement. Further research and replication of existing studies with emphasis placed on more dependable reporting measures. More focus on environmental elements and how changes in those elements can improve patient care.

32. References Balas, M.C.,Scott, L.D., & Rogers, A.E. (2004) The prevalence and nature of errors and near errors reported by hospital staff nurses. Applied Nursing Research, 17(4), 224-230 Biron, A., Loiselle, C., & Lavoie-Tremblay, M. (2009). Work interruptions and their contribution to medication administration errors: an evidence review. Worldviews on Evidence-Based Nursing, 6(2), 70-86. Retrieved from CINAHL Plus with Full Text database. Carlton, G., & Blegen, M. (2006). Medication-related errors: a literature of review and antecedents. Annual Review Of Nursing Research. 24(1), 19-38. Retrieved from CINAHL Plus with Full Text database. Hedberg, B., & Satturlund Larson, U. (2003). Environmental elements affecting the decision-making process in nursing practice. Journal of Clinical Nursing, 13, 316-324. Greengold, Nancy L., Shane, Rita, Schneider, Philip, Flynn, Elizabeth, Elashoff, Janet, Hoying, Cheryl L., Barker, Kenneth & Burnes Bolton, Linda. (2003). The impact of dedicated medication nurses on the medication administration error rate. Arch Intern Med, 163, 2359-2367. Kreckler, S., Catchpole, K., Bottomley, M., Handa, A., & McCulloch, P. (2008). Interruptions during drug rounds: an observational study. British Journal of Nursing, 17(21), 1326-1330.

33. Questions?