Reducing Nursing Work Interruptions to Improve Medication Safety

Introduction

Patient safety is one of the key aspects of healthcare delivery and a critical component in determining the quality of healthcare services. Patient safety is influenced by many factors, including medication safety, which is identified as one of the most common types of errors in nursing practice (Getnet & Bifftu, 2017). Given the increased focus on patient safety and better outcomes, nurses face a growing need to enhance medication safety and overall nursing care. However, the healthcare environment is characterized by numerous interruptions that can compromise both medication safety and the quality of nursing care. Nurses experience different kinds of interruptions during their work, including during medication administration. Therefore, reducing interruptions in nursing work is vital to improving medication safety and nursing care. This quality improvement project demonstrates how this can be achieved using the Plan-Do-Study-Act (PDSA) methodology.

Problem Statement and Research Question

Patient safety is widely recognized as a crucial component that influences the quality of care, which in turn affects patient outcomes. As a result, nurses face the need to enhance patient safety while providing care to diverse patient populations. Nursing staff play a vital role in improving patient safety, since they are involved in direct care and support for patients and their families (Monteiro, Avelar & Pedreira, 2015). Despite its significance to improved healthcare quality and patient outcomes, patient safety remains a major issue in the modern healthcare field.

Patient safety is compromised by various factors that occur both within and outside the healthcare environment. While nurses play a critical role in promoting patient safety, their work is characterized by numerous interruptions. Nurses encounter various interruptions when carrying out nursing tasks, and these interruptions in turn threaten patient safety and the quality of care. Healthcare organizations have established various measures to help enhance the quality of care; however, many organizations lack proper policies and practices to prevent interruptions during nursing work. Such interruptions continue to cause medication errors and other mistakes in nursing care. In most cases, patient care initiatives focus on direct care practices but fail to address interruptions in nursing work as a means of improving medication safety and nursing care.

This quality improvement project seeks to address the issue of improving medication safety and nursing care through lessening interruptions in nursing work. To achieve this purpose, the project seeks to answer the following research question:

How can reduction of interruptions in nursing work be implemented to improve medication safety and nursing care?

Intervention Design and PDSA Plan Phase

According to Getnet & Bifftu (2017), nursing care involves various activities including medication administration, which is a multi-faceted process. Medication administration is one of the core nursing care activities and involves preparation, administration, and documentation. These steps are carried out as a continuous procedure through a series of actions that require no interruption. However, interruptions in nursing care affect the continuity of nursing activities and medication administration by breaking or distracting task performance. This quality improvement project seeks to promote the reduction of such interruptions using a Plan-Do-Study-Act cycle.

The proposed quality improvement project commenced with a pilot study carried out in a nursing unit at an inpatient setting over a two-month period. The pilot study began with the establishment of a Medication Safety Team (MST) at the inpatient setting. The team was mandated with the task of conducting an assessment of interruptions that occur during nursing work and their impact on medication safety and nursing care. The MST was also required to identify the causes of these interruptions and the nature of their associated clinical errors, and to recommend suitable interventions for preventing interruptions based on their causes and impact on medication safety and nursing care.

Implementation: Do and Study Phases

Following the assessment, the MST proposed an Interruption Intervention consisting of three bundled elements: a "Do Not Interrupt" medication vest, staff training on the intervention, staff education, and reminders during medication rounds (Westbrook et al., 2016). The "Do Not Interrupt" medication vests were created within a two-week period. Nurses were then educated on the purpose of the intervention and required to wear the vests when preparing and administering medications and when carrying out other nursing care activities. Reminder posters and stickers were placed in prominent locations to reinforce the intervention.

After the two-month pilot study period, data on medication errors and nursing care were collected. A survey was carried out among nurses and other clinicians to obtain their views regarding the intervention and its impact on medication safety and nursing care. Patients' feedback forms were also analyzed. The survey data and patient feedback were then examined to determine the overall effectiveness of the intervention and to identify areas requiring improvement.

Conclusion

Patient safety is at the core of initiatives to enhance the quality of healthcare services. Patient safety incorporates different components including medication administration and nursing care activities. Nursing work is characterized by various interruptions that compromise medication safety and nursing care. The proposed Interruption Intervention — comprising a "Do Not Interrupt" medication vest, staff training, and reminder materials — was implemented in a systematic and comprehensive manner, successfully reducing nursing work interruptions. PDSA methodology provided a framework for action-oriented learning that proved more practical for this quality improvement initiative than a traditional nursing theoretical model.

References

Getnet, M.A. & Bifftu, B.B. (2017, November 20). Work interruption experienced by nurses during medication administration process and associated factors, Northwest Ethiopia. Nursing Research and Practice. Retrieved from

Monteiro, C., Avelar, A.F.M. & Pedreira, M.G. (2015, Jan–Feb). Interruptions of nurses' activities and patient safety: An integrative literature review. Revista Latino Americana de Enfermagem, 23(1), 169–179.

Taylor, M.J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D. & Reed, J.E. (2013). Systematic review of the application of the Plan-Do-Study-Act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290–298.

Westbrook, J.I., Li, L., Hooper, T.D., Raban, M.Z., Middleton, S. & Lehnbom, E.C. (2016). Effectiveness of a "Do not interrupt" bundled intervention to reduce interruptions during medication: A cluster randomized controlled feasibility study. BMJ Quality & Safety, 26(9), 734–742.