Bilaga 5a
Author: Colligan L, Guerlain S, Steck S, Hoke T
Title: Designing for
distractions: a human factors approach to decreasing interruptions at centralised medication station. Country: USA Year: 2012
Aim: The aim of this study was to decrease interruptions around a centrally located, centralized, open pediatric medication station.
Sample: Event sample. Peak medication administration hour: 10:00-11:00. Nurses at a pediatric medication station. Nurses with nursing students were excluded Data collection: One or two researchers watched, counted and classified interruptions while nurses administrated medicine. This was to collect pre- and post intervention data to evaluate the effectiveness of the interventions.
Survey were also made to
understand nurses perceptions of their work at the medication station. Method: Observationa l study Surveys Analysis: Surveys, which included likert-scales, were analyzed with Mann-Whitney U test. Means and statistical significance to evaluate the effectiveness of the
Findings: After the implementation of the interventions, especially the barrier around the medication station, reductions of interruptions were observed. The way it was constructed helped to keep the feeling of a family-friendly environment. Quality: Medium 8/15 points - Contained the perspective of nurses on a pediatric nurse. - Contained ethical approval. - Did not describe the inclusioncriteri as. (see annex 3)
Bilaga 5b Author: Flynn F, Evanish Q. J, Fernald M. J, Hutchinson E. D, Lefaiver C. Title: Progressive Care Nurses Improving Patient Safety by Limiting Interruptions During Medication Administration. Country: USA Year: 2016 Aim: To evaluate the effectiveness of evidence-based strategies to limit interruptions during scheduled, peak medication administration. The secondary aim was to evaluate the impact of limiting interruptions on medication errors.
Sample: Event selection. Scheduled medication rounds: 5 am, 7 am, 8 am, 10 am, 8 pm and 10 pm.
A convenience sample of nurses at 3 Cardiac cares units. The number of nurses that participated was not presented. The numbers of 130 medication passes was observed. Data collection: Blinded data collectors during observation. Observations tools: Medication Administration Accuracy Observation Code sheet and Medication Administration Accuracy Record Review
Worksheet (a modified version). 64 medications passes before and 66 medication passes after guideline implementation. Method: Direct observations of nurses on 2 cardiac care units and a 3rd unit as a comparison group. Analysis: Means and statistically significance from collected data.
Findings: Using the NEUPASS guidelines to limit the amount of avoidable interruptions decreases promotes patient safety and help to reduce the amount of interruptions during medicine round.
Quality: High 12/15 points - Evidence-based strategies in the intervention. - Control group - Validated instruments - Nurse perspective (see annex 3)
Bilaga 5c
Author: Fore. M, A, L. Sculli. G, Albee. D, Neily. J.
Title: Improving
patient safety using the sterile cockpit principle during medication administration: a collaborative, unit-based project. Country: USA Year: 2012 Aim: To implement the sterile cockpit principle to decrease interruptions and distractions during high volume medication administration and reduce the number of medication errors.
Sample: The project was out spread on 11 week in a unit in Mid-Atlantic that have a high reported
interruptions and distractions during patients care. 97 nurses were asking to participate. Only 88% of the nurses gave their approval.
Data collection: The instrument that the nurses used under medication administration was the MADOS instrument. The nurse them self completed this sheet with every medication administration road. Together with this instrument “Do Not Disturb” signs and orange vest was implemented. One year before and after this 11 week the scientists collected data about medications errors. Method: Self report interventions study. Analysis: Standard z-scores, Simple linear regression, two-tailed Fisher exact test and Chi-squared test.
Findings: The interruptions and distractions decreased from 4.1 times at week one to 1.5 times at week 11. The total of all distractions was significant decrease.
Significant decreases the most was distractions and interruptions from other hospital staff and patients. The result show a significant decreasing in interruption from the year before implemented the intervention to one year after. The hospital continues to use the signs but not the vest.
Quality: Medium 10/15 points -Validated instrument used. - Nurses were the participated. - Tested over a longer time. - No samples analyze. That lowers the quality. (see annex 3)
Bilaga 5d Author: Mccomas. J, Riingen. M, Chae Kim.S. Title: Impact of an Electronic Medication Administration Record on Medication Administration Efficiency and Errors. Country: USA Year: 2014
Aim: The aims of this study were to evaluate the impact of eMAR implementation on medications administration efficiency and occurrence of medication administration of medication errors and to identify the predictors of medication administration efficiency in an acute care setting.
Sample: This observational study took place on a 40-bed medical-oncology unit in a not-for-profit community hospital in California. The participation in this study was voluntary. 38 nurses from the unit participated.
Data collection: The intervention that was tested was an electronic medication administration record (eMAR). 78 medication
administrations rounds both pre- and postoperative were observed. It was two different groups, one pre operative and one post operative. Administration-related task, interruptions or discretions and the time from started the task to ending of every task was observed.
Method: Prospective observation study. Analysis: t-test, Pearson test, Dummy Coding.
Findings: The post-observation group had a higher percentage of distraction and interruptions. Most commend interruptions or
distractions were from patients, that the phone rang or to obtaining medications or other supplies. The medication administration time took longer postoperative then
preoperative. There was a significant decrease of medication errors post observed.
Quality: Medium 8/15 points - The aim is not intent to
distractions or interruption witch effect the quality. - Nurses were the participated. - Evidence-based intervention. - Two different groups pre and postoperative lower the quality.
Bilaga 5e Author: Pape M. T Title:
The Effect of a Five-Part Intervention to Decrease Omitted Medications
Country: USA Year: 2013
Aim: The aim of this study was to determine whether nurses who wore a visible symbol or other interventions would experience fewer distractions and interruptions, save time in the process, and reduce errors of omission or delays in medication delivery.
Sample: 24 nurses at a Medical surgical unit and a control group. Exclusion: if they were orienting a student or a new employee. Data collection: Nurses were observed during medication administration cycles, and the medication time was measured in hours and minutes using a
stopwatch. The number of
distractions and interruptions was counted by category study.
Method: Pre-post interventiona l Observation during a 4 week period. Analysis: Data was analyzed using means, standard deviations and frequencies.
Findings: Distractions and interventions decreased by 84%. The interventions decrease the distractions and interruptions, save time in the process, and reduce omitted medications. Quality: High 12/15 points - Aim to determine if and how interventions affects interruption rate. - Ethical-approval. - Validated instruments. - Nurse perspective. - Control group (see annex 3)
Bilaga 5f Author: Parkash V, Koczmara C, Savage P, Trip K, Stewart J, McCurdie T, Cafazzo A. J, Trbovich P Title: Mitigating errors caused by interruptions during medication verification and administration: interventions in a simulated ambulatory chemotherapy setting. Country: Canada Year: 2014
Aim: The aim of this study were to asses the effects of interruptions on medication verification and administration errors, and design a test the effectiveness of targeted interventions and reducing these errors.
Sample: Nurses from the chemotherapy unit, recruited via sign-up sheet. In the
pre-intervention the participants was 18 nurses and post-intervention was it 19 nurses.
Data collection: Two trained observers collected live data from an observation room.
Experiment took place in a high-fidelity simulation laboratory.
Method: Experimental design allowing test administrator s to make detailed observations of the impact of interruptions and interventions . Analysis: McNemar’s chi-square test and Fisher´s exact test were used
Findings: Interventions are making interruptions increase and were effective at reducing errors of commission in medication administration.
Interventions are less effective at reducing errors connected with verification tasks. Quality: Medium 10/15 points - Nurse perspective - Validated instruments - Contains interventions to reduce interruptions during medication administration - Ethical approval - No control group (see annex 3)
Bilaga 5g Author: Relihan E, O’Brien V, O’Hara S, Silke B.
Title: The impact of
a set of interventions to reduce interruptions and distractions to nurses during medication administration Country: Ireland Year: 2010
Aim: To assess the impact of a set of interventions in reducing the interruption/distrac tion rate during medication administration.
Sample: Event selection
31 nurses undertaking medication rounds at a short-stay high-intensity unit.
Data collection: A pre- and post interventional study. A modified version of a validated instrument, MADOS was used to collect data. Four at each of the four times rounds are scheduled.
Method: Observations for a total of 16 medication rounds. Analysis: Descriptive statistics, Poisson regression analysis, Statistical significance.
Findings: Post intervention, the interruption/distraction rate was found to have decreased for each of the scheduled medication rounds except the 22.00 h round. Post intervention behavioral changes between staff, visitors and patients were observed.
Quality: Medium 10/15 points - Nurse perspective. - Validated instruments. - Contains interventions to reduce interruptions during medication administration. - Ethical approval. - No control group. (see annex 3)
Bilaga 5h Author: Tomietto. M, Sartor. A, Mazzocoli. E, Palese. A. Title: Paradoxical effects of a hospital-based, multi-intervention programme aimed at reducing medication round interruptions. Country: Italy Year; 2012
Aim: The main aim of the present study was to evaluate interruptions that occurred during medication rounds within a hospital-based, multi-intervention programme.
Sample: The medication was administrated with a trolley. The study was tested in seven surgical units. The researchers randomized the observation. In each unit two morning medication rounds was observed, two midday rounds, two afternoon rounds and two evening rounds. The time for this was 8.00am, 12.00am, 16.00pm and 20.00pm.
Data collection: The study started in 2006 (T0) with a baseline evaluation to se how mush the nurses get interrupted during meditation administration. The observation get place in a hospital in northern Italy. In 2008 (T1) an anther evaluation was done with a multi-intervention medication round programme in the same hospital. 18 months (T2) after
Method: A pre- and post-multi-intervention programme study. Analysis: Statistical Package for Social Sciences v.18, Student´s t-test.
Findings: The interruptions
decreased significant from T0 to T2. The interruptions from patients decreased because the red vest but the interruptions from stuff members increased. From the T0 evolution to the T1 there was no significant differences but the percentage of errors was reduced.
Quality: Medium 10/15 points - Evidence-based intervention. - The study was adapted over a longer time. - Detailed ethical considerations. (see annex 3)
Bilaga 5i Author: Williams. T, W.King. M, A.Thompson. J, T.Champagne. M. Title: Implementing Evidence-Based Medication Safety Interventions on a Progressive Care Unit. Country: USA Year: 2014
Aim: The aim of the study was to implement five medication safety interventions designed to reduce distractions and interruptions during medication preparation.
Sample: The studied took place on a surgical unit with 32-beds. In the pre-observation 52 nurses
participated and in the
post-observation 48 nurses participated. Data collection: Direct observation on medication preparations using a modified instrument (MADOS). 32 randomly selected shifts in 8 days during two-months period
observed. The nurses also
answered in a dictations perceptions survey in a Likert-type scale in 5-0.
Method: Observation pilot study and a survey study Analysis: Descriptive statistic and Mann-Whitney U test.
Findings: From pre- to post- intervention there was no
significant different in the number of patients and the number of medication administration to each patient during the medication round.
The interruptions and distractions decrees in number significant from pre- to post- intervention. There were four types of interruptions that reduce significant to
post-intervention. They were
interruptions or distraction from physician, phone calls, other
personnel and loud conversations in the area that not were related to medication administration. Quality: High 12/15 points - Evidence-based interventions. - Nurses were the study participants. - Aim to reduce interruptions during medication administration. - Ethical approval. - Failure analysis (see annex 3)
Bilaga 5j Author; Yoder. M, Schadewald. D, Dietrich. K.
Title: The effect of a
Safe Zone on Nurse Interruptions, Distractions, and Medication Administration Errors. Country: USA Year: 2015
Aim: The aim of the study was to adapt a protocol based on airline industry safety measures to reduce nurse’s interruptions and distractions during medication administration.
Sample: The study took place in a Community hospital in USA. It included both nurses and nursing students. It was 56 nurses and 24 students that participated but only 22 nurses and 11 students
participated both pre- and post surveys.
Data collection: The study used an evidence-based “Safe zone”
protocol to reduce medication errors. Whit interventions to reduce interruption and distractions. The survey tool that was used were modified MADOS instrument that measure twelve sources of
interruptions and distractions. All medication administrations errors compared pre- and post
interventions. Method: Surveys study with self-report. Analysis: 2-taild t test
Findings: The test shows a increasing in interruptions and distractions from pre intervention to post intervention time.
Based on participates answer on the survey the increasing can be
categorized in to 3 themes; 1. That education and discussions about the interruption and distraction may have increased them. 2. Wearing the vest may have increased
interruptions because staff, patients and visitor stop the nurse to ask about the vest. 3. The “Safe zone” protocols interventions did not followed consistently among all nurses. Which may have a negative effect. Quality: Medium 10/15 points - Nurses were the study participants. - Evidence-based interventions but was modified. - Major drop-of that lower the quality. (see annex 3)
