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Effectiveness of a ‘Do not interrupt’ bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study
  1. Johanna I Westbrook1,
  2. Ling Li1,
  3. Tamara D Hooper2,
  4. Magda Z Raban1,
  5. Sandy Middleton3,
  6. Elin C Lehnbom4
  1. 1 Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
  2. 2 Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
  3. 3 Nursing Research Institute, St. Vincent's & Mater Health Sydney and Australian Catholic University, Darlinghurst, New South Wales, Australia
  4. 4 Faculty of Pharmacy, Sydney, New South Wales, Australia
  1. Correspondence to
    Professor Johanna Westbrook, Macquarie University, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Sydney, NSW 2109, Australia; Johanna.westbrook{at}mq.edu.au

Abstract

Aim To evaluate the effectiveness of a ‘Do not interrupt’ bundled intervention to reduce non-medication-related interruptions to nurses during medication administration.

Methods A parallel eight cluster randomised controlled study was conducted in a major teaching hospital in Adelaide, Australia. Four wards were randomised to the intervention which comprised wearing a vest when administering medications; strategies for diverting interruptions; clinician and patient education; and reminders. Control wards were blinded to the intervention. Structured direct observations of medication administration processes were conducted. The primary outcome was non-medication-related interruptions during individual medication dose administrations. The secondary outcomes were total interruption and multitasking rates. A survey of nurses' experiences was administered.

Results Over 8 weeks and 364.7 hours, 227 nurses were observed administering 4781 medications. At baseline, nurses experienced 57 interruptions/100 administrations, 87.9% were unrelated to the medication task being observed. Intervention wards experienced a significant reduction in non-medication-related interruptions from 50/100 administrations (95% CI 45 to 55) to 34/100 (95% CI 30 to 38). Controlling for clustering, ward type and medication route showed a significant reduction of 15 non-medication-related interruptions/100 administrations compared with control wards. A total of 88 nurses (38.8%) completed the poststudy survey. Intervention ward nurses reported that vests were time consuming, cumbersome and hot. Only 48% indicated that they would support the intervention becoming hospital policy.

Discussion Nurses experienced a high rate of interruptions. Few were related to the medication task, demonstrating considerable scope to reduce unnecessary interruptions. While the intervention was associated with a statistically significant decline in non-medication-related interruptions, the magnitude of this reduction and its likely impact on error rates should be considered, relative to the effectiveness of alternate interventions, associated costs, likely acceptability and long-term sustainability of such interventions.

  • Medication safety
  • Nurses
  • Randomised controlled trial
  • Interruptions
  • Cluster trials

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors All authors contributed to the design of the study. TDH and ECL conducted training, undertook data collection and coordinated the study. LL conducted the data analyses. JIW prepared the manuscript and all authors provided critical review and approved the final version.

  • Funding National Health and Medical Research Council (Programme grant APP1054146).

  • Competing interests None declared.

  • Ethics approval Royal Adelaide Hospital Human Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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