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Interruptions in medication administration: are we asking the right questions?
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  1. Anne Marie Rafferty1,2,
  2. Bryony Dean Franklin2,3
  1. 1 Florence Nightingale Faculty of Nursing and Midwifery, King’s College London and PTSRC Imperial College London, London, UK
  2. 2 NIHR Imperial Patient Safety Translational Research Centre, London, UK
  3. 3 Pharmacy Department, UCL School of Pharmacy and Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Bryony Dean Franklin, Professor of Medication Safety, UCL School of Pharmacy and Imperial College Healthcare, London; bryony.deanfranklin{at}imperial.nhs.uk

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The nature of today’s healthcare practice makes interruptions, distractions and multitasking commonplace, even during complex and high-risk tasks.1–3 Interruptions are often cited as a problem in medication safety, particularly in relation to nurses administering medication.1 4 Previous studies5 6 suggest an association between interruptions and medication administration errors. While a direct causal relationship remains to be proven, reducing interruptions during medication administration to decrease multitasking and cognitive load represents a generally accepted goal.1 4

In this issue of BMJ Quality and Safety, Westbrook7 and colleagues report a cluster randomised controlled trial of a bundled intervention to reduce interruptions during medication administration in a hospital using paper-based prescribing. This well-designed feasibility study tested a bundled intervention based on ‘Do Not Disturb’ vests and the education of healthcare professionals, patients and visitors. At baseline, nurses experienced 57 interruptions per 100 dose administrations, with over 85% unrelated to the dose of medication being prepared. The intervention moderately reduced these non-medication-related interruptions, with intervention nurses experiencing 15 fewer interruptions per 100 dose administrations compared with control nurses. However, the study also included a survey in which participating nurses characterised the vests as time consuming and uncomfortable. Only 48% supported the intervention becoming hospital policy. Given the likely small impact of this modest reduction in interruptions on medication administration error rates, challenges to sustainability and the availability of alternate interventions, the authors conclude that wearing such …

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