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P01 Reducing Interruptions during administration of medicines to children
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  1. Andrea Gill,
  2. Georgina McIntosh,
  3. David Walker,
  4. Helen Baldwin,
  5. Sian Falder
  1. Alder Hey Children’s NHS FT

Abstract

Aim Many studies have identified that interruptions occur frequently during administration of medicines and may cause errors.1–3 Bundles of interventions aimed at reducing interruptions have been investigated in adults.4 This study aimed to determine whether a ‘Do not interrupt’ bundle of interventions on paediatric wards, would reduce the number of interruptions to medicines administration and whether this would reduce the number of administration errors reported.

Method Six paediatric wards in a specialist children’s hospital was included in the study. Three were designated as ‘control’ wards and 3 as ‘intervention wards’. Baseline observations were undertaken on all 6 wards prior to the introduction of a ‘Do not interrupt’ bundle on the intervention wards. Four weeks later observations were repeated on all 6 wards. Electronic surveys were circulated to staff before and after the introduction of the bundle.

The ‘Do not interrupt’ bundle consisted of staff education; information for parents/patients; red aprons; banners; posters and ‘Distraction free zone’ floor stickers.

Results Red aprons were worn during 82% episodes of medicines administration on the intervention wards compared with 43% on the control wards. 92% of medicines were prepared in a designated ‘distraction free zone’ on the intervention wards.

There was at least 1 interruption during medicines administration for 69% of patients. The number of interruptions per 100 patient episodes reduced from 157 to 135 (14%) on the intervention wards compared to an increase from 191 to 218 (14%) on the control wards. Nurses were most often observed to be responsible for causing interruptions (48%) compared with other staff, parents/patients, buzzers etc. The most common types of preventable interruptions on all wards were social conversation and missing equipment or keys. Use of ‘distraction free zones’ did not prevent interruptions.

Reported administration error incidents increased from 2 to 7 per month (350%) on the intervention wards and from 4 to 15 (375%) on the control wards. This increase corresponded with an increase in activity and winter pressures across the hospital.

15% of nurses responded to the electronic survey. 76% thought the bundle did not make a difference, however 85% wanted the interventions to continue. Nurses disagreed with the finding that they were the most common cause of interruptions.

Conclusion Use of red aprons increased following introduction of the bundle indicating it did have some effect. Overall, interruptions occurred more frequently than expected. Interruptions appear to have reduced on the intervention wards although this wasn’t significant. Nurses were the most common cause of interruptions although they thought other staff and parents were. Many interruptions happened when medications were prepared near the nursing station, despite these being ‘distraction free zones’. The bundle does not appear to have influenced the number of administration errors reported.

The ‘Do not interrupt’ bundle requires revision prior to trust-wide roll out. This will include provision of more education for staff, especially nurses, regarding interruptions; a focus on the awareness of preventable interruptions and strategies to avoid preparation of medicines at nursing stations.

References

  1. Raban MZ, Westbrook JI. Are interventions to reduce interruptions and errors during medication administration effective? A systematic review. BMJ Qual Saf 2014;23:414–21.

  2. Westbrook JI, Woods A, Rob MI, et al. Association of interruptions with an increased risk and severity of medication administration errors. Arch Intern Med 2010;170:683–90.

  3. Blignaut AJ, Coetzee SK, Klopper HC, Ellis SM. Medication administration errors and related deviations from safe practice: an observational study. J Clin Nurs 2017 Nov;26(21-22):3610-3623. doi: 10.1111/jocn.13732. Epub 2017 Mar 22. PMID: 28102918.

  4. Westbrook JI, Li L, Hooper TD, et al. Effectiveness of a ‘do not interrupt’ bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study. BMJ Qual Saf 2017:bmjqs-2016-006123.

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