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Interruptions during hospital nurses’ medication administration rounds

Marian Smeulers, Marjoke Hoekstra, Emma van Dijk, Femke Overkamp, Hester Vermeulen
  • Marian Smeulers
    Department of Quality and Process Innovation, Academic Medical Center, Netherlands | m.smeulers@amc.nl
  • Marjoke Hoekstra
    Department of Nursing, Amsterdam School of Health Professions, Amsterdam, Netherlands
  • Emma van Dijk
    Department of Nursing, Amsterdam School of Health Professions, Amsterdam, Netherlands
  • Femke Overkamp
    Department of Nursing, Amsterdam School of Health Professions, Amsterdam, Netherlands
  • Hester Vermeulen
    Department of Quality and Process Innovation, Academic Medical Center; Department of Nursing, Amsterdam School of Health Professions, Amsterdam, Netherlands

Abstract

Medication administration errors are common, costly and the cause of adverse events in clinical practice. Interruptions during medication administration rounds are thought to be a prominent causative factor of these medication errors. In this observational study, data were collected on the number and duration of several different sources of verbal and non-verbal interruptions using unobtrusive structured observations on 32 medication administration rounds. Interruptions occurred very often (6.9 times per nurse each hour), differed in frequency among the medication administration rounds and were from a variety of sources. The most frequent interruptions were caused by nursing colleagues (43%) and non-verbal interruptions from the ward environment (25%), such as noises from pagers, conversations in the vicinity of the nurse, the work of cleaners, or stock management by pharmacy staff. The longest durations of interruptions were from nursing colleagues’ verbal interrup- interruptions. When comparing the medication rounds, more and longer interruptions were observed during the morning rounds than those at noon. A comparison between surgical and non-surgical units showed that interruptions occurred more often and lasted longer in non-surgical units than those in surgical units. But the observed differences were not statistically significant. In conclusion, interruptions during medication administration rounds are frequent and originated from different human and environmental sources. Interventions should target not only interruptions by colleagues, but should also consider ways to reduce self-initiated interruptions and those arising from the immediate ward environment.

Keywords

work interruptions, medication administration errors, patient safety, nursing care, quality assurance.

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Submitted: 2013-01-17 12:44:42
Published: 2013-05-30 16:47:01
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