Interruptions Risk Medication Errors by Nurses

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This was the topic of a research class I attended last week.  This is such a no-brainer, but at least people are starting to take note that there really are times in the nurse’s day that need to be uninterrupted to assure a good patient outcome.  Medication errors happen, it’s a fact.  What we want to be doing is all we can to minimize the number of occurrences and to eliminate them before they reach the patient.

It’s pretty hard to focus on checking medications when you have eight patients clamoring for their medications and you have admissions telling you to hurry up because they have an admission for you.  On my unit, you can add the possiblity of having a code called for an aggressive patient when you are getting medications ready to pass.  This is very stressful for the nurse and potentially harmful to the patient.

Please read this article and let me know your thoughts.

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By Charles Bankhead, Staff Writer, MedPage Today
April 27, 2010

MedPage Today Action Points

• Explain to patients that this study showed that interruptions were associated with an increased error rate among nurses administering medication.

Review
When nurses are interrupted while administering medication, the risk of procedural failure and clinical error increases, data from an Australian study showed.

Such interruptions occurred more than half of the time, and three during the same drug administration led to a procedural failure rate of 85% and a clinical error rate of almost 40%, according to a study reported in the April 26 issue of Archives of Internal Medicine.

Every interruption increased the risk of procedural failure and clinical error by 12% to 13%.”We found a significant dose-response relationship between interruptions and procedural failures and clinical errors in medication administration in both study hospitals,” Johanna Westbrook, PhD, of the University of Sydney, and co-authors wrote.

“Furthermore, we found that, as interruptions increased within a single drug administration, the greater the severity of the error. Without interruption, the estimated risk of a major error was 2.3%; with four interruptions this risk doubled to 4.7% (P<0.001).”

Interruptions have been implicated as a cause of clinical errors, but evidence to support the contention has been lacking.

Studies based on surveys and self-reports have indicated the medication error rate might be as high as one per patient per day, the researchers noted. And a study of three dozen U.S. healthcare organizations showed that medication errors occur in almost 20% of administrations (Arch Intern Med 2002; 162: 1897-1903).

In an effort to add to the knowledge base, Westbrook and co-authors conducted a prospective study at two teaching hospitals in Sydney. The two hospitals have a combined 726 beds.

The study involved 98 nurses in six units at the two hospitals. Investigators directly observed the nurses during preparation and administration of medication to 720 adult patients over a total of 500 hours from September 2006 through February 2007.

All observers were registered nurses or physicians. Participation was voluntary, and the nurses at the two hospitals were aware that the study’s objectives included documenting medication errors.

For several weeks before data collection began, observers had multiple practice sessions at both hospitals. Interobserver reliability also was confirmed in practice sessions and during data collection, involving a total of 528 drug administrations.

Procedural failures included occurrences such as failure to read a medication label, failure to check patient identification, and nonseptic technique. Clinical errors involved mistakes that included wrong drug, wrong dose, and wrong strength of medication.

Failures and errors were classified according to severity on a scale of 1 (unlikely to affect patient) to 5 (likely to lead to death). Errors with a severity of 1 or 2 were considered minor and 3 to 5 as major.

Investigators observed 4,271 medication administrations at the two hospitals. Overall, 2,266 (53.1%) of administrations were interrupted one or more times.

Interruptions were more common at one hospital (73.9% of cases) than at the other (39.5%).  […read more…]

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