Paradoxical effects of a hospital-based, multi-intervention programme aimed at reducing medication round interruptions.

AIM: The main aim of the present study was to evaluate interruptions that occurred during medication rounds within a hospital-based, multi-intervention programme. BACKGROUND: There are no standardized ways to reduce medication interruptions during medication rounds and no guidelines or standards on the use of tabards during medication rounds. MATERIALS AND METHODS: In 2006, a preliminary baseline evaluation (T0) was conducted at the hospital level observing the occurrence of interruptions during medication rounds in daily practice. Subsequently, a hospital-based policy for a multi-intervention medication round programme was implemented at of the beginning of 2008 (T1). After 18 months, an evaluation of the frequency of interruptions was repeated (T2). RESULTS: At T0, 298 interruptions were observed for 945 medications administered, or one for every 3.2 medications given. At T2, 385 interruptions were observed for 895 medications given, an interruption for every 2.3 medications administered (P = 0.041). At T0, the mean interruption duration per medication round was 10.48 min whereas at T2 it was 5.08 min. Patient interruptions were reduced (26.5-14.0%, P = 0.05); in spite of this effect, staff member interruptions increased (15.8-40.5%, P = 0.01). CONCLUSIONS: With the implementation of the multi-intervention programme, the interruptions changed their pattern. While wearing the red tabard was paradoxically effective with patients, it was ineffective with other staff members. IMPLICATIONS FOR NURSING MANAGEMENT: Before introducing new strategies, an evaluation of their appropriateness with regard to the culture of the patients and nurses is recommended: in the present study, patients seem to have considered the warning message worn by nurses as mainly intended for them.

Interruptions during nurses' drug rounds in surgical wards: observational study.

AIMS: The purpose of the study was to examine the frequency and perceived risk of interruptions to nurses during drug rounds in seven Italian surgical wards. BACKGROUND: Management of drug therapy is an integral part of the clinical role of nurses. Many errors are caused by interruptions to which the nurse is subjected during the drug rounds. However, the frequency of interruptions to nurses during drug rounds has not yet been documented. MATERIALS AND METHODS: An observational study design was developed: (1) 56 randomized drug rounds, eight for each ward included, were observed and (2) 28 convenience samples of observed nurses were interviewed. RESULTS: The administration of a total of 945 medications was observed, an average of 2.2 per patient being treated: 298 interruptions were observed (one for every 3.2 drugs given). Ten different categories of interruption emerged. The highest risk of error as a result of interruption perceived by these nurses was related to the management of telephone calls. IMPLICATIONS FOR NURSING MANAGEMENT: Many of the interruptions as a result of the organization of work could be avoided: one organizational priority should be to create a calm atmosphere for administering drugs. Ways to develop a calm atmosphere are discussed.