Working in a minefield; Nurses' strategies for handling medicine administration interruptions in hospitals, -a qualtiative interview study.

BACKGROUND: Administering medicines is one of the most high-risk tasks in health care. However, nurses are frequently interrupted during medicine administration, which jeopardises patient safety. Few studies have examined nurses' experiences and the strategies they adopt to cope with interruptions during medicine rounds. This paper identifies nurses' strategies for handling and reducing interruptions and ensuring safety during medicine rounds, within the confines of the hospitals' organisational systems. METHODS: This descriptive and exploratory research study was undertaken with experienced nurses in Norwegian hospitals in 2015 using semi-structured interviews. Interviews were designed to elicit experiences and strategies used for handling interruptions to medicine rounds. Data were analysed using qualitative content analysis based on inductive reasoning to identify meaningful subjects and reach an interpretive level of understanding regarding nurses' experiences. RESULTS: All 19 senior nurses who were approached were interviewed. From 644 condensed meaning units, we identified eight interpretative units and three themes: 'working in environments of interruptions', 'personal coping strategies', and 'management-related strategies'. Nurses' working environments were characterised by interruptions and distractions, which often threatened patient safety. To handle this unpredictability and maintain ward organisation, nurses developed their own personal strategies to overcome inherent problems with their working conditions, the absence of effective management, and colleagues' reluctance to assume responsibility for minimising interruptions. CONCLUSIONS: Administration of medicines in hospitals can be described as 'working in a minefield'. Our findings indicate that the hospital management, in cooperation with nurses and other healthcare professionals, should take responsibility for improving the routine process of medicine administration by minimising avoidable interruptions. Patient safety can be improved when the hospital management takes steps to protect nurses' work environments and assumes responsibility for resolving these challenges.

Conflicting priorities: Observation of medicine administration.

AIMS AND OBJECTIVES: To identify sources of interruptions and distractions to medicine administration rounds in hospitals. BACKGROUND: Nurses are frequently interrupted during medicine administration. There is no systematic description of nurses' behaviours and interruptions during administration of medicines to patients. DESIGN: Exploratory nonparticipant observational study. METHODS: Three hundred and fifty-one episodes of medicine administration with 32 nurses from three hospitals in Norway were observed using paper-based observation grids between December 2013 and March 2014. RESULTS: Nurses were frequently interrupted and distracted, mainly by nurses and other healthcare professionals. One-third of the nurses interrupted their medicine administration: They prioritised helping patients with direct patient care. When the nurses were interrupted, they left the round and re-entered the procedure. Even so, they managed to refocus and continue to administer the medicines: Interruptions and disturbances made little difference to most behaviours and actions, possibly because nurses double-checked more frequently. Some differences were seen in behaviours potentially affecting the safety of the medicine administration, such as leaving medicines at the bedside and not helping patients take their medicines. Some interruptions were avoidable, such as those by other nurses and professionals. CONCLUSIONS: This study offers insights into nurses' behaviours and actions when they are interrupted and distracted during medicine administration. The findings highlight a conflict for nurses administering medicines. Nurses are forced to prioritise between two important activities: direct patient care and medicine administration. Management and education providers need to recognise that nurse interrupting each other is a potential threat to patient safety. RELEVANCE TO CLINICAL PRACTICE: Our data indicate that nurses and other healthcare professionals should be warned not to interrupt colleague administering medicines and managers should ensure other staff are available to respond to patients' immediate needs during medicine rounds.