The effect of a five-part intervention to decrease omitted medications.

PROBLEM: Nursing administrators reported that medication administration errors had continued despite the use of bar code medication administration, especially in terms of omitted medications. Nurse administrators within the study hospital identified a need to add back up safety systems in order to reduce the number of omitted medications. Interruptions and distractions were identified as leading constraints to accurate medication administration. METHODS: This pre-post quality improvement study used a convenience sample of nurses on one medical surgical unit to observe the effect of specific protocols to decrease interruptions and distractions during medication administration. Nurses' were observed during medication administration cycles, and the medication time was measured in hours and minutes using a stop watch. The number of distractions and interruptions was counted by category. A participant survey was used to determine nurses perceptions of distractions and interruptions experienced. FINDINGS: The five-part intervention decreased nurses interruptions and distractions by 84% compared with the control group. The results indicated the type of distractions and interruptions nurses typically experience during medication administration was highest from conversation in the environment (M = 5.0 ± 3.4) and by other personnel (M = 6.38 ± 2.6). CONCLUSION: This process improvement project determined that a five-part protocol would reduce distractions and interruptions for nurses, save time in the process, and reduce omitted medications. Other visible symbols such as a vest with wording may show different results when combined with the other elements of the protocol. Anecdotal comments from nurses during and after observations divulged workplace issues surrounding medication delivery that may need investigation.

Innovative approaches to reducing nurses' distractions during medication administration.

BACKGROUND: Contributing factors to medication errors include distractions, lack of focus, and failure to follow standard operating procedures. The nursing unit is vulnerable to a multitude of interruptions and distractions that affect the working memory and the ability to focus during critical times. Methods that prevent these environmental effects on nurses can help avert medication errors. METHODS: A process improvement study examined the effects of standard protocols and visible signage within a hospital setting. The project was patterned after another study using similar techniques. Rapid Cycle Testing was used as one of the strategies for this process improvement project. Rapid Cycle Tests have become a part of the newly adopted Define, Measure, Analyze, Improve, and Control steps at this particular hospital. RESULTS: As a result, a medication administration check-list improved focus and standardized practice. Visible signage also reduced nurses' distractions and improved focus. CONCLUSION: The results provide evidence that protocol checklists and signage can be used as reminders to reduce distractions, and are simple, inexpensive tools for medication safety.

Evidence-based nursing practice: to infinity and beyond.

BACKGROUND: Medical errors are in the news almost daily, frequently after patients have experienced ineffective and unsafe protocols. As a result, patients and family members lose trust in the healthcare system. Nursing practice is changing almost daily with advances in nursing research and improvements in technology and practice. Reading, understanding, and managing these large amounts of information have become difficult for most nurses and organizations. METHODS: This article provides an historical background for evidence-based practice and methods for assimilating research into practice. RESULTS: Systematic reviews and other decision-making models are discussed using specific questions for establishing policy guidelines. CONCLUSION: Evidence-based practice encompasses implementing the best-known practices into the clinical setting using a scientific approach. As a result, safe, high-quality, and cost-effective care will be more likely to occur consistently.

Invitational theory and perioperative nursing preceptorships.

The role of perioperative nurses is unique in that they must be able to maintain clinical expertise in nursing practice and develop technical surgical skills. Even experienced perioperative nurses who transfer to the OR from other hospital settings or change employment to another facility require a certain amount of preceptor orientation. The current shortage of experienced perioperative nurses calls for the development of strategies to increase their number. "Inviting" OR preceptorship experiences may increase the recruitment, retention, and, subsequently, number of perioperative nurses. Nurse preceptors may be either personally or professionally "inviting" or "disinviting" when sharing knowledge and techniques with less experienced nurses. This article includes findings from a research study of perioperative nurse preceptees. The intent of the study was to identify whether the invitational operating room teaching survey could be used as a reliable tool in the OR. Survey items evaluate preceptees' attitudes toward preceptors and characteristics of effective preceptors. Cronbach's alpha reliability analysis revealed reliability of the tool.