Applying Airline Safety Practices to Medication Administration

Department of Acute Nursing Care, University of Texas Health Science Center, San Antonio, TX, USA.
Medsurg nursing: official journal of the Academy of Medical-Surgical Nurses 05/2003; 12(2):77-93; quiz 94.
Source: PubMed


Medication administration errors (MAE) continue as major problems for health care institutions, nurses, and patients. However, MAEs are often the result of system failures leading to patient injury, increased hospital costs, and blaming. Costs include those related to increased hospital length of stay and legal expenses. Contributing factors include distractions, lack of focus, poor communication, and failure to follow standard protocols during medication administration.

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    • "One-third of all MEs that cause harm to patients arise during medication preparation and administration (Leape et al. 1995, Barker et al. 2002b, Fijn et al. 2002). These medication administration errors (MAEs) occur when one or more of the seven rights of medication administration (right patient, right drug, right dose, right time, right route, right reason and right documentation) are violated (Wakefield et al. 1999, Pape 2003). The medication administration process is error-prone because of the many environmental and workload issues encountered by nurses (Pape 2001, Mayo & Duncan 2004, Tang et al. 2007, Armutlu et al. 2008, Brady et al. 2009). "
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    ABSTRACT: To explore nurses' experiences with and perspectives on preventing medication administration errors. Insight into nurses' experiences with and perspectives on preventing medication administration errors is important and can be utilised to tailor and implement safety practices. A qualitative interview study of 20 nurses in an academic medical centre was conducted between March and December of 2011. Three themes emerged from this study: (1) nurses' roles and responsibilities in medication safety: aside from safe preparation and administration, the clinical reasoning of nurses is essential for medication safety; (2) nurses' ability to work safely: knowledge of risks and nurses' work circumstances influence their ability to work safely; and (3) nurses' acceptance of safety practices: advantages, feasibility and appropriateness are important incentives for acceptance of a safety practice. Nurses' experiences coincide with the assumption that they are in a pre-eminent position to enable safe medication management; however, their ability to adequately perform this role depends on sufficient knowledge to assess the risks of medication administration and on the circumstances in which they work. Safe medication management requires a learning climate and professional practice environment that enables further development of professional nursing skills and knowledge.
    Journal of Nursing Management 03/2014; 22(3). DOI:10.1111/jonm.12225 · 1.50 Impact Factor
    • "In this study, an interruption was defined as an unplanned break in workflow caused by an external source (i.e. the interrupter). This definition is deliberately broad to encompass many of the definitions other researchers have used for interruptions (e.g., Coiera and Tombs, 1998; Flynn et al., 1999; Pape, 2003) and distractions (e.g., Healey et al., 2007), disruptions (e.g., Wiegmann et al., 2007), breaks-in-task (e.g., Chisholm et al., 2000), etc. Interruptibility (see research questions below) can be thought of as a combination of 1) how interruptible someone is based on the interruption's potential impact on their task performance, which takes into consideration their cognitive and social state; and 2) how interruptible someone is based on a conscious choice of their willingness to be interrupted (Grandhi and Jones, 2009). This study, being the first to examine interruptions in this way, took an exploratory approach, to answer the following research questions (RQs): RQ 1: How do nurses determine the interruptibility of other nurses? "
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    ABSTRACT: The purpose of this study was to understand the cognitive processes underlying nurses' decision to interrupt other nurses. The Institute of Medicine (2000) reported that interruptions are likely contributors to medical errors. Unfortunately, the research to date has been quite homogenous, focusing only on the healthcare provider being interrupted, ignoring the true complexities of interruptions. This study took a socio-technical approach being the first to examine interruptions from the viewpoint of the interrupting nurse. Over 15 h of observations and 10 open-ended interviews with expert nurses in a Neuroscience Surgical Intensive Care Unit were conducted. It was found that nurses conduct a quick cost-benefit assessment to determine the interruptibility of other nurses and whether an interruption is value-added vs. non-value added. To complete the assessment, nurses consider several conditional factors related to the interruptee, the interrupter, and the nature of the interruption content, and different potential consequences of the interruption.
    Applied ergonomics 10/2013; 45(3). DOI:10.1016/j.apergo.2013.08.009 · 2.02 Impact Factor
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    • "Interruptions during medication tasks have been shown to be directly associated with the rate and severity of medication administration errors by nurses [33]. While nurses experienced rates of interruptions lower than their medical colleagues[15,19], their concentration during medication tasks suggests this task is at specific risk and interventions to reduce interruptions during this process are required [34,35]. "
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    ABSTRACT: Time nurses spend with patients is associated with improved patient outcomes, reduced errors, and patient and nurse satisfaction. Few studies have measured how nurses distribute their time across tasks. We aimed to quantify how nurses distribute their time across tasks, with patients, in individual tasks, and engagement with other health care providers; and how work patterns changed over a two year period. Prospective observational study of 57 nurses for 191.3 hours (109.8 hours in 2005/2006 and 81.5 in 2008), on two wards in a teaching hospital in Australia. The validated Work Observation Method by Activity Timing (WOMBAT) method was applied. Proportions of time in 10 categories of work, average time per task, time with patients and others, information tools used, and rates of interruptions and multi-tasking were calculated. Nurses spent 37.0%[95%CI: 34.5, 39.3] of their time with patients, which did not change in year 3 [35.7%; 95%CI: 33.3, 38.0]. Direct care, indirect care, medication tasks and professional communication together consumed 76.4% of nurses' time in year 1 and 81.0% in year 3. Time on direct and indirect care increased significantly (respectively 20.4% to 24.8%, P < 0.01;13.0% to 16.1%, P < 0.01). Proportion of time on medication tasks (19.0%) did not change. Time in professional communication declined (24.0% to 19.2%, P < 0.05). Nurses completed an average of 72.3 tasks per hour, with a mean task length of 55 seconds. Interruptions arose at an average rate of two per hour, but medication tasks incurred 27% of all interruptions. In 25% of medication tasks nurses multi-tasked. Between years 1 and 3 nurses spent more time alone, from 27.5%[95%CI 24.5, 30.6] to 39.4%[34.9, 43.9]. Time with health professionals other than nurses was low and did not change. Nurses spent around 37% of their time with patients which did not change. Work patterns were increasingly fragmented with rapid changes between tasks of short length. Interruptions were modest but their substantial over-representation among medication tasks raises potential safety concerns. There was no evidence of an increase in team-based, multi-disciplinary care. Over time nurses spent significantly less time talking with colleagues and more time alone.
    BMC Health Services Research 11/2011; 11(1):319. DOI:10.1186/1472-6963-11-319 · 1.71 Impact Factor
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