Article

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

ABSTRACT

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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    • "In this study, the term interruption was used for distractions as well as for interruptions. MAEs are defined as a breach of one of the seven rights of medication administration: correct patient , drug, dose, time, route, reason, and documentation (Pape, 2003). "
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    ABSTRACT: The use of drug round tabards is a widespread intervention that is implemented to reduce the number of interruptions and medication administration errors (MAEs) by nurses; however, evidence for their effectiveness is scarce. Evaluation of the effect of drug round tabards on the frequency and type of interruptions, MAEs, the linearity between interruptions and MAEs, as well as to explore nurses’ experiences with the tabards. A mixed methods before-after study, with three observation periods on three wards of a Dutch university hospital, combined with personal inquiry and a focus group with nurses. In one pre-implementation period and two post-implementation periods at 2 weeks and 4 months, interruptions and MAEs were observed during drug rounds. Descriptive statistics and univariable linear regression were used to determine the effects of the tabard, combined with personal inquiry and a focus group to find out experiences with the tabard. A total of 313 medication administrations were observed. Significant reductions in both interruptions and MAEs were found after implementation of the tabards. In the third period, a decrease of 75% in interruptions and 66% in MAEs was found. Linear regression analysis revealed a model R2 of 10.4%. The implementation topics that emerged can be classified into three themes: personal considerations, patient perceptions, and considerations regarding tabard effectiveness. Our study indicates that this intervention contributes to a reduction in interruptions and MAEs. However, the reduction in MAEs cannot be fully explained by the decrease in interruptions alone; other factors may have also influenced the effect on MAEs. We advocate for further research on complementary interventions that contribute to a further reduction of MAEs. We can conclude that drug round tabards are effective to improve medication safety and are therefore important for the quality of nursing care and the reduction of MAEs.
    Full-text · Article · Jun 2014 · Journal of Nursing Scholarship
    • "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.
    No preview · Article · Mar 2014 · Journal of Nursing Management
    • "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.
    No preview · Article · Oct 2013 · Applied ergonomics
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