Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
BMJ Qual Saf. 2017 Sep;26(9):734-742. doi: 10.1136/bmjqs-2016-006123. Epub 2017 Feb 23.
To evaluate the effectiveness of a 'Do not interrupt' bundled intervention to reduce non-medication-related interruptions to nurses during medication administration.
A parallel eight cluster randomised controlled study was conducted in a major teaching hospital in Adelaide, Australia. Four wards were randomised to the intervention which comprised wearing a vest when administering medications; strategies for diverting interruptions; clinician and patient education; and reminders. Control wards were blinded to the intervention. Structured direct observations of medication administration processes were conducted. The primary outcome was non-medication-related interruptions during individual medication dose administrations. The secondary outcomes were total interruption and multitasking rates. A survey of nurses' experiences was administered.
Over 8 weeks and 364.7 hours, 227 nurses were observed administering 4781 medications. At baseline, nurses experienced 57 interruptions/100 administrations, 87.9% were unrelated to the medication task being observed. Intervention wards experienced a significant reduction in non-medication-related interruptions from 50/100 administrations (95% CI 45 to 55) to 34/100 (95% CI 30 to 38). Controlling for clustering, ward type and medication route showed a significant reduction of 15 non-medication-related interruptions/100 administrations compared with control wards. A total of 88 nurses (38.8%) completed the poststudy survey. Intervention ward nurses reported that vests were time consuming, cumbersome and hot. Only 48% indicated that they would support the intervention becoming hospital policy.
Nurses experienced a high rate of interruptions. Few were related to the medication task, demonstrating considerable scope to reduce unnecessary interruptions. While the intervention was associated with a statistically significant decline in non-medication-related interruptions, the magnitude of this reduction and its likely impact on error rates should be considered, relative to the effectiveness of alternate interventions, associated costs, likely acceptability and long-term sustainability of such interventions.
评估“不打断”捆绑干预措施在减少护士给药期间与药物无关的中断的效果。
在澳大利亚阿德莱德的一家主要教学医院进行了一项平行的八集群随机对照研究。四个病房被随机分为干预组，干预措施包括给药时穿背心；转移干扰的策略；临床医生和患者教育；以及提醒。对照组对干预措施一无所知。对药物管理过程进行了结构化的直接观察。主要结局是在单次药物剂量给药过程中发生的与药物无关的中断。次要结局是总中断和多任务率。对护士的经验进行了调查。
在 8 周和 364.7 小时内，观察了 227 名护士给 4781 名患者给药。在基线时，护士经历了 57 次/100 次给药的中断，其中 87.9%与正在观察的药物任务无关。干预病房的与药物无关的中断从 50/100 次给药（95%CI 45 至 55）显著减少至 34/100 次（95%CI 30 至 38）。控制聚类、病房类型和给药途径后，与对照组相比，每 100 次给药减少 15 次与药物无关的中断。共有 88 名护士（38.8%）完成了研究后的调查。干预病房的护士报告说，背心很耗时、麻烦且很热。只有 48%的人表示支持将干预措施纳入医院政策。
护士经历了很高的中断率。很少与药物任务有关，这表明有很大的空间可以减少不必要的中断。虽然干预措施与与药物无关的中断显著下降相关，但应考虑这种减少的幅度及其对错误率的可能影响，相对于其他干预措施的有效性、相关成本、可接受性和此类干预措施的长期可持续性。
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