Constant ED interruptions make drug errors likely
Clinical experience doesn't protect you
The more often you are interrupted when giving medication to a patient, the more likely you are to make a mistake, according to a recent study.1 Researchers observed 98 nurses preparing 4,271 medications for 720 patients in 2006 to 2008, and they found they were interrupted 53% of the time. Each interruption was linked with a 12-13% increase in errors.
Even if the nurses had a great deal of clinical experience, this experience didn't keep them from making errors because of interruptions, warns Johanna Westbrook, PhD, the study's lead author and director of The University of Sydney's Health Informatics Research and Evaluation Unit in Australia. "Interruptions are a team responsibility. Thus, effective strategies must involve the entire ED team," she says. "Previous studies have shown that both doctors and nurses in emergency departments have higher rates of interruptions than clinical staff on general wards.2 As interruption rates are higher in EDs, the risk of medication administration errors may be greater."
Amy Waunch, MSN, FNP, CEN, an advanced practice nurse in the ED at St. Joseph Hospital of Orange (CA), says ED nurses work in a "fast-paced, high-pressure environment, with high rates of multi-tasking and interruption."
Multiple steps occur from the time a medication order is written, to the time it is actually prepared and administered to the patient. "During this time, ED nurses are frequently interrupted. This results in a potential loss of concentration which could lead to an error," says Waunch.
The interruptions might cause delays in the patient receiving medication, and the ED nurse might try to work faster to make up for time lost, which could also put patients at risk, adds Waunch.
Section off area
At St. Joseph's ED, the immediate area surrounding medication dispensing machines and medication preparation areas is a "no interruption" zone. The floors are marked with colored tape. "When a nurse is inside the indicated area, no one is permitted to speak to him or her," says Waunch.
Here are three other changes the ED made to stop interruptions:
The medication dispensing machine was moved to a less congested area.
Instead of being located at the central nursing station, where staff members gather to obtain charts, exchange patient information with other care providers, and make phone calls, the machine was moved to the perimeter of the station. "There is less traffic and less conversation," says Waunch.
ED nurses worked closely with pharmacy to decrease the number of medications that must be reconstituted or "mixed."
Many commonly administered antibiotics are readily available, pre-mixed, in the medication dispensing machine. "This decreases the number of steps that must occur to obtain and administer medications to patients," says Waunch. "As a result, there is less opportunity for interruption."
Single-dose vials of medication are brought to the patient's bedside.
"The nurse can withdraw the medication from the vial into a syringe and administer to the patient with little to no interruption," says Waunch.
References
- Westbrook JI, Woods A, Rob MI, et al. Association of interruptions with an increased risk and severity of medication administration errors. Arch Intern Med 2010;170:683-690.
- Spencer R, Coiera E, Logan P. Variation in communication loads on clinical staff in the emergency department. Ann Emerg Med 2004;44:268-273.
Sources
For more information on medication safety in the ED, contact:
- Amy Waunch, MSN, FNP, CEN, Advanced Practice Nurse, Emergency Department, St. Joseph Hospital of Orange (CA). Phone: (714) 771-8000 Ext. 17136.
- Johanna Westbrook, PhD, Director, Health Informatics Research and Evaluation Unit, The University of Sydney in Australia. E-mail: [email protected].
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