In the medical field, the issue of interruption has grown to be topical due to the impact it has on the medication preparation as well as during the double-checking process where there is a need to make sure that medical processes have been done properly and are free from error (Huckels-Baumgart et al., 2016). This paper will seek to analyze two academic articles that are centered on the topic of medical interruptions and their impact on the effectiveness of nurses and how this can be averted. This will be followed by a general comparison of the two articles to establish any meeting or diversion of the minds on the topic and the impact it has on the medical field.
This prompted empirical research that was done by a team of five medical researchers entitled, “A combined intervention to reduce interruptions during medication preparation and double-checking: a pilot-study evaluating the impact of staff training and safety vests.” (the first article). This study was based on the appreciation of the challenging the nursing job is stemming from the numerous steps that a nurse has to follow in the duties and acknowledging that any interruptions to the nurse processes and procedures may have severe effects on the patients and the system should they lose their focus on their job (Huckels-Baumgart et al., 2017). An interruption here is defined as any circumstances whereby the nurse stops preparing or checking medication to pay attention to an external stimulus that may emanate from the nurse herself, colleagues, or the environment. Distractions are also considered as a form of interruption. The study, therefore, sought to establish if training and safety vests may have a positive impact on the reduction of interruptions during medication preparation and double checking which key procedures in medicine considering the negative impact that the interruptions have on the processes of clinicians (KIM et al., 2011).
To spearhead this study, the researchers depended on the PubMed and Embase databases for accessing literature on the topic using keywords that include medication safety, safety vests, interruptions, medication/drug preparation, drug administration, interventions, distraction, and medication among others. However, this was a pilot study hence there was not much information that was found in the databases. From the literature amassed from the PubMed and Embase databases, there was an appreciation that even though there has not been any physical evidence that training and safety vests do help in minimizing interruption during medication preparation, although safety vest has been used with a positive impact in fields such as construction, aviation, and road traffic industry where they are used in areas of maximum concentration (Anthony et al., 2010). As such a study was carried out in the clinical setting to establish whether lack of interruption and wearing of brightly colored safety vests will help alleviate the problem.
The pilot study was therefore done in a medical ward which had 20-beds allotted to 12 patient rooms manned by a total of 28 nurses who were rotating through four shifts. The medical preparation was to be done by one nurse before being checked by another nurse throughout the day. All nurses who participated in the study were qualified and participation was consensual (Relihan et al., 2010). The interventions that were on the table were staff training and safety vests. Regarding the safety vests, all nurses who were ceased with critical tasks were asked to wear safety vests that were labeled ‘Do Not Disturb’. The data collection was done before the training and implementation of the safety vests and comparison data was collected after training and the implementation of safety vests. The pilot study was done over a period of 3 months.
Results from the pilot study indicated that mean interruption rates were reduced from 36.8 pre-intervention to 32.1 interruptions per hour during medication preparation post-intervention 1. The interruption rates also reduced to 28.3 interruptions per hour due to post-intervention 2. This produced an overall decrease in interruptions by 23.1%. Observation before the interventions, nearly half of the interruptions were caused by the nursing colleagues whereas post the intervention, 32% of the interruptions were self-initiated with now only 23% now being due to colleagues. Other interruptions were also found to be caused by the missing records (Bower et al., 2015).
The research, therefore, concluded that the interruptions were first being caused by nursing staff mostly and after the implementation of the safety vests and training, there was a significant decrease in interruptions.
Regarding the validity of the study, it pertains to how much we can be confident with the results of the study. Given that the pilot study was taken over a reasonable period and in a medical setup with all participants being professional nurses, the findings can be trusted (Anthony et al., 2010). Also, there are fewer chances of confounding.
It is also important to note that the participating nurses were chosen randomly from a population of 90 and that there was a study protocol that outlined how to administer the study all of which increase internal validity. Concerning external validity, this is where there is the consideration of how well the results of the study may be used in other settings. From the project, it appears that these results may be generalized to the real world as the issue of safety vests is already being used in other industries such as construction and aviation in areas that are of intensive concentration (TOMIETTO et al., 2012).
The second article is entitled, “Nurses’ experiences with newly acquired knowledge about medication management: A qualitative study” that was carried out by a team of four medical academics. This was a qualitative study that sought to ascertain how nurses can apply new knowledge in their practices that would have been acquired through initiatives such as the Medication Management Programme (MMP). This was motivated by the appreciation that lack of knowledge has affected the delivery of service by nurses which has caused avoidable mistakes and errors in the past (Høghaug et al., 2019). The study acknowledges that the most errors that occur in the health setup occur during the medication preparation and administration stages.
The MMP program is a qualification that combines e‐learning and classroom teachings that are focused on pharmaceutical preparation and distribution. The participants were allowed to take tests immediately after the program and after the subsequent three months. This study involved the interviewing of participants openly after they had taken their tests allowing them to speak openly about their experiences. The data was collected from 10 female respondents who were between the age of 24 and 34 years with a range of experience that spanned between 3 months and 11 years.
The analysis of data was done through thematic coding following verbatim transcribing of the interviews soon after the interviews had taken place. Upon transcribing, phrases in the text were reduced and organized into various common headings, which allowed the identification of themes (TOMIETTO et al., 2012). From this study, two themes were ascertained as follows:
There was an appreciated awareness of one’s knowledge and the confidence to use and share that knowledge, There were also barriers to safe practice that included time pressure as well as the divergence between MMP‐based knowledge and clinical practice
This study, however, concluded that the nursing workforce is appreciative of the impact that programs such as the MMP can have in their capacities and capabilities and hence there is a general understanding that the MMP should be administered to all health institutions and regularly as opposed to providing it to new nurses alone. According to the interviews, all nurses who partook acknowledged that the MMP program had improved their knowledge which enabled them to share it through professional discussions thereby revealing any errors that they may have been practicing (Høghaug et al., 2019).
Also, the interviews revealed that there is great importance for a good working environment as it helps them to practice safe medicine and also allows them to work with an open mind. This creates an atmosphere of teamwork which makes it comfortable for a person to ask questions whenever they need support and help. A good working environment also assists in boosting professionalism (Prakash et al., 2014).
However, despite having established that the training programs such as the PMM have an impact on the performance of the nurses, there was also a revelation from the thematic analysis that there are also factors that deter good practice in medicine which may also need to be attended to (Smeulers et al., 2013). This is also supported by previous studies that found out that important tasks are often omitted when nursing shifts are characterized by time pressures, lack of resources, and high workloads.
Also, the nurses highlighted that medication management is considered a high-risk area and hence it is generally tressing as one would want to avoid errors or mistakes but inevitably increasing the risk of the same errors. However, the general findings of this study revealed that there is a general divergence between the MMP acquired knowledge and the clinical practice with regards to switching medicines with the same effect when double-checking as well during hygiene procedures.
However, the validity of the study may face some challenges in that most of their participants had less than 1-year experience as nurses which has a high chance of affecting the findings. Also, the aspect of conducting a study based only on interviewing the participants may have less strength rather than conducting a study of evaluating the impact of the PMM program through the use of on the job observations (Huckels-Baumgart et al., 2016).
From the examination of the two articles, it is sufficient to say that knowledge is important in improving the performance of nurses during medical preparation and double-checking the medicines. Also, interruptions may be managed through training and the adoption of safety vests as well as a full acknowledgment by the staff that they exist and need to be managed. The two articles also agree to the fact that the level of interruptions will be reduced significantly when training is administered to the clinical staff.
Word count: 1680
Anthony, K., Wiencek, C., Bauer, C., Daly, B., & Anthony, M. (2010). No Interruptions Please: Impact of a No Interruption Zone on Medication Safety in Intensive Care Units. Critical Care Nurse, 30(3), 21-29. https://doi.org/10.4037/ccn2010473
Bower, R., Jackson, C., & Manning, J. (2015). Interruptions and medication administration in critical care. Nursing In Critical Care, 20(4), 183-195. https://doi.org/10.1111/nicc.12185
Høghaug, G., Skår, R., Tran, T., & Schou-Bredal, I. (2019). Nurses’ experiences with newly acquired knowledge about medication management: A qualitative study. Journal Of Nursing Management, 27(8), 1731-1737. https://doi.org/10.1111/jonm.12864
Huckels-Baumgart, S., Baumgart, A., Buschmann, U., Schüpfer, G., & Manser, T. (2016). Separate Medication Preparation Rooms Reduce Interruptions and Medication Errors in the Hospital Setting. Journal Of Patient Safety, Publish Ahead of Print. https://doi.org/10.1097/pts.0000000000000335
Huckels-Baumgart, S., Niederberger, M., Manser, T., Meier, C., & Meyer-Massetti, C. (2017). A combined intervention to reduce interruptions during medication preparation and double-checking: a pilot-study evaluating the impact of staff training and safety vests. Journal Of Nursing Management, 25(7), 539-548. https://doi.org/10.1111/jonm.12491
KIM, K., KWON, S., KIM, J., & CHO, S. (2011). Nurses’ perceptions of medication errors and their contributing factors in South Korea. Journal Of Nursing Management, 19(3), 346-353. https://doi.org/10.1111/j.1365-2834.2011.01249.x
Leon, A., Davis, L., & Kraemer, H. (2011). The role and interpretation of pilot studies in clinical research. Journal Of Psychiatric Research, 45(5), 626-629. https://doi.org/10.1016/j.jpsychires.2010.10.008
Prakash, V., Koczmara, C., Savage, P., Trip, K., Stewart, J., & McCurdie, T. et al. (2014). Mitigating errors caused by interruptions during medication verification and administration: interventions in a simulated ambulatory chemotherapy setting. BMJ Quality & Safety, 23(11), 884-892. https://doi.org/10.1136/bmjqs-2013-002484
Relihan, E., O’Brien, V., O’Hara, S., & Silke, B. (2010). The impact of a set of interventions to reduce interruptions and distractions to nurses during medication administration. BMJ Quality & Safety, 19(5), e52-e52. https://doi.org/10.1136/qshc.2009.036871
Smeulers, M., Hoekstra, M., Van Dijk, E., Overkamp, F., & Vermeulen, H. (2013). Interruptions during hospital nurses’ medication administration rounds. Nursing Reports, 3(1), 4. https://doi.org/10.4081/nursrep.2013.e4
TOMIETTO, M., SARTOR, A., MAZZOCOLI, E., & PALESE, A. (2012). Paradoxical effects of a hospital-based, multi-intervention programme aimed at reducing medication round interruptions. Journal Of Nursing Management, 20(3), 335-343. https://doi.org/10.1111/j.1365-2834.2012.01329.x
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