Are interventions to reduce interruptions and errors during medication administration effective?: a systematic review
Open Access
- 26 August 2013
- journal article
- review article
- Published by BMJ in BMJ Quality & Safety
- Vol. 23 (5), 414-421
- https://doi.org/10.1136/bmjqs-2013-002118
Abstract
Background Medication administration errors are frequent and lead to patient harm. Interruptions during medication administration have been implicated as a potential contributory factor. Objective To assess evidence of the effectiveness of interventions aimed at reducing interruptions during medication administration on interruption and medication administration error rates. Methods In September 2012 we searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Effective Practice and Organisation of Care Group reviews, Google and Google Scholar, and hand searched references of included articles. Intervention studies reporting quantitative data based on direct observations of at least one outcome (interruptions, or medication administration errors) were included. Results Ten studies, eight from North America and two from Europe, met the inclusion criteria. Five measured significant changes in interruption rates pre and post interventions. Four found a significant reduction and one an increase. Three studies measured changes in medication administration error rates and showed reductions, but all implemented multiple interventions beyond those targeted at reducing interruptions. No study used a controlled design pre and post. Definitions for key outcome indicators were reported in only four studies. Only one study reported κ scores for inter-rater reliability and none of the multi-ward studies accounted for clustering in their analyses. Conclusions There is weak evidence of the effectiveness of interventions to significantly reduce interruption rates and very limited evidence of their effectiveness to reduce medication administration errors. Policy makers should proceed with great caution in implementing such interventions until controlled trials confirm their value. Research is also required to better understand the complex relationship between interruptions and error to support intervention design.This publication has 43 references indexed in Scilit:
- Reducing Interruptions to Improve Medication SafetyJournal of Nursing Care Quality, 2013
- Shhh! Conducting a Quiet Zone pilot study for medication safetyNursing2021, 2012
- Improving patient safety using the sterile cockpit principle during medication administration: a collaborative, unit-based projectJournal of Nursing Management, 2012
- Paradoxical effects of a hospital-based, multi-intervention programme aimed at reducing medication round interruptionsJournal of Nursing Management, 2012
- How much time do nurses have for patients? a longitudinal study quantifying hospital nurses' patterns of task time distribution and interactions with health professionalsBMC Health Services Research, 2011
- Interruptions During the Delivery of High-Risk MedicationsJONA: The Journal of Nursing Administration, 2010
- Medication error prevalenceInternational Journal of Health Care Quality Assurance, 2010
- No Interruptions Please: Impact of a No Interruption Zone on Medication Safety in Intensive Care UnitsCritical Care Nurse, 2010
- Work Interruptions and Their Contribution to Medication Administration Errors: An Evidence ReviewWorldviews on Evidence-Based Nursing, 2009
- The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after studyQuality and Safety in Health Care, 2007