Interruptions during nurses' work: A state‐of‐the‐science review

The purpose of this state‐of‐the‐science review was to examine empirical evidence from studies of interruptions conducted in acute care nurses' work environments. A total of 791 articles published from 2001 through 2011 were reviewed; 31 met the criteria to be included in the sample. Despite sustained multinational and multidisciplinary attention to interruptions during nurses' work, the current findings suggest that beliefs about the ill effects of interruptions remain more conjecture than evidence‐based. Pre‐existing beliefs and biases may interfere with deriving a more accurate grasp of interruptions and their effects. Future research would benefit from examinations of interruptions that better capture their complexity, to include their relationships to both positive and negative outcomes for both patients and health care workers. © 2012 Wiley Periodicals, Inc. Res Nurs Health 36:38–53, 2013     

Interruptions during nurses' drug rounds in surgical wards: observational study

Aims  The purpose of the study was to examine the frequency and perceived risk of interruptions to nurses during drug rounds in seven Italian surgical wards.
Background  Management of drug therapy is an integral part of the clinical role of nurses. Many errors are caused by interruptions to which the nurse is subjected during the drug rounds. However, the frequency of interruptions to nurses during drug rounds has not yet been documented.
Materials and methods  An observational study design was developed: (1) 56 randomized drug rounds, eight for each ward included, were observed and (2) 28 convenience samples of observed nurses were interviewed.
Results  The administration of a total of 945 medications was observed, an average of 2.2 per patient being treated: 298 interruptions were observed (one for every 3.2 drugs given). Ten different categories of interruption emerged. The highest risk of error as a result of interruption perceived by these nurses was related to the management of telephone calls.
Implications for nursing management  Many of the interruptions as a result of the organization of work could be avoided: one organizational priority should be to create a calm atmosphere for administering drugs. Ways to develop a calm atmosphere are discussed.     

Medication management by graduate nurses: before, during and following medication administration

The purpose of the present study was to explore graduate nurses' perceptions of their medication management activities in the acute care context. A qualitative research design with a semistructured interview schedule was used to elicit information from participants. The sampling population consisted of graduate nurses involved in direct patient care in medical and surgical wards of a Melbourne metropolitan teaching hospital, completing a graduate nurse program. Twelve graduate nurses participated in the interviews. Two major themes emerged: (i). monitoring medications and (ii). interventions for patient care. The findings indicate that graduate nurses are required to address several facets of the medication management role in their daily practice. It is pertinent to examine ward dynamics to ensure that graduate nurses have ready access to experienced health care professionals. Through collegial support, graduate nurses should also be encouraged to critically examine the different possibilities when making clinical judgments about monitoring patient medications.     

时点静脉用药规范管理的效果

目的探讨时点静脉用药规范管理在临床护理工作中的应用效果。方法制作时点用药标识,专柜放置时点静脉用药,合理调配护理人员,规范时点静脉用药流程。结果治疗室考核评分提高(P0.05);操作前静脉用药核对时间缩短(P0.01),护士满意度提高(P0.01);规范管理后,未发生静脉用药不良事件。结论时点静脉用药规范管理提高了护理工作效率,保证了患者安全、有效用药,值得临床推广。     

Errors in the administration of intravenous medication in Brazilian hospitals

Aim. To verify the frequency of errors in the preparation and administration of intravenous medication in three Brazilian hospitals in the State of Bahia. Background. The administration of intravenous medications constitutes a central activity in Brazilian nursing. Errors in performing this activity may result in irreparable damage to patients and may compromise the quality of care. Design. Cross‐sectional study, conducted in three hospitals in the State of Bahia, Brazil. Methods. Direct observation of the nursing staff (nurse technicians, auxiliary nurses and nurse attendants), preparing and administering intravenous medication. Results. When preparing medication, wrong patient error did not occur in any of the three hospitals, whereas omission dose was the most frequent error in all study sites. When administering medication, the most frequent errors in the three hospitals were wrong dose and omission dose. Conclusions. The rates of error found are considered low compared with similar studies. The most frequent types of errors were wrong dose and omission dose. The hospitals studied showed different results with the smallest rates of errors occurring in hospital 1 that presented the best working conditions. Relevance to clinical practice. Studies such as this one have the potential to improve the quality of care.     

Improving patient safety using the sterile cockpit principle during medication administration: a collaborative,unit-based project

Aim To implement the sterile cockpit principle to decrease interruptions and distractions during high volume medication administration and reduce the number of medication errors. Background While some studies have described the importance of reducing interruptions as a tactic to reduce medication errors, work is needed to assess the impact on patient outcomes. Methods Data regarding the type and frequency of distractions were collected during the first 11 weeks of implementation. Medication error rates were tracked 1 year before and after 1 year implementation. Results Simple regression analysis showed a decrease in the mean number of distractions, (β = −0.193, P = 0.02) over time. The medication error rate decreased by 42.78% (P = 0.04) after implementation of the sterile cockpit principle. Conclusions The use of crew resource management techniques, including the sterile cockpit principle, applied to medication administration has a significant impact on patient safety. Implications for nursing management Applying the sterile cockpit principle to inpatient medical units is a feasible approach to reduce the number of distractions during the administration of medication, thus, reducing the likelihood of medication error. ‘Do Not Disturb’ signs and vests are inexpensive, simple interventions that can be used as reminders to decrease distractions.     

静脉用药的微粒污染及防护措施

综述了临床静脉用药过程中微粒污染来源,包括静脉用药器具污染、操作环境污染、操作方法不当等;并提出了针对性的防护措施:严把输液器具关、保证药液可靠性、合理用药、加强操作环境管理、严格遵守操作规程等.     

减少静脉用药中不溶性微粒的研究进展

介绍了静脉用药中不溶性微粒的来源及危害 ,重点阐述了减少静脉用药中不溶性微粒的措施     

基层医院静脉化疗安全给药情况的调查

目的调查基层医院静脉化疗安全给药情况,并探讨管理对策。方法采用自行设计的基层医院静脉化疗安全用药问卷,对40名护理部主任及200名执行静脉化疗操作的护士和196例接受静脉化疗的患者进行调查。结果仅17．50％的基层医院对静脉化疗患者进行了集中管理;仅8．50％的护士在执行静脉化疗时首选较安全的PICC通路;59．89％的患者因PICC导管维护困难而未选择PICC化疗通路。结论尽快建立健全静脉化疗安全管理制度,规范静脉化疗操作流程及通路的管理,加强静脉化疗专科知识培训,建立肿瘤患者护理管理网络,以保证静脉化疗安全用药。     

移动信息技术在改进门诊输液管理流程中的应用

目的：讨论移动信息技术在门诊输液室的应用优势。方法：通过对传统输液流程和移动输液流程的对比分析,论证了将移动信息技术应用于门诊输液的优势。结果：将移动信息技术应用于门诊输液流程后,有效地减少了传统门诊输液在核对患者身份及其药物的准确性方面所存在的安全隐患以及因呼叫响应不及时所产生的医患纠纷,提高了护士的工作效率,给病人营造出安全、安静、安心的输液环境。结论：移动信息技术在门诊输液室的应用保证了门诊病人的输液安全,提升了医院的医疗安全管理水平,是医院信息化建设不断发展的必然趋势。     

Implementation of an intravenous medication infusion pump system: implications for nursing

AIM: To assess perceptions of nurses regarding the implementation of intravenous medication infusion system technology and its impact on nursing care, reporting of medication errors and job satisfaction. BACKGROUND: Medication errors are placing patients at high risk and creating an economic burden for hospitals and health care providers. Infusion pumps are available to decrease errors and promote safety. METHODS: Survey of 1056 nurses in a tertiary care Magnet hospital, using the Infusion System Perception Scale. Response rate was 65.43%. RESULTS: Nurses perceived the system would enhance their ability to provide quality nursing care, reduce medication errors. Job satisfaction was related to higher ratings of the management team and nursing staff. Perceptions verified the pump was designed to promote safe nursing practices. CONCLUSIONS: It is important to consider relationships with job satisfaction, safe nursing practice and the importance of ratings of nursing staff and management teams when implementing infusion technology. IMPLICATIONS FOR NURSING MANAGEMENT: Infusion pumps are perceived by nurses to enhance safe nursing practice. Results stress the importance of management teams in sociotechnological transformations and their impact on job satisfaction among nurses.