Interruptions and medication errors: a mixed methods feasibility study

Owen, Samantha (2024). Interruptions and medication errors: a mixed methods feasibility study. University of Birmingham. M.Sc.

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Abstract

Background: Medication errors have been found to have numerous contributing factors and interruptions and distractions have been identified as a key cause. A scoping review was conducted to identify and evaluate educational interventions that have been employed to reduce medication interruptions and improve medication safety. Eight studies were found to have employed educational interventions often using multifaceted interventions making it difficult to determine the effectiveness of education alone.

The aim of this study is to determine if an educational intervention can change the way nurses manage interruptions in a Paediatric Intensive Care (PICU) setting, with a focus on the number of interruptions handled appropriately by nurses.

Methods: The study was conducted in a 31-bed PICU in the United Kingdom. An educational intervention, informed by the scoping review, was designed and developed, consisting of a teaching session on appropriate behaviour management strategies, a simulation session to practice strategies, and an eLearning module. A randomised, un-blinded trial design was selected, where participants were randomised to either receive the educational intervention alongside the standard training provided by the unit (intervention group) or to just receive the standard training (control group). Band 5 nurses new to the unit were invited to participate. Observational data was collected at two months to identify the management strategies used by the nurses and then participants were invited to take part in interviews to explore their experiences of the learning and the perceived impact this had.

Ethical, governance and Health Research Authority approval was sought and gained for this study.

Results: A total of 27 nurses were recruited to the study, with 11 randomised to the intervention group and 16 to the control group. Due to sickness and unavailability when the intervention was implemented, two participants randomised to the intervention group had to be switched to the control group.

A high rate of interruptions was found in the observational data, with 89% of medication episodes interrupted at least once. The main source of interruptions were nursing staff communications, ranging from questions about breaks, social conversations to clinical communication. Observation of the medication episodes showed that the main strategy used by both groups was multitasking, which was never adopted appropriately. The blocking strategy was found to be used least. Upon analysis, no statistical difference was found between the intervention and control groups in the strategies they adopted to manage their interruption.

Six themes emerged during the interviews: 1) Situational awareness, 2) Empowerment, 3) Simulation sessions, 4) Team cohesion, 5) Embedded in the culture and 6) Shared learning. All the participants reported they would recommend the educational intervention to their colleagues. The interview data supported findings from the with the observational study, where the nurses reported they didn’t always utilise the appropriate strategy but had an increased awareness of the interruption. A fear of being perceived as rude and lack of embedded education in the culture, were identified as the main barriers to using the blocking strategy.

Discussion: A high rate of interruptions was found to occur in PICU, with nurses one of the main sources of these. A need for a consistent approach among all professionals emerged from the interviews, allowing behaviours such as choosing to block an intervention to be understood in the moment and accepted. The main management strategy utilised by all participants was multitasking.

The high interruption rates observed and the nurses’ desire for change needs to be further explored. Although there was no statistical difference between the intervention and control groups, the education increased awareness of the issue and highlighted the need for this to be made more widely available within the organisation to encourage wider cultural change. This would make strategies to block interruptions more acceptable.

Type of Work:

Thesis (Masters by Research > M.Sc.)

Award Type:

Masters by Research > M.Sc.

Supervisor(s):