title: Mitigating errors caused by interruptions during medication verification and administration: interventions in a simulated ambulatory chemotherapy setting.
abstract: BACKGROUND
  Nurses are frequently interrupted during medication verification and administration; however, few interventions exist to mitigate resulting errors, and the impact of these interventions on medication safety is poorly understood.
  
  
  OBJECTIVE
  The study objectives were to (A) assess the effects of interruptions on medication verification and administration errors, and (B) design and test the effectiveness of targeted interventions at reducing these errors.
  
  
  METHODS
  The study focused on medication verification and administration in an ambulatory chemotherapy setting. A simulation laboratory experiment was conducted to determine interruption-related error rates during specific medication verification and administration tasks. Interventions to reduce these errors were developed through a participatory design process, and their error reduction effectiveness was assessed through a postintervention experiment.
  
  
  RESULTS
  Significantly more nurses committed medication errors when interrupted than when uninterrupted. With use of interventions when interrupted, significantly fewer nurses made errors in verifying medication volumes contained in syringes (16/18; 89% preintervention error rate vs 11/19; 58% postintervention error rate; p=0.038; Fisher's exact test) and programmed in ambulatory pumps (17/18; 94% preintervention vs 11/19; 58% postintervention; p=0.012). The rate of error commission significantly decreased with use of interventions when interrupted during intravenous push (16/18; 89% preintervention vs 6/19; 32% postintervention; p=0.017) and pump programming (7/18; 39% preintervention vs 1/19; 5% postintervention; p=0.017). No statistically significant differences were observed for other medication verification tasks.
  
  
  CONCLUSIONS
  Interruptions can lead to medication verification and administration errors. Interventions were highly effective at reducing unanticipated errors of commission in medication administration tasks, but showed mixed effectiveness at reducing predictable errors of detection in medication verification tasks. These findings can be generalised and adapted to mitigate interruption-related errors in other settings where medication verification and administration are required.
authors.affiliation: Faculty of Medicine, Institute for Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada Healthcare Human Factors, Techna Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Varuna
authors.identifier: http://orcid.org/0000-0003-1204-6500
authors.initials: V
authors.lastname: Prakash
authors.affiliation: Institute for Safe Medication Practices Canada, Toronto, Ontario, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Koczmara
authors.affiliation: Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Pamela
authors.initials: P
authors.lastname: Savage
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Trip
authors.affiliation: Odette Cancer Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Janice
authors.initials: J
authors.lastname: Stewart
authors.affiliation: Healthcare Human Factors, Techna Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: McCurdie
authors.affiliation: Faculty of Medicine, Institute for Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada Healthcare Human Factors, Techna Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Cafazzo
authors.affiliation: Faculty of Medicine, Institute for Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada HumanEra, Techna Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Trbovich
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D001288:Attention; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000451:nursing; D064420:Drug-Related Side Effects and Adverse Reactions / Q000451:nursing / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000451:nursing* / Q000517:prevention & control*; D008875:Middle Aged; D017751:Safety Management / Q000379:methods*; D000066908:Simulation Training / Q000379:methods*; D013647:Task Performance and Analysis
keywords: Interruptions; Medication safety; Patient safety; Quality improvement; Simulation