title: Quiet please! Drug round tabards: are they effective and accepted? A mixed method study.
abstract: BACKGROUND
  The use of drug round tabards is a widespread intervention that is implemented to reduce the number of interruptions and medication administration errors (MAEs) by nurses; however, evidence for their effectiveness is scarce.
  
  
  OBJECTIVE
  Evaluation of the effect of drug round tabards on the frequency and type of interruptions, MAEs, the linearity between interruptions and MAEs, as well as to explore nurses' experiences with the tabards.
  
  
  METHODS
  A mixed methods before-after study, with three observation periods on three wards of a Dutch university hospital, combined with personal inquiry and a focus group with nurses.
  
  
  METHODS
  In one pre-implementation period and two post-implementation periods at 2 weeks and 4 months, interruptions and MAEs were observed during drug rounds. Descriptive statistics and univariable linear regression were used to determine the effects of the tabard, combined with personal inquiry and a focus group to find out experiences with the tabard.
  
  
  RESULTS
  A total of 313 medication administrations were observed. Significant reductions in both interruptions and MAEs were found after implementation of the tabards. In the third period, a decrease of 75% in interruptions and 66% in MAEs was found. Linear regression analysis revealed a model R2 of 10.4%. The implementation topics that emerged can be classified into three themes: personal considerations, patient perceptions, and considerations regarding tabard effectiveness.
  
  
  CONCLUSIONS
  Our study indicates that this intervention contributes to a reduction in interruptions and MAEs. However, the reduction in MAEs cannot be fully explained by the decrease in interruptions alone; other factors may have also influenced the effect on MAEs. We advocate for further research on complementary interventions that contribute to a further reduction of MAEs.
  
  
  CONCLUSIONS
  We can conclude that drug round tabards are effective to improve medication safety and are therefore important for the quality of nursing care and the reduction of MAEs.
authors.affiliation: Senior Nurse and Junior Researcher, Department of Neurosurgery and Department of Quality Assurance & Process Innovation, Academic Medical Center at the University of Amsterdam, and the Netherlands.
authors.forename: Lotte
authors.initials: L
authors.lastname: Verweij
authors.forename: Marian
authors.initials: M
authors.lastname: Smeulers
authors.forename: Jolanda M
authors.initials: JM
authors.lastname: Maaskant
authors.forename: Hester
authors.initials: H
authors.lastname: Vermeulen
mesh_terms: D000328:Adult; D001288:Attention; D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000451:nursing*; D008510:Medication Systems, Hospital; D008875:Middle Aged; D009426:Netherlands; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000523:psychology* / Q000706:statistics & numerical data; D012308:Risk Management / Q000379:methods*; D057188:Workflow; D055815:Young Adult
keywords: Patient safety; drug round tabard; evidence-based practice; focus group; intervention research; medication administration errors; quality improvement