title: Interruptions and medication administration in critical care.
abstract: BACKGROUND
  Medication administration has inherent risks, with errors having enormous impact on the quality and efficiency of patient care, particularly in relation to experience, outcomes and safety. Nurses are pivotal to the medication administration process and therefore must demonstrate safe and reliable practice. However, interruptions can lead to mistakes and omissions.
  
  
  OBJECTIVE
  To critique and synthesize the existing literature relating to the impact that interruptions have during medication administration within the paediatric critical care (PCC) setting.
  
  
  METHODS
  Key terms identified from background literature were used to search three electronic databases (Medline, CINHAL and BNI). Selected sources were critically appraised using the Critical Appraisal Skills Programme (CASP) tool.
  
  
  RESULTS
  There is confusion within the literature concerning the definition of interruption. Moreover, an assumption that all interruptions have a negative impact on patient safety exists. The literature identifies the multi-dimensional nature of interruptions and their impact on medication administration and patient safety. The cumulative effect of interruptions depends on what type of task is being completed, when it occurs, what the interruption is and which method of handling is utilized. A conceptual schema has been developed in order to explicate the themes and concepts that emerged.
  
  
  CONCLUSIONS
  This review summarizes debates within the international arena concerning the impact of interruptions on medication administration. However, conclusions drawn appear applicable in relation to practice, education and future research to other critical care settings.
  
  
  CONCLUSIONS
  Findings show that no single strategy is likely to improve the negative effect of interruptions without focus on patient safety. Practice education to improve team building interactions is required that equips nurses with the skills in managing interruptions and delegating high priority secondary tasks.
authors.affiliation: Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Bower
authors.affiliation: School of Health and Social Care, University of Lincoln, Lincoln, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Jackson
authors.affiliation: Nottingham Children's Hospital & Neonatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.|School of Health Sciences, Faculty of Medicine and Health Sciences, The University of Nottingham, Nottingham, UK.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Manning
mesh_terms: D064648:Critical Care Nursing; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control*; D061214:Patient Safety; D010371:Pediatric Nursing
keywords: Critical care nursing; Paediatric intensive/critical care; Patient safety and medication; Practice development