title: Effectiveness of a 'Do not interrupt' bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study.
abstract: OBJECTIVE
  To evaluate the effectiveness of a 'Do not interrupt' bundled intervention to reduce non-medication-related interruptions to nurses during medication administration.
  
  
  METHODS
  A parallel eight cluster randomised controlled study was conducted in a major teaching hospital in Adelaide, Australia. Four wards were randomised to the intervention which comprised wearing a vest when administering medications; strategies for diverting interruptions; clinician and patient education; and reminders. Control wards were blinded to the intervention. Structured direct observations of medication administration processes were conducted. The primary outcome was non-medication-related interruptions during individual medication dose administrations. The secondary outcomes were total interruption and multitasking rates. A survey of nurses' experiences was administered.
  
  
  RESULTS
  Over 8 weeks and 364.7 hours, 227 nurses were observed administering 4781 medications. At baseline, nurses experienced 57 interruptions/100 administrations, 87.9% were unrelated to the medication task being observed. Intervention wards experienced a significant reduction in non-medication-related interruptions from 50/100 administrations (95% CI 45 to 55) to 34/100 (95% CI 30 to 38). Controlling for clustering, ward type and medication route showed a significant reduction of 15 non-medication-related interruptions/100 administrations compared with control wards. A total of 88 nurses (38.8%) completed the poststudy survey. Intervention ward nurses reported that vests were time consuming, cumbersome and hot. Only 48% indicated that they would support the intervention becoming hospital policy.
  
  
  CONCLUSIONS
  Nurses experienced a high rate of interruptions. Few were related to the medication task, demonstrating considerable scope to reduce unnecessary interruptions. While the intervention was associated with a statistically significant decline in non-medication-related interruptions, the magnitude of this reduction and its likely impact on error rates should be considered, relative to the effectiveness of alternate interventions, associated costs, likely acceptability and long-term sustainability of such interventions.
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Johanna I
authors.initials: JI
authors.lastname: Westbrook
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.affiliation: Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Hooper
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Magda Z
authors.initials: MZ
authors.lastname: Raban
authors.affiliation: Nursing Research Institute, St. Vincent's & Mater Health Sydney and Australian Catholic University, Darlinghurst, New South Wales, Australia.
authors.forename: Sandy
authors.initials: S
authors.lastname: Middleton
authors.affiliation: Faculty of Pharmacy, Sydney, New South Wales, Australia.
authors.forename: Elin C
authors.initials: EC
authors.lastname: Lehnbom
mesh_terms: D001315:Australia; D005240:Feasibility Studies; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D008508:Medication Errors / Q000451:nursing* / Q000517:prevention & control*; D008510:Medication Systems, Hospital / Q000458:organization & administration* / Q000592:standards; D009741:Nursing Staff, Hospital / Q000458:organization & administration* / Q000592:standards; D017751:Safety Management / Q000458:organization & administration*; D016037:Single-Blind Method
keywords: Cluster trials; Interruptions; Medication safety; Nurses; Randomised controlled trial