Carolyn Hayes

Medication errors in hospitals: A literature review of disruptions to nursing practice during medication administration

AIMS AND OBJECTIVES The purpose of this review was to explore what is known about interruptions and distractions on medication administration in the context of undergraduate nurse education. BACKGROUND Incidents and errors during the process of medication administration continue to be a substantial patient safety issue in health care settings internationally. Interruptions to the medication administration process have been identified as a leading cause of medication error. Literature recognises that some interruptions are unavoidable; therefore in an effort to reduce errors, it is essential understand how undergraduate nurses learn to manage interruptions to the medication administration process. DESIGN Systematic, critical literature review. METHODS Utilising the electronic databases, of Medline, Scopus, PubMed and CINAHL, and recognised quality assessment guidelines, 19 articles met the inclusion criteria. Search terms included: nurses, medication incidents or errors, interruptions, disruption, distractions and multitasking. RESULTS Researchers have responded to the impact of interruptions and distractions on the medication administration by attempting to eliminate them. Despite the introduction of quality improvements, little is known about how nurses manage interruptions and distractions during medication administration or how they learn to do so. A significant gap in the literature exists in relation to innovative sustainable strategies that assist undergraduate nurses to learn how to safely and confidently manage interruptions in the clinical environment. CONCLUSIONS Study findings highlight the need for further exploration into the way nurses learn to manage interruptions and distractions during medication administration. This is essential given the critical relationship between interruptions and medication error rates. RELEVANCE TO CLINICAL PRACTICE Better preparing nurses to safely fulfil the task of medication administration in the clinical environment, with increased confidence in the face of interruptions, could lead to a reduction in errors and concomitant improvements to patient safety.

Nurse interrupted: Development of a realistic medication administration simulation for undergraduate nurses

BACKGROUND Medication errors are a global phenomenon. Each year Australia-wide there are up to 96,000 preventable medication errors and in the United States there are approximately 450,000 preventable medication errors. One of the leading causes of errors is interruption yet some interruptions are unavoidable. In the interest of patient safety, nurses need to not only understand the impact of interruptions, but also be empowered with the knowledge and skills required to develop effective interruption management strategies. Well-planned simulation experiences have the potential to expose students to authentic clinical cases, otherwise unavailable to them, building critical thinking and clinical reasoning skills and preparing them for practice. AIM This paper describes a simulated role-play experience that was developed to enable undergraduate nurses to experience, reflect on and analyse their responses to interruptions during medication administration. METHODS The simulation design presented in this paper was underpinned by both nursing and educational theorists, in combination with established simulation frameworks. SETTING AND PARTICIPANTS Embedded within a clinical subject in 2013, the simulation experience was run over two campuses within a large Australian University. Participants included 528 second year undergraduate nursing students and 8 academic teaching staff. OUTCOME MAPPING To stimulate reflective learning debriefing immediately followed the simulation experience. Written reflections were completed and submitted over the following 4weeks to extend the reflective learning process and review the impact of the experience from the student perspective. CONCLUSIONS Undergraduate student nurses often have limited experiential background from which to draw knowledge and develop sound clinical judgements. Through exposure to clinical experiences in a safe environment, simulation technologies have been shown to create positive learning experiences and improve deductive reasoning and analysis. The heightened awareness of interruptions and their impacts on the medication administration process, along with techniques to manage interruptions more effectively serves to better prepare nurses for practice.

Editorial: Interruptions and medication: Is 'Do not disturb' the answer?

Medication related incidents and errors continue to be a significant patient safety issue in health care settings internationally and despite decades of research and quality improvement initiatives, we have failed to identify innovative and sustainable solutions. The importance and significance of this problem not only challenges us, but emphasises the need to develop and implement sustainable interventions that are realistic and appropriate for the clinical setting. Nurses are not only the largest group of health professionals who administer medications, but are also considered to be in the best position to recognise and prevent medication errors before patient safety is compromised (Flynn, Liang, Dickson, Xie, & Suh, 2012). Hence the need to adequately prepare student nurses by providing appropriate learning opportunities. In 2009 in New South Wales (NSW) (Australia) public hospitals there were 21,717 reported medication and intravenous (IV) fluid incidents; 38% of which occurred within the administration phase (Clinical Excellence Commission Health and NSW Department of Health, 2011). There is a paucity of peer reviewed literature that accurately reports current Australia wide statistics that include both oral and IV incidents. However, some relevant contemporary data was submitted in 2008 as part of a submission to the National Health and Hospitals Reform Commision. One submission stated there are between 77,000 and 96,000 preventable medication/IV fluid errors per annum, and it was further estimated that 27% of these errors caused patient harm (Hospira Pty Ltd, 2008). This problem is not unique to the Australian context, it aligns with a similar situation in many other countries including Editorial Interruptions and medication: Is ‘Do not disturb’ the answer?Medication related incidents and errors continue to be a significant patient safety issue in health care settings internationally and despite decades of research and quality improvement initiatives, we have failed to identify innovative and sustainable solutions. The importance and significance of this problem not only challenges us, but emphasises the need to develop and implement sustainable interventions that are realistic and appropriate for the clinical setting. Nurses are not only the largest group of health professionals who administer medications, but are also considered to be in the best position to recognise and prevent medication errors before patient safety is compromised (Flynn, Liang, Dickson, Xie, & Suh, 2012). Hence the need to adequately prepare student nurses by providing appropriate learning opportunities.In 2009 in New South Wales (NSW) (Australia) public hospitals there were 21,717 reported medication and intravenous (IV) fluid incidents; 38% of which occurred within the administration phase (Clinical Excellence Commission Health and NSW Department of Health, 2011). There is a paucity of peer reviewed literature that accurately reports current Australia wide statistics that include both oral and IV incidents. However, some relevant contemporary data was submitted in 2008 as part of a submission to the National Health and Hospitals Reform Commision. One submission stated there are between 77,000 and 96,000 preventable medication/IV fluid errors per annum, and it was further estimated that 27% of these errors caused patient harm (Hospira Pty Ltd, 2008). This problem is not unique to the Australian context, it aligns with a similar situation in many other countries including North America, the United Kingdom, and Canada (Kohn, Corrigan, & Donaldson, 2000; Smallwood, 2000). In the North American context, an average of 450,000 preventable medication errors is estimated each year (Flanders & Clark, 2010). However, it must be acknowledged that these figures may not be accurate. For every reported medication error or incident, there are many more that go undetected and unreported (Choo, Hutchinson, & Bucknall, 2010; Flynn, Barker, Pepper, Bates, & Mikeal, 2002; Hughes & Blegen, 2008; McBride-Henry & Foureur, 2006).Projected estimates of up to two errors per patient per day (Wu, Pronovost, & Morlock, 2006) or one in five administrations of medications resulting in error (Reid-Searl, Happell, Burke, & Gaskin, 2013) have been documented. The associated cost Australia wide for medication error related hospital admissions is estimated to be

Where Is the Nurse? Towards Automatically Visualising Meaningful Team Movement in Healthcare Education

660 million/annum (Roughead & Semple, 2009). The costs accrue from a combination of increased lengths of stay, patient mortality and personal impacts including post discharge disability, and emotional distress (MacDonald, 2010; Roughead & Semple, 2009). In addition to the burden for patients and their families, there are also costs to nurses and the health care system. These costs may be professional, financial, physical and/or emotional (Flanders & Clark, 2010).Interruption or distraction to the administering clinician during the process of medication administration has been widely identified as a leading cause of errors (Hughes & Blegen, 2008; Nichols, Copeland, Craib, Hopkins, & Bruce, 2008; Westbrook, Woods, Rob, Dunsmuir, & Day, 2010). Westbrook et al. (2010) reported over 50% of observed medication administration encounters were interrupted in some way and nearly 85% of interrupted encounters resulted in either clinical error (e.g., wrong dose, timing, IV administration rate) or procedural error (e.g., not checking patient identification, inadequate attention to hand washing) or both (Westbrook et al., 2010). Palese, Sartor, Costaperaria, and Bresadola (2009) observed one interruption for every three patients given medication.Even the processes through which nurses attempt to control and reduce the effects of interruptions can be disruptive. …

Development of the RIPE model (Reflective Interprofessional Education Model) to enhance interprofessional collaboration

Providing immediate, effective feedback on team and individual performance in healthcare simulations is a challenging task for educators, such is their complexity. Focusing on emergency procedures on patient manikins, our prior work has demonstrated the feasibility of using multimodal data capture and analysis to generate visualisations of student movement, talk and treatment actions. The limitation to date has been the need for manual steps in the analytic workflow. This paper documents how we have automated several key steps, using new technologies, which were piloted during a nursing simulation. Combining role-based nurses’ movement data with high fidelity manikin logs, we have implemented a zone-based classification model, and are able to automatically visualise movements within an emergency response team, providing the data needed to design near real-time feedback for both educators and students.

Learning to liaise: using medication administration role-play to develop teamwork in undergraduate nurses.

ABSTRACT This paper describes a novel model to providing interprofessional education (IPE) and interprofessional collaboration (IPC) within a simulated healthcare environment, in the higher education setting. The RIPE Model (Reflective Interprofessional Education Model) was developed for the purpose of enhancing IPE and IPC, clinical judgement, and decision‐making between health professional students (pharmacy and nursing students) at the patients simulated hospital bedside. A foundation ‘unfolding’ case utilizing the RIPE model was piloted with first year Master of pharmacy students and postgraduate nursing students at an Australian university and included a pharmacy practitioner acting as a resident medical officer (RMO) for the purpose of the teaching module. The RIPE model rotated students through 10 stations (including 2 reflection stations) to unpack an unfolding case. The development of the RIPE model, processes, and future directions are included in this article. The RIPE Model provides the flexibility to adapt and tailor different cases and scenarios to include other health professional students to enhance educational outcomes, with the feedback of the learning to potentially improve future patient outcomes. Furthermore, the model has the potential to be tailored and utilized for the purpose of upskilling practicing pharmacists for Continuing Professional Development (CPD) and changing scopes of practice.

Plastic with personality: Increasing student engagement with manikins

Aim: To describe undergraduate nursing students’ situational awareness and understanding of effective liaison and collaboration within the nursing team during interrupted medication administration. Background: Medication errors related to interruptions are a major problem in health care, impacting on patient morbidity and mortality and increasing the burden of related costs. Effective liaison, teamwork and situation awareness are requisite skills for nurses to facilitate the safe management of interruptions during medication administration. Method: A role-play simulation was offered to 528 second-year undergraduate Bachelor of Nursing students. Qualitative written reflective responses were subsequently collected and subject to thematic analysis to derive themes. Results: Participants (451:528) reported an improved understanding of an unfamiliar and challenging situation that required cooperation and collaboration amongst the nursing team to improve outcomes. Conclusion(s): This simulation exposed undergraduate nurses with limited clinical experience to a situation otherwise unavailable to them. The skills required to engage in effective liaison and teamwork in dynamic situations are vital elements in achieving quality care and must begin to be taught at an undergraduate level.