Interrupting a Nurse Makes Medication Errors More Likely - page 4

by DoGoodThenGo | 10,058 Views | 39 Comments

"MONDAY, April 26 (HealthDay News) -- Distracting an airline pilot during taxi, takeoff or landing could lead to a critical error. Apparently the same is true of nurses who prepare and administer medication to hospital patients. ... Read More


  1. 1
    Quote from JoPACURN
    Hm...wonder how this will affect me at work. I am giving drugs every single second of the day.
    Are you in the Recovery Room? Shouldn't be too many non-staff in there, right? You're in a small, enclosed area, not out on the open range of the M/S floor, right? Just wondering who interrupts you. Not that being in RR would mean it's perfect, but it seems there'd be far fewer interruptions by families, docs or anesthetists making rounds, etc.
    wooh likes this.
  2. 2
    Quote from updogrn
    agree 100%! staffing is the main factor in the difference between the expectations of management and what is actually possible for nursing staff to accomplish. 30 or more patients, 2 nurses that arrive at 7p for evening shift, and hs meds need to be passed by 9? all this after count, shift report, and about 100 interruptions in between? and a threatening memo from administration regarding patient complaints that meds are not getting out on time and failure to do so will result in disciplinary action. the patients absolutely should receive their meds in a timely manner, i would never dispute that. we hit the ground running to get them out on time but it's a challenge, and it's clearly not a good idea to rush through a med pass....so something's gotta give here.
    what is the response from those who are threatening you when you tell them what you have shared here? i think maybe your shift should begin an hour earlier.




    that would be more realistic if you are expected to count, get report, and prepare meds and have the meds passed by 2200, especially if you are being interrupted to do anything other than get meds ready. i never realized how unrealistic it really is to expect someone to start work at 1900, take up the first hour of their shift with count, report, assignment issues, quick rounding, and heaven knows what else, then expect that they could possibly have 2100 meds poured for 30 patients within an hour and passed within another hour. pretty tough if there are interruptions. and you are actually saying that hs meds have to be finished by 2100? that's only 1 hour then, so forget making eyeball rounds or taking more than a lickety split 30 minutes for count and report. that would give you about 1.5 hours to pour and pass meds - barely, barely doable, i would think, especially with blood sugars thrown in.
    pagandeva2000 and wooh like this.
  3. 5
    Unfortunately these things usually are tolerated by the nursing staff who will vent to each other about how flawed the system in place is, but do not bring it up to administration for fear of retribution or loss of employment. I did email my DON this morning and respectfully voiced my concerns, with examples of actual situations that occurred on the shift that are potentially dangerous and that she should know about. I know as nurses that administrators can understand the concerns, but it is different when you are removed from the actual day to day issues that staff nurses encounter daily. Then there are the constraints that are placed on them by their bosses that, at the end of the day, dictate the action or inaction that takes place regarding the issues. I would rather effectively communicate my concerns, knowing they are documented, because otherwise it is typical to be negatively labeled as a "complainer" or not a "team player." The concern is for the patients, who are the reason we are there doing the job in the first place. I am not looking for any specific response, and most likely I won't get one, not expecting to anyway. But at least I expressed my concerns to someone who is in a position to acknowledge them.
  4. 5
    I've mentioned this to my administrator more than once. She is always wondering why we miss signatures in the MARs. I told her...it is because you give the med, answer the phone, sign for deliveries from pharmacy, help with a lift, give a PRN, answer questions from the family, and then finally get back to the MAR, which has been flipped to another page by the med aide, had ordered checked by the DON, and had pages removed by the MDS coordinator. (How's that for a run-on sentence?) She wanted to know why we can't multi-task.

    A charge nurse once interrupted her while she was signing some papers for the home office. While she was distracted, the DON went into her office and moved the papers to the corner of her desk. She didn't get the papers signed until the next day when the home office called to find out where they were.

    :-)
  5. 1
    Quote from cotjockey
    A charge nurse once interrupted her while she was signing some papers for the home office. While she was distracted, the DON went into her office and moved the papers to the corner of her desk. She didn't get the papers signed until the next day when the home office called to find out where they were.

    :-)
    LOVE it!!!
    southernbeegirl likes this.
  6. 1
    Quote from casper1
    The constant interuptions Nurses experience is a major factor in medical errors, phone calls, family questions, doctors inquiries all contribute to the interuptions that lead to errors. Med host and med carts are also centrally located and have no barriers so that nurses can prepare meds in a quiet, no distraction atmosphere.

    Staffing also an issue, Nurses are constantly called away while preparing meds because a patient needs help to the bathroom or a bedpan or a glass of water.
    Personally, while I don't have a dog in this hunt, was always amazed when working as a NA, and still to this day on how the "med nurse" for each shift could manage that cart up one side of the floor and down the other with ten thousand distractions, and still get the job done safely. This was back in the 1980's and 1990's with little or no unit dosage, so everything was done by the nurse. Later when I took Med Dose Calc in nursing school, it boggled my mind on how one would be able to concentrate on all those caculations with all the "noise" on a floor. I mean a quite classroom is one thing, and aside from the occasional Chatty Cathy sitting next to one.

    Some places I worked did have med rooms, however it usually was where the narcs cabinet was and or used for preparing IV's and other meds that simply couldn't be done out in the open on the cart.

    With primary care mostly having taken over from team nursing, it would have to be one big med room to handle the "rush hour" crush when there is a mad dash for the pyxis.
    pagandeva2000 likes this.
  7. 3
    I have worked in hospitals that ban all visitation during busy med passing hours... it was really great.
  8. 2
    Quote from Chico David RN
    . And what to do about those phones they make nurses carry now, I don't know.
    I'll tell you what to do with those $#@%$#@$%%^ phones. I want to flush mine in the toilet!!!!! I have had my phone ring non stop especially monday mornings. I hate working mondays. I have had it ring non stop when I'm trying to assess my patient. Nothing like trying to listen to lungs in a seriously ill patient and the phone rings. I have been known to turn mine off or "accidently" leave it in the hall somewhere.
    StNeotser and pagandeva2000 like this.
  9. 0
    Here's the primary source:

    Westbrook, J. I., Woods, A., Rob, M. I., Dunsmuir, W. T. M., & Day, R. O. (2010). Association of interruptions with an increased risk and severity of medication administration errors. Archives of Internal Medicine, 170(8), 683-690. doi:10.1001/archinternmed.2010.65

    I'm thinking of making a power-point, in the hopes of having some unnecessary interruptions eliminated. Unfortunately, the full text reference is not yet available.
  10. 0
    Quote from DoGoodThenGo

    With primary care mostly having taken over from team nursing, it would have to be one big med room to handle the "rush hour" crush when there is a mad dash for the pyxis.
    And HOW!! This is what made me stop doing med-surg nursing overtime in order to maintain my skills post graduation! The constant interruptions! Arguements at the pyxis station because one nurse wanted to cut before the other one.


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