Yellow Sashes for Med Passes

[Testa Rosa, RN]

Management at my current hospital has reinstated having nurses wear yellow safety sashes” during med administration. It's being done to create a bubble of silence while we pass meds.

I was all for it the first go around. However, it's one of those things that sound good in theory yet is a total fail in practice. Nurses hate It. It creates more steps, nobody pays attention to what it signifies—especially the managers, pick up the line the line and take report now!”

Posters have been mounted and staff has been trained. But this does not preclude phones or speaker device ringing—oblivious that you have the sash of silence” on. Doctors and families still interrupt you. As they should be able to as It's the way of work life in the hospital.

These sashes are just one more detail piled on the mountain of details we navigate. Furthermore, it's one more thing we get taken to task for, You have meds in your hands, why are you not wearing your sash!?!?!” or ”Why do you still have your sash on when you're ot passing meds?” I am an intelligent, grown-assed nurse, not an errant child.

We focus on this donning and doffing of this worthless sash to comply to policy when we should be focusing in on safe med pass. We need to simplify nurse tasks around critical safety points--not increase tasks.

Does anyone know of any evidence based research supporting the wearing of sashes or vests while passing meds?

[amoLucia]

Had a terrible sexist thought. Sashes remind me of those sash-banners worn by beauty pageant contestants.

Oh, Gawd. Just another thought - "Miss Room 101" and "Miss Room 104". Could you imagine requiring staff to wear sashes with room numbers so that others could identify staff assignments?!?! Need to wash my brain out!

[Testa Rosa, RN]

Yes, I can see where the wearing of sashes would work best in a LTC setting where the nurse has to travel with the med cart and med times are standardized, but in an acute care hospital situation most nurses have med rooms where only nurses are allowed and it's understood to be a place of focus and quiet unless there's something important that needs to be said (good gossip). But the donning and doffing of these stupid sashes as you go about acute care work is just stupid. That these sashes just don't work in a hospital setting does not take rocket science--but how management loves to pile on this crap--just one more stupid step to process in a mountain of stupid details, in order to get to the heart of safe patient care. Piling less routine upon the floor nurse rather than more would be common sense, but obviously NO.

[SWM2009]

I work in LTC and no thank you to sashes of any kind. IMO, they are ridiculous in any setting.

[Testa Rosa, RN]

So what you are saying is wearing sashes for safety during med pass is stupid and ridiculous even in LTC, the place I imagined they might work...

[K+MgSO4, BSN]

I went down the route of educating my clerk......no phone calls before 9 AM, no calls at midday. When she started getting push back from families I took the call and explained that the nurses should not be interrupted while making high risk descisions about medicines with calls from family or when they are trying to feed nonna. I have now rolled it out across the organization despite consumer engagement giving kickback.

[macawake, MSN]

Does anyone know of any evidence based research supporting the wearing of sashes or vests while passing meds?

There are studies that show that interventions like for example wearing a vest in conjunction with other safety interventions during med pass decreases the number of interruptions:

The impact of a set of interventions to reduce interruptions and distractions to nurses during medication administration --

Relihan et al. 19 (5): e52 -- BMJ Quality and Safety

There are studies that suggest that decreasing the number of interruptions during med pass might reduce the number of medication errors:

Implementing evidence-based medication safety interventions on a progressive care unit. - PubMed - NCBI

But many of the studies have limitations/weaknesses in their designs:

Are interventions to reduce interruptions and errors during medication administration effective?: a systematic review

The conclusions of the review article:

There is weak evidence of the effectiveness of interventions to significantly reduce interruption rates and very limited evidence of their effectiveness to reduce medication administration errors. Policy makers should proceed with great caution in implementing such interventions until controlled trials confirm their value. Research is also required to better understand the complex relationship between interruptions and error to support intervention design.

As is often the case in the world of research, more studies are needed :)

Personally, I always try to avoid interrupting a coworker when they are busy preparing/drawing up/administering medications unless what I have to say, absolutely can not wait. Most of the time, it can. I suspect that distractions and interruptions have a negative impact on focus/medication safety and will continue to behave this way until the research catches up with my own personal convictions

Actually, this expectation that nurses should always be available right.this.second to whomever wishes to blabber on about something is a pet peeve of mine. Nurses are expected to multi-task to a ridiculous degree, meanwhile maintaining a cheerful smile. To me, minimizing the amount of unwarranted interruptions is a matter of respect for the work a person is doing as well as a potential safety issue.

Medication errors are a serious problem and can and do lead to patient harm and even death. We need to look for ways to minimize them. But even if we do identify interventions/strategies that do work, they won't be successful unless the organization/management makes sure that staffing levels and other important factors are adequate. Unless the organization provides the necessary support so that the interventions can be implemented, the interventions themselves will only be one more added stressor to an already overworked/stressful workday.

[westieluv]

Will doctors be required, then, to wear a yellow sash while writing orders so that they are less likely to get interrupted and write an erroneous order? Makes sense to me. What's good for the goose must be good for the gander.

[Testa Rosa, RN]

Wonderful information--I had come across the last study via my own resources and plan to share with my manager. Thank you so much for the information!

[Alisonisayoshi, LVN]

I work in LTC and no thank you to sashes of any kind. IMO, they are ridiculous in any setting.

I don't need a sash, I already have a "do not disturb" on my Med Cart that every single person actively ignores...

[Been there,done that, ASN, RN]

Management at my current hospital has reinstated having nurses wear yellow safety sashes” during med administration. It's being done to create a bubble of silence while we pass meds.

I was all for it the first go around. However, it's one of those things that sound good in theory yet is a total fail in practice. Nurses hate It. It creates more steps, nobody pays attention to what it signifies—especially the managers, pick up the line the line and take report now!”

Posters have been mounted and staff has been trained. But this does not preclude phones or speaker device ringing—oblivious that you have the sash of silence” on. Doctors and families still interrupt you. As they should be able to as It's the way of work life in the hospital.

These sashes are just one more detail piled on the mountain of details we navigate. Furthermore, it's one more thing we get taken to task for, You have meds in your hands, why are you not wearing your sash!?!?!” or ”Why do you still have your sash on when you're ot passing meds?” I am an intelligent, grown-assed nurse, not an errant child.

We focus on this donning and doffing of this worthless sash to comply to policy when we should be focusing in on safe med pass. We need to simplify nurse tasks around critical safety points--not increase tasks.

Does anyone know of any evidence based research supporting the wearing of sashes or vests while passing meds?

The donning and doffing takes seconds. The REAL issue is that the sashes are ignored.

That is what needs to be brought to management's attention.

"Your freaking sashes are being ignored". Good little nurses are following management direction.. everyone else.. is not.