Elsevier

Nurse Education Today

Volume 69, October 2018, Pages 41-47
Nurse Education Today

A qualitative study of nurses' perceptions of a behavioural strategies e-learning program to reduce interruptions during medication administration

https://doi.org/10.1016/j.nedt.2018.06.028Get rights and content

Highlights

  • Behavioural approaches to reduce interruptions during medication administration increased nurses' awareness of ways to manage interruptions.

  • Findings support learner recall and engagement with embedded authentic images of patient interruptions and positive and negative responses.

  • Changes in ward culture and individual behaviour in specific clinical areas were supported.

Abstract

Objectives

We sought to evaluate the perceptions of nurses of an e-learning educational program to encourage the use of behavioural strategies—blocking, engaging, mediating, multitasking, and preventing—to reduce the negative effects of interruptions during medication administration.

Design

A qualitative design was used to evaluate the impact of this e-learning educational intervention on nurses' behaviour.

Settings

Two wards (palliative care and aged care) from two different hospitals within a large local health service within Sydney Australia, were included in the study. These wards were also involved in a cluster randomised trial to test the effectiveness of the program.

Participants

A purposive sample participated comprising nine registered and enrolled nurses certified to conduct medication administration, who had reviewed the educational modules.

Methods

Two focus groups were conducted and these sessions were digitally recorded and transcribed verbatim. Thematic analysis identified seven themes.

Results

The major themes identified included: perceptions of interruptions, accessing the program, content of the program, impact, maintaining good practice and facilitators and barriers to changing behaviour.

Conclusions

The use of embedded authentic images of patient interruptions and management strategies increased some nurses' perceived use of strategies to manage interruptions. Nurses varied in their perception as to whether they could change their behaviour with some describing change at the individual and ward team levels, while others described patient caseload and other health professionals as a barrier. The use of this innovative educational intervention is recommended for staff orientation, student nurses, medical officers and allied health staff. Further research is required in how this e-learning program can be used in combination with other effective interventions to reduce interruptions.

Introduction

Medication errors are one of the most frequently reported hospital incidents (Thomas et al., 2011) with reports indicating that 50–52% of all medicines are either prescribed, dispensed, administered, or used inappropriately (Wimpenny and Kirkpatrick, 2010; World Health Organization, 2014). Medication errors can occur at any stage of the medication process from prescription through to preparation and administration. Research into the factors that lead to medication errors and strategies to reduce such errors is essential. A well-recognised factor in medication errors by nurses is interruptions occurring during the preparation and administration process (Prakash et al., 2014; Westbrook et al., 2010).

An array of strategies to reduce interruptions and prevent medication errors have been trialled, including interruption-free zones (Williams et al., 2014; Yoder et al., 2015), signage, and education and the wearing of vests, tabards or sashes (Palese et al., 2015; Williams et al., 2014). Results from such studies are mixed, with some reporting a positive effect while others have reported a limited or negative effect on the rate of interruptions and/or medication errors (Bower et al., 2015; Raban and Westbrook, 2014; Williams et al., 2014). In light of such mixed results, it has been argued that educational interventions that provide nurses with strategies to effectively manage interruptions, not just to prevent or reduce them, must be implemented and evaluated (Hayes et al., 2015; Hayes et al., 2014).

We explored interruptions occurring within our local health services, and found that a considerable number (47%) were associated with non-patient related communication, and that a range of behavioural strategies were used to reduce and manage these interruptions (Johnson et al., 2017a; Johnson et al., 2017b). Our research also found that nurses had varied views about whether interruptions were predictable or unpredictable (those that must be attended immediately to support patient safety) (Johnson et al., 2017b) and whether they were amenable to behavioural interventions. Further to the work of Colligan and Bass (2012), we validated the four behavioural strategies—blocking, engaging, mediating and multitasking (Colligan and Bass, 2012) and included the additional strategy of preventing (Johnson et al., 2017b).

This study describes the development and evaluation of an educational intervention that was derived from this earlier research (Johnson et al., 2017a; Johnson et al., 2017b), which aimed at providing clinical nurses with behavioural strategies to help prevent and mitigate the negative consequences of interruptions occurring during medication preparation and administration.

Section snippets

Aims

We aimed to describe and evaluate the perceptions of nurses of an authentic e-learning module that demonstrates strategies that can be used by clinical nurses when preparing and administering medications to prevent and manage interruptions. In addition, aspects of how participants perceive interruptions and interrupters, and how they perceive themselves as they manage the interruptions were described. This study is part of a larger feasibility study of a cluster randomised trial to reduce

Design

A qualitative approach, using focus groups, was used to determine the nurses' perceptions of this e-learning module, and how nurses perceived interrupters and their management.

Setting

Two units (referred to as Ward A and B) from two different public teaching hospitals located in Sydney, Australia, participated in the study. Ward A was a ten-bed single room ward. All patients were admitted for palliative care and were at the end stage of their illness. The Nursing Unit Manager (NUM) and most staff

Results

The two focus groups were very different in their responses to the questions posed. The analysis therefore highlights contradictions where they occurred by reporting both Ward A (aged care) and Ward B (palliative care) responses.

Discussion

The aim of this study was to describe nurses' perceptions of an e-learning program that teaches behavioural strategies to nurses to reduce interruptions during medication administration. Although some intervention studies have focused on interruption free zones with the use of vests or other approaches (Flynn et al., 2016; Westbrook et al., 2017), this training program explored behavioural strategies for managing predictable and unpredictable interruptions (Johnson et al., 2017b).

Conclusions

This paper describes nurses' perceptions of an e-learning module that teaches behavioural interventions to reduce interruptions during medication preparation and administration. This type of module can easily be replicated and adapted to cater to local settings, to facilitate change in managing interruptions that are predictable or unpredictable. Embedding authentic images of interruptions with negative and positive approaches to resolving the interruptions were critical to the effectiveness of

Conflict of Interest

No conflict of interest has been declared by the authors.

Author Contributions

MJ, TLJ, EM, GW, RL, were responsible for the study conception and design, the data collection (MJ) and performed the data analysis (MJ, EM, RL). MJ, GW, TLJ, and BE, were responsible for the development of the e-learning program. MJ & TLJ & RL were responsible for drafting the manuscript. BE, EM, & GW made contributions and critical revisions to the paper for important intellectual content.

Acknowledgements

We would like to thank the nursing staff of South Western Sydney Local Health District for assisting in this study.

Funding

Funding was provided by the Nursing Strategic Fund, Office of Nursing and Midwifery, NSW Health.

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