A qualitative study of nurses' perceptions of a behavioural strategies e-learning program to reduce interruptions during medication administration
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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Affiliated with the Ingham Institute of Applied Medical Research, Liverpool, Sydney Australia.