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

Journal Article (Journal Article)

While preparing medications in complex health care environments, nurses are frequently distracted or interrupted, which can lead to medication errors that may adversely affect patient outcomes. This pilot quality improvement project, which took place in a 32-bed surgical progressive care unit in an academic medical center, implemented five medication safety interventions designed to decrease distractions and interruptions during medication preparation: nursing staff education, use of a medication safety vest, delineation of a no-interruption zone, signage, and a card instructing nurses how to respond to interruptions. Four types of distractions and interruptions decreased significantly between the two-month preimplementation and two-month postimplementation periods: those caused by a physician, NP, or physician assistant; those caused by other personnel; phone calls and pages placed or received by the nurse during medication administration; and conversation unrelated to medication administration that involved the nurse or loud nearby conversation that distracted the nurse. The total number of reported adverse drug events also decreased from 10 to four, or by 60%. Thus, medication safety interventions may help decrease distractions and interruptions in high-acuity settings.

Full Text

Duke Authors

Cited Authors

  • Williams, T; King, MW; Thompson, JA; Champagne, MT

Published Date

  • November 2014

Published In

Volume / Issue

  • 114 / 11

Start / End Page

  • 53 - 62

PubMed ID

  • 25353136

Electronic International Standard Serial Number (EISSN)

  • 1538-7488

International Standard Serial Number (ISSN)

  • 0002-936X

Digital Object Identifier (DOI)

  • 10.1097/01.naj.0000456433.07343.7f


  • eng