Objective To assess the effectiveness of an improvement programme to reduce the number of interruptions during the medication administration process in a paediatric hospital.
Design and methods A prestudy–post study design was used to monitor nursing interruptions during medication cycles in a paediatric hospital. Interruptions were reported on an observation sheet (MADOS-P) adapted to the paediatric context.
Setting A 600-bed tertiary paediatric research hospital in Italy.
Intervention The interventions included a yellow sash worn by nurses during medication cycles, a yellow-taped floor area indicating the ‘No interruption area’, visual notices in the medication areas, education sessions for healthcare providers and families, patient and parent information material.
Results 225 medication cycles were observed before the intervention (T0) and 261 after the intervention (T1). The median of interruptions occurring in each cycle decreased significantly from baseline to postintervention (8.0 vs 2.0, p=0.002), as the rate ratios (interruptions/patient post–pre ratio: 0.34; interruptions/medication post–pre ratio: 0.37; interruptions/hour of medication cycle post–pre ratio: 0.53, p<0.001). During preintervention, the main causes of interruptions were ‘other patients’ (19.9%), ‘other nurses’ (17.2%) and ‘conversation’ (15.7%); during postintervention, they were ‘other nurses’ (26.1%), ‘conversation’ (18.2%) and ‘other patients’ (17.4%).
Conclusions This bundle of interventions proved to be an effective improvement programme to prevent interruptions during medication administration in a paediatric context.
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Collaborators Alert System Study Group: Ilaria Campagna (Pediatric RN, Student at Master of Nursing Sciences, Tor Vergata University, Rome, Italy), Martina Di Carlo (RN, Research Fellow, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy), Ilaria Franconi (RN, Research Fellow, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy), Stephanie Lapadula (Pediatric RN, Student at Master of Nursing Sciences, Tor Vergata University, Rome, Italy), Patrizia Paolella (RN, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy), Luisa Russo (RN, Student at Master of Nursing Sciences, Tor Vergata University, Rome, Italy).
Contributors ID planned the study, coordinated the implementation programme, helped in the translation procedure of instrument for data collection, supervised data collection and analysis, drafted and revised manuscript; MF helped planning the study, was primarily responsible for conducting the data collection, participated in data analysis and drafted manuscript; VDC helped planning the study, helped in the translation procedure of instrument for data collection, analysed data and revised manuscript; ET helped planning the study, collaborated in the implementation programme, revised the instrument for data collection and helped revising manuscript; RM participated in data collection and data analysis, drafted and revised the manuscript; NB helped in planning the study, collaborated in the implementation programme and helped in revising manuscript; MLCDA contributed in data collection and analysis of medication errors; AF helped in planning the study, participated in data collection, drafted the manuscript; OG helped in the translation procedure of tool for data collection, and revised the manuscript; MP helped in planning the study, collaborated in the implementation programme, helped in revising the manuscript; MR conceived the study, supervised the implementation programme and revised the manuscript. All authors reviewed and approved the final version of the manuscript. Alert System Research Group: IC, MDC, IF, SL, PP and LR participated in data collection and imputation.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Ethics approval Ethics Committee of Bambino Gesù Children's Hospital (Italy).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
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