NUR 683 Module 5 Milestone Two Example

Milestone Two: What Reduces Interruptions During Medication Administration, and Do Errors Follow?

[Student Name]

Southern New Hampshire University

NUR 683: Patient Safety and Quality Capstone

Module Five Milestone Two

[Instructor Name]

[Date]

Milestone Two: What Reduces Interruptions During Medication Administration, and Do Errors Follow?

The capstone's baseline showed interruptions in just over half of medication administrations and about nine clinical errors per 100 doses on a telemetry unit. Before choosing an intervention, the project needs to know two things: which strategies reduce interruptions, and whether reducing interruptions actually reduces errors. These are different questions, and the literature answers the first much better than the second. This review searched CINAHL, PubMed and Embase for studies of interventions targeting interruptions during medication preparation or administration by nurses, in English, from 2000 onward, and it organizes the evidence around the causal chain from interruptions to errors.

Interruptions and Errors: The Starting Link

The case for intervening rests largely on Westbrook et al. (2010), who observed nurses in two teaching hospitals and linked each interruption to a higher probability of both procedural failures and clinical errors, with the chance of a major error rising as interruptions accumulated. The study was observational, so other factors, such as busy periods that bring both interruptions and rushing, could contribute. Still, the dose-response pattern and the plausibility of the mechanism, since attention broken mid-task is easily misdirected on return, make interruptions a reasonable target. The unit's own data show a similar clustering: errors were more frequent during the morning pass, when interruptions peaked.

What Interventions Have Tried

Relihan et al. (2010) introduced a set of measures on wards of a teaching hospital in Ireland, including brightly colored vests signaling that a nurse should not be disturbed during the medication round, a protocol for handling calls and questions and education for staff, patients and visitors. Observed interruptions fell after the change. The study was small and uncontrolled, but it established a template that many later projects copied.

Raban and Westbrook (2014) systematically reviewed interventions of this kind, including vests, signs, protected areas for preparing medications, checklists and education. Most studies reported fewer interruptions after intervention, but study quality was generally low, few had control groups and only a handful measured medication errors at all. Where errors were measured, results were inconsistent, and the reviewers concluded that evidence that these interventions reduce errors was weak.

Westbrook et al. (2017) then tested a do-not-interrupt bundle, with vests, signage, education and reminders, in a cluster randomized feasibility study on hospital wards. Interruptions unrelated to medications fell on intervention wards compared with control wards, but nurses reported that the vests were cumbersome and time-consuming, and some felt the vests signaled unavailability to patients. The study was not designed to detect changes in errors.

Not All Interruptions Are Equal

A theme running through the literature is that interruptions differ in value. Some carry information a nurse needs, such as a pharmacist calling about a changed dose or a colleague reporting that a patient's heart rhythm has shifted. Others, such as a question about a lunch break or a family member asking for a blanket, could safely wait. The 2017 trial targeted only interruptions unrelated to medications for this reason, and several studies in the systematic review noted that nurses sometimes interrupted themselves. A blanket ban would therefore be neither realistic nor safe on a telemetry unit, where a new arrhythmia cannot wait for the medication pass to end. The capstone bundle must instead reduce avoidable interruptions while leaving a clear path for urgent ones, and staff will need simple guidance on which is which.

Synthesis

Across the literature, one conclusion is reasonably firm: bundled interventions can reduce interruptions during medication tasks, and the best-designed study confirms this against controls. A second conclusion is much less certain: whether fewer interruptions translate into fewer errors. The link rests on observational evidence and a few small intervention studies with mixed results. A third conclusion concerns acceptability: vests in particular create friction with staff and patients, which threatens sustainability.

Table 1 summarizes these points. For the capstone, the synthesis supports reducing interruptions as a reasonable strategy with plausible benefit, while making clear that the project must measure errors directly rather than assume that fewer interruptions mean safer care.

Table 1. Strength of Evidence by Question

Note. Strength ratings reflect design and consistency.

Gaps in the Evidence

Four gaps stand out. First, few studies were powered to detect changes in errors. Second, most studies examined general wards rather than high-acuity settings such as telemetry, where titrated drips and alarms create a different interruption pattern. Third, little is known about which components matter most, since nearly every intervention was bundled. Fourth, follow-up rarely extended beyond a few months, leaving sustainability unknown.

Design Lessons for the Capstone

The synthesis shapes the capstone bundle in five ways. The bundle will use a physical protected zone around the medication room and cabinet rather than vests, to reduce friction with patients. It will redirect calls during the morning pass to a unit secretary and a designated resource nurse, addressing the most common interruption sources. It will measure errors by direct observation using the same method as the baseline, so the project contributes evidence on the uncertain link. It will include a brief staff acceptability survey. And it will track results for six months to address sustainability. These choices respond directly to the weaknesses and gaps the review identified.

The bundle will also give nurses a script for deferring non-urgent requests politely, such as telling a colleague they will be free in five minutes, and it will teach patients and families at admission why the nurse may not stop to talk during medication preparation. Both steps address the acceptability problems reported with vests while keeping the purpose visible.

Conclusion

The evidence supports interventions to reduce interruptions, while leaving open whether they reduce errors. The capstone therefore adopts a bundle designed for acceptability and measures errors directly. The next milestone sets out the measurement plan in detail.

References

Raban, M. Z., & Westbrook, J. I. (2014). Are interventions to reduce interruptions and errors during medication administration effective? A systematic review. BMJ Quality & Safety, 23(5), 414-421. https://doi.org/10.1136/bmjqs-2013-002118

Relihan, E., O'Brien, V., O'Hara, S., & Silke, B. (2010). The impact of a set of interventions to reduce interruptions and distractions to nurses during medication administration. Quality and Safety in Health Care, 19(5), e52. https://doi.org/10.1136/qshc.2009.036871

Westbrook, J. I., Li, L., Hooper, T. D., Raban, M. Z., Middleton, S., & Lehnbom, E. C. (2017). Effectiveness of a 'Do not interrupt' bundled intervention to reduce interruptions during medication administration: A cluster randomised controlled feasibility study. BMJ Quality & Safety, 26(9), 734-742. https://doi.org/10.1136/bmjqs-2016-006123

Westbrook, J. I., Woods, A., Rob, M. I., Dunsmuir, W. T. M., & Day, R. O. (2010). Association of interruptions with an increased risk and severity of medication administration errors. Archives of Internal Medicine, 170(8), 683-690. https://doi.org/10.1001/archinternmed.2010.65