Research Critique of Medication Interruptions on Clinical Errors and Procedural Failures among Nurses in a Metropolitan Teaching Hospital

This research critique analyzes the impact of medication interruptions on clinical errors and procedural failures among nurses in a metropolitan teaching hospital. The study used a non-participant prospective observational design and convenience sampling approach. The findings suggest that medical interruptions are associated with clinical errors and procedural failures, and there is a need for medication administration systems that minimize interruptions.

NUR131 TASK 3 RESEARCH WORKBOOK Semester 2 2018 Name:
Part B: Research Critique (60 marks)
Article Reference (in Harvard style):
Specific critique area Answer
Explain the purpose of the study. Use the
PICO or PICo format to identify the
research question.
(150 words)
PICO
Population
The study population consists of nurses conducting medication rounds in a large metropolitan
teaching hospital in Sydney. Two critical care units and five medical-surgical units were sampled,
and a total of 25 nurses were observed while on duty.
Intervention
The study did not have an intervention since it was an observational study not like in clinical trials.
The observational study comprised of the nature of the interruptions on medication during
preparation and administration. A standard observation tool was used to record the kind of the
intrusion, its source, whether it stopped the medication administration and the nurse had to attend
to it, the time taken away from the primary task, and the place of interruption.
Comparison
The study did not conduct any comparison.
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Outcomes
The study’s Outcome shows that medical interruptions are associated with clinical errors and
procedural failures. It the observation took approximately one hour per ward
What kind of interruptions occurs during medication preparation and administration, alongside the
sources of interruptions, the time consumed by the disruptions and incidence of clinical errors and
procedural failures?
Discuss the design used in the research.
(150 words)
The study adopted a non-participant prospective observational study. This is a study design that
follows a group with similar subjects but with varying specific factors over a given time, to ascertain
how these factors the results (Song and Chung, 2010). A unique feature of a prospective study is
that when the researchers start to enroll the subjects and gather baseline exposure data, none of
the target population have known about the expected outcomes (LaMorte, 2013). The study
allows the researcher to approximate the procedural and clinical errors due to its prospective
nature. This approach also enables easy calculation of the outcomes and prevalence of diseases or
medical malpractices which can be compared with actual results to determine the accuracy and
credibility of the findings. Furthermore, in this design, the investigators do not have to address
ethical matters like in the case of clinical trials in which treatment procedures are required.
Identify and explain sampling and
recruitment procedures were in the
The study used convenience sampling approach to select a sample of two critical care and five
medical-surgical units from a public metropolitan teaching hospital in Sydney. Before the
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research.
(200 words)
commencement of the study, the prospective unit nurses were notified by the Unit managers of
the expected research during their routine duty. Their consent to participate in the study was
obtained in writing by the investigating nurse. A total of 25 nurses at the ward level agreed to be
observed while organizing and administering medications to 47 distinguished patients leading to
108 observed interruptions. The patient rooms observed comprised of single and four-bed rooms.
Both oral and non-regulated medical preparations were kept in a specific medication trolley, which
the nurse moved to the particular bed of the patient or positioned it outside the ward if the patient
was placed under isolation. The medication trolley was kept in the corridor adjacent to the nurses’
station when not in use. All medications were held in the preparation room.
Identify and discuss the ethical
considerations for this study.
(200 words)
Informed consent from the potential participants was obtained in writing before the
commencement of the study. The nurses were made aware by the clinical nurse educator or the
nurse unit manager of the expected observations while they were undertaking their regular duties
of going around the wards. Informed consent is essential in research that involves human beings
because it creates a connection of shared trust between the researcher and the study subjects by
opening significant ways of communication (Mandal and Parija, 2014). This further increases the
credibility and reliability of the collected data because the responses from human subjects are
determined by their willingness and total trust to participate in the study and provide honest
information (Noble and Smith, 2015).
The researchers also obtain ethical approval from the district health services and ethics approval
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committee. This implies that it complied with the good clinical practice such as the protection of
the rights, safety, and well-being of the subjects. Furthermore, the approval is an assurance that
the study findings and inferences are credible and accurate, thus can be relied on. The study has
also observed the privacy and confidentiality of the nurses or unit managers involved in the
research by not mentioning their names or identification numbers in the entire survey (Kaiser,
2009).
Explain how the data was collected and
analysed.
(200 words)
Data was collected using a standard observation tool that was designed to comprise of the details
of the ward, identification of the nurse, medication history of the patient, administered
medications, and the secondary interruptions during the delivery of primary medications. The
observational tool was initially tested during the 0800 hours of nurses’ round. Necessary
modifications were made to the instrument. The primary task consisted of the medication
administration activity, whereas secondary task consisted of responding to the other colleague on
matters not related to the primary function. The clock application of a mobile phone was used to
record the time taken to deal with the interruption. Any procedural failure that contravened
established treatment procedures was also recorded Data collection was carried out by one
practicing nurse with expertise, and he/she was positioned some 3 meters from the patient
undergoing a regular medical check-up at different times. The researcher could take one hour of
observation in giving unit level and was under instruction to intervene in case a risky incident was
observed (Johnson et al., 2017).
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The collected data was analyzed using SPSS software version 22. The regularity of the interruptions
alongside other features were described using descriptive statistics. Additionally, the NVivo
software version nine was used to analyze, code and quantify the documented characteristics of
the secondary interruption activities.
Briefly summarise the results of this study
(200 words)
The study outcomes show that there were different patients diagnosed with gastrointestinal
conditions (30%) reporting the highest and urinary conditions (9%) record the lowest among
others. There were a total of 56 detected medical events and 108 interruptions during the nurses’
routine duty. There was a 99% medical interruptions including self-interruptions. A greater
percentage of the interruptions were initiated by nurses (40%) most of which took place during
medical preparation (73.3%). The registered nurses recorded the most interruptions (63.4%)
followed by practicing nurses. Most of the interruptions took place at the corridor (47%) with only
1% taking place at the nurses’ station. An average time taken for the secondary tasks was 2.5
minutes with a two to three times interruption per medication event (Johnson et al., 2017).
One-third of the source of interruptions consisted of other nurses wanting to share information
regarding the workflow and patients. The highest proportion of the disruptions was about social
associations (28%) with the least (11%) being about inquiring of the absence or presence of the
patients in their rooms. Based on the definitions by Westbrook and Ampt (2009), Procedural
failures accounted for 34% with only 3.6% making up for clinical errors which majorly consisted of
administering medications at the inappropriate time.
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Discuss implications for health
professionals practice.
(400 words)
Several studies have attributed the inefficiency of clinicians and low-quality health care to
increased workload (Carayon and Gurses, 2008; Liu et al., 2012). Part of the factors that contribute
to the workload is the interruptions that take place during medication organization and
management (Redding and Robinson, 2009). The findings of this study provide additional
information on the source of medication interruptions, time wasted, and the impact of
interruptions on the effectiveness of the nurses and service delivery quality. Furthermore, the
outcomes of the study point out the area of weakness in medical interruptions and the possible
recommendations to counter the issue. For instance, there is a need for medication administration
systems that minimize the interruptions and consequently the time consumed in secondary tasks.
This can be achieved by designing the medication administration systems in such a way that they
have in close patient contiguity, a feature of double-checking.
Studies have also shown that little time between patient and clinicians contribute to poor
healthcare services because no mutual relationship of trust, which is fundamental in healing, is
developed due to limited time (Twigg et al., 2011; Carayon and Gurses, 2008). The study by
Johnson et al. (2017) has demonstrated that approximately 0.6 to 28.94 minutes are taken away
from medication arrangements and management by interruptions. The reduction or elimination of
the time consumed in socialization between nurses or between nurses and non-patients during
nursing hours can be redeemed and used in attending to patient needs. This will improve the nurse
to the patient relationship and the quality of healthcare services.
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The observation tool designed and effectively used in this study can be used by the hospital
management and another researcher to determine the source, nature, and volume of medical
interruptions towards improving the quality of service delivery in any medical set-up.
The study findings also have an implication for professional practice in health care because they
can be used in designing an educational intervention program or other innovative effective
intervention strategies in minimizing procedural and clinical errors associated with medical
interruptions. The study outcomes also provide a basis for further research on the strategy for
conducting double-checking and the resulting impacts.
Workbook References
Carayon, P. and Gurses, A.P. (2008) Nursing workload and patient safety—a human factors engineering perspective. Rockville (MD): Agency for
Healthcare Research and Quality (US)
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Johnson, M., Sanchez, P., Langdon, R., Manias, E., Levett‐Jones, T., Weidemann, G., Aguilar, V. and Everett, B (2017) The impact of
interruptions on medication errors in hospitals: an observational study of nurses. Journal of nursing management, 25(7), pp.498-507.
Kaiser, K. (2009). Protecting respondent confidentiality in qualitative research. Qualitative health research, 19(11), pp.1632-1641.
LaMorte, W.W. (2013) Prospective and retrospective cohort studies. Boston University College of Public Health. Retrieved from
http://sphweb.bumc.bu.edu/otlt/MPH-Modules/EP/EP713_AnalyticOverview/EP713_AnalyticOverview3.html
Liu, L.F., Lee, S., Chia, P.F., Chi, S.C. and Yin, Y.C. (2012) Exploring the association between nurse workload and nurse-sensitive patient safety
outcome indicators. Journal of nursing research, 20(4), pp.300-309.
Mandal, J. and Parija, S.C. (2014). Informed consent and research. Tropical parasitology, 4(2), p.78.
Noble, H. and Smith, J. (2015). Issues of validity and reliability in qualitative research. Evidence-Based Nursing, pp.ebnurs-2015.
Redding, D.A. and Robinson, S. (2009) Interruptions and geographic challenges to nurses' cognitive workload. Journal of nursing care
quality, 24(3), pp.194-200.
Song, J.W. and Chung, K.C. (2010). Observational studies: cohort and case-control studies. Plastic and reconstructive surgery, 126(6), p.2234.
Twigg, D., Duffield, C., Bremner, A., Rapley, P. and Finn, J. (2011) The impact of the nursing hours per patient day (NHPPD) staffing method on
patient outcomes: a retrospective analysis of patient and staffing data. International journal of nursing studies, 48(5), pp.540-548.
Weigl, M., Müller, A., Vincent, C., Angerer, P. and Sevdalis, N. (2012) The association of workflow interruptions and hospital doctors' workload:
a prospective observational study. BMJ Qual Saf, 21(5), pp.399-407.
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Westbrook, J.I. and Ampt, A (2009) Design, application and testing of the Work Observation Method by Activity Timing (WOMBAT) to measure
clinicians’ patterns of work and communication. international journal of medical informatics, 78, pp.S25-S33.
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