Critique: Johnson et al. Study on Interruptions and Medication Errors

This assignment is a research critique of a study by Johnson et al. (2017) focusing on the impact of interruptions on medication errors in hospitals. The critique analyzes the study's purpose, which was to demonstrate the effects of interruptions during medication administration and preparation, examining sources of interruptions, time consumption, secondary tasks, procedural failures, and clinical errors. The study employed a non-participant prospective observational design, observing nurses in critical care and medical-surgical wards. The critique assesses the sampling procedures, ethical considerations, data collection and analysis methods, and the study's findings, including patient characteristics, the frequency and sources of interruptions, and secondary tasks. The results revealed a high frequency of interruptions during medication events, with implications for healthcare professionals. The critique discusses the importance of the study for the nursing profession, emphasizing the need for strategies to reduce interruptions and enhance patient safety, such as reducing socialization, adopting medication administration policies, and providing educational interventions. The assignment references several related studies to support its analysis.

Research Critique 1
Research Critique
By Student’s Name
Course + Code
Class
Institution
Date

Research Critique 2
Johnson, M. Sanchez, P, Langdon, R, Levett-Jones, T, Weidemann, G, Aguilar, V & 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. doi: 10.1111/jonm.12486.
Specific critique area Answer
Purpose of the study and
PICO question
Interruptions have been defined as a break in the performance of
individual’s activities brought by both internal and external
sources(Huckels-Baumgart et al., 2016). Medication preparation and
administration interruptions are normal in nursing care of which they can
provide significant information that helps daily nursing care. However,
interruptions that occurs during medication preparation and administration
can lead patient harm due to medical errors(Özkan, Kocaman and Öztürk,
2016). Several studies have found that about 49% of all medication errors
are due to drug administration interruptions(Smeulers et al., 2013). The
aim of the study was to demonstrate the impacts of interruptions during
medication administration and preparation. The study sought to examine
the sources of such interruptions, the time consumed during the
interruptions, the secondary task undertook, procedural failures and
frequency of clinical errors. In addition, the purpose of the study was to
demonstrate various behavioral strategies that can be used to manage
medication administration interruption.
Research Question
What are the effects of interruptions on medical errors in hospitals?
PICO Strategy

Research Critique 3
Population- Nurses providing care in hospital.
Interventions-Nursing strategies used to manage medical interruptions
like a reduced nurse to nurse socialization.
Comparison- Other causes of medication errors like failure to follow
medication administration policies.
Outcome- Reduced interruption during drug preparation and
administration
Research Design used A research design is an overall strategy used in conducting a research.
A research design normally forms a basic guide the researcher use in
planning a particular study(Polit and Beck, 2013). The study has used
non-participant prospective observational design in conducting the
research. This study design involves a researcher observing participants
without actively participating(Pan and Bai, 2016). This study design is
used to undertake qualitative research where a researcher analyze a
phenomenon by entering where the activities are being involved but
staying separate from the activities being observed(Sereika et al., 2017).
In the study, the nurse researcher observed the process of medical
preparation and administration while taking notes on any interruptions
observed.
Sampling and
recruitment procedures
Sampling is a process of selecting participants in a
research(Sandelowski, 2014). A sample is a number of participants who
represent a population in a research process(Shin, 2017). In the study, a
sample of two critical care units the Emergency Department and Neonatal
Intensive Care Units and five medical-surgical wards from the
metropolitan teaching hospital in Sydney were selected. 25 nurses were

Research Critique 4
selected from both departments who agreed to be observed while
administering medication where 56 medication events from 47 different
patients were recorded. The events resulted in 108 medical administration
interruptions. Four-bed and single patient rooms were selected to be used
in the study. Patient medications which comprised oral and non-
controlled preparations were stored in medication trolley. Controlled and
injectable drugs were stored and stored in separate locked rooms with the
wards. When the medication trolleys were not in use, they were stored
near the nurse station in the corridor. The inclusion criteria included all
nursing from the critical care units and the surgical wards who accepted to
be observed during medication administration and preparation and signed
the informed consent. All unwilling nurses were excluded from the study.
The ethical
considerations for this
study.
Prior the study was conducted all the participants were issued with an
informed consent of which those who qualified the inclusion criteria
signed the consent to show the study was voluntarily and no nurse was
recruited by force(Smeulers et al., 2013). The researcher informed all the
participant's everything concerning the study before they were engaged in
demonstrating a high level of transparency(Butts and Rich, 2013). All the
nurses were informed earlier before the study was stated through the nurse
educators and nurse managers in the wards selected. No name of the
participant was mentioned in the study were all the participants remained
autonomous(International Council of Nurses, 2012). Other than that, the
study has demonstrated high levels of beneficence. Although the study
was conducted for educational purposes, the key areas that the research
targeted were for the benefit of patients, nurses and the participants.

Research Critique 5
The process of data
collection and analysis
Before the study was conducted, all ward nurses were informed about
the study through the nurse unit managers or nurse educator. The
researcher requested nurses whether they were willing to be observed of
which those who accepted were issued with informed consent before the
observations were started. Data were collected by a professional research
nurse with enough clinical expertise who stood about three meters from
the patient during medication administration in the surgical wards. In the
Emergency Department and Neonatal Intensive Care Units the research
was conducted outside the normal medication time as per hospital rules
and regulations. The research nurse was instructed to help where
potentially dangerous incidents were observed or where the researcher
believed that the process of drug administration and preparation could
result in potential harm to the patient. The regular time that data were
collected in the surgical unit includes 0800, 1200 and 1400 hours. The
process of data analysis was performed using IBM SPSS Statistic for
Windows Version 22.0. The frequency of interruption and other results
characteristics were described using proportions and descriptive statistics.
Written descriptions of the interruption related to the activities were
grouped and analyzed using NVivo™ version 9.
Results of the study The results were grouped into four major categories based on the
research objectives namely patient characteristics, interruptions during
medication administration and preparation, sources of interruptions and
secondary tasks attended following an interruption. The results from
patient characteristic included the following diagnoses; 30 % of
gastrointestinal conditions, 21% of skin, spinal and musculoskeletal

Research Critique 6
conditions, 15% of, endocrine, renal and hepatic conditions, 9% of urinary
conditions and 25% of other conditions. Regarding interruptions made
during drug preparation and administration, the study resulted in 108
interruptions from 56 observed medical administration events. 55 out of
56 medication events were interrupted which consisted of 99% of all the
events where most of them were from self-interruptions. The most
common interruptions observed were nurses initiated which comprised 40
% of all interruptions followed by 13% of patient interactions and 11%
from medical officers. 73.3% of all interruptions occurred from medical
preparations and the rest 26.7% from medical administration process. The
registered nurses had the most interruption consisting of 63.4% followed
by endorsed enrolled nurses 14.7%, nurse educators 4.9% and other
healthcare workers 12.2%. The corridor interruptions 47%, in the
patients’ room 36%, at the nurse station was 1% and in 16% were from
preparation room. The average time from medication task due to
interruption was 2.5 minutes although the number varied. One medication
event was interrupted two or more times. The mean number per
medication event was 1.79 interruptions per client. The secondary tasks
that lead to interruptions were social interruption which consisted 28%,
19% of administrative issues, 14% of patient needs and 11% were from
checking the patients who were not in their bed.
Implications for health
professionals practice.
The study is important to the nursing profession as it has address
critical situation that normally hinders quality and safe care. All nurses
and student nurses need to understand various factors and elements that
can either increase or limit patient care(Berg et al., 2013). Medication

Research Critique 7
preparation and administration are crucial procedures in nursing care and
anything that hinder them is considered as a potential problem in
practice(Bower, Jackson and Manning, 2015). Understanding the potential
problems that may arise during medication preparation and administration
will not only save the working time available for nurses but also will
increase quality performance thus leading to quality and safety care of
patients in any setting.
Interruptions that occur during drug administration and preparation
normally add significant workload to nurses (Dante et al., 2016). Due to
that fact, hospitals should adopt medication administration systems and
strategies that reduce such opportunities. This should include strategies
like increasing close patient proximity during medication preparation and
administration, introducing a double checking strategy and continuous
education to nurses concerning interruptions during patient care(Flynn et
al., 2016). Due to the time loss associated with interruptions, there are
high chances that nurses would have a reduced time to attend to patients
as required(Hopkinson and Jennings, 2013). Reduction of socialization
among nurses and nonpatient related interruptions can lead to a better use
of the available working hours(Prakash et al., 2014). Various ways of
working with nurses and nurse managers have been identified and can be
used to identify various sources of interruptions thus enhancing quality
improvements in hospitals.
The study has confirmed that interruptions frequently occurs of
which they are associated with clinical errors and procedural
failures(Johnson et al., 2017). Due to that fact, educational interventions

Research Critique 8
are needed in order to teach nurses the importance of interruptions in term
of their associations with clinical errors and procedural failures and their
impacts in terms of time wasted during medication administration(Lapkin
et al., 2016). In addition, the study has taught us how avoiding such
interruptions can reduce the time taken in completing the medication
rounds. High-risk behaviors that always lead to interruptions including
social interruption during drug preparation and administration should be
eliminated(Hayes et al., 2015). In addition, medication administration
policies that reduce interruption should be adopted to prevent medication
administration errors(Sandelowski, 2014).

Research Critique 9
Workbook References
Berg, L. M. et al. (2013) ‘Interruptions in emergency department work: An observational and interview
study’, BMJ Quality and Safety, 22(8), pp. 656–663. doi: 10.1136/bmjqs-2013-001967.
Bower, R., Jackson, C. and Manning, J. C. (2015) ‘Interruptions and medication administration in
critical care’, Nursing in Critical Care, 20(4), pp. 183–195. doi: 10.1111/nicc.12185.
Butts, J. B., and Rich, K. L. (2013) ‘Ethics in Professional Nursing Practice’, Nursing Ethics Across the
Curriculum and Into Practice, pp. 69–98. doi: 10.1111/j.1552-6909.1979.tb00973.x.
Dante, A. et al. (2016) ‘Occurrence and duration of interruptions during nurses’ work in surgical wards:
Findings from a multicenter observational study’, Journal of Nursing Care Quality, 31(2), pp. 174–182.
doi: 10.1097/NCQ.0000000000000159.
Flynn, F. et al. (2016) ‘Progressive care nurses improving patient safety by limiting interruptions during
medication administration’, Critical Care Nurse, 36(4), pp. 19–35. doi: 10.4037/ccn2016498.
Hayes, C. et al. (2015) ‘Medication errors in hospitals: A literature review of disruptions to nursing
practice during medication administration’, Journal of Clinical Nursing, pp. 3063–3076. doi:
10.1111/jocn.12944.
Hopkinson, S. G., and Jennings, B. M. (2013) ‘Interruptions during nurses’ work: A state-of-the-science
review’, Research in Nursing and Health, pp. 38–53. doi: 10.1002/nur.21515.
Huckels-Baumgart, S. et al. (2016) ‘Separate Medication Preparation Rooms Reduce Interruptions and
Medication Errors in the Hospital Setting: A Prospective Observational Study’, Journal of Patient
Safety. doi: 10.1097/PTS.0000000000000335.
International Council of Nurses (2012) ‘The ICN Code of Ethics for Nurses’, The Michigan nurse. doi:
10.1111/j.0028-1425.2007.ethics.x.

Research Critique 10
Lapkin, S. et al. (2016) ‘The effectiveness of interventions designed to reduce medication administration
errors: a synthesis of findings from systematic reviews’, Journal of nursing management, pp. 845–858.
doi: 10.1111/jonm.12390.
Özkan, S., Kocaman, G. and Öztürk, C. (2016) ‘Interruptions During Pediatric Medication Preparation
and Administration’, The Journal of Pediatric Research, 3(2), pp. 104–108. doi: 10.4274/jpr.98704.
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Information and Modeling. doi: 10.1017/CBO9781107415324.004.
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administration: Interventions in a simulated ambulatory chemotherapy setting’, BMJ Quality and Safety,
23(11), pp. 884–892. doi: 10.1136/bmjqs-2013-002484.
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pp. 3–8. doi: 10.1002/nur.21570.
Sereika, S. M. et al. (2017) ‘Modern Methods for Modeling Change in Obesity Research in Nursing’,
Western Journal of Nursing Research, 39(8). doi: 10.1177/0193945917697221.
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Nursing Reports, 3(1), p. 4. doi: 10.4081/nursrep.2013.e4.