ISE 468 ETM 568 Healthcare Process Improvement

1. ISE 468 ETM 568 Healthcare Process Improvement Dr. Joan Burtner, CQE Associate Professor of Industrial Engineering and Industrial Management

2. Work Interruptions Study • “Characteristics of Work Interruptions During Medication Administration” • Biron, A.D., Lavoie-Tremblay, M., and Loiselle, C. G. • Journal of Nursing Scholarship, 2009, 41(4), pp. 330-336 • Montreal, Quebec, Canada 2013

3. Study Design Overview • Descriptive observational study design • 102 medication administration rounds • Fall 2007 • Direct structured observation of registered nurses • Data collected • Source • Secondary task • Location • Management strategies • Duration 2013

4. Study Methodology • Single medical patient care unit using a unit dose distribution system • Process studied: Nurses prepare all medications for assigned patients at a specific time and then administer them one patient at a time • Medication preparation phase • Medication administration phase • Approval obtained from hospital institutional review board (IRB) • Paper-based observation grid used to record data • Two observers • Interobserver agreement kappa values 0.78 initial and 0.66 at midpoint of study 2013

5. Definitions and Categories • Work Interruption (WI) - “A break in the activity being performed to carry out a secondary task.” • Work Sampling of nursing care activities • Direct care – all nursing care activities performed in the presence of the patient or family • Indirect care – all nursing care activities done away from the patient, but on a specific patient’s behalf • Unit-related • Personal • Typical secondary task categories • Direct care, verbal report, communication, coordination • Failure resolution, meetings, administration • Clerical, personal, teaching 2013

6. Selected Results for 374 WIs • During the medication preparation phase, the most frequent secondary task was failure resolution. • During the administration phase, the most frequent secondary task was direct patient care. • During the medication preparation phase, the most frequent sources of WIs were nurse colleagues (29.3%) and system failures (22.8%). • During the administration phase, the most frequent sources of WIs were self-initiation (16.9%) and patients (16%). . 2013