Use of a timed observation tool to study interruptions during nurses’ medication administration.

1. Use of a timed observation tool to study interruptions during nurses’ medication administration. Amy McLaughlin, BSN, RN, PCCN Heather Cable, RN Rutland Regional Medical Center

2. I’m passing meds…have some respect!!

3. Who We Are… • We work together on the Progressive Care Unit at Rutland Regional Medical Center (RRMC) in Rutland, Vermont. • Our patient population is varied and consists of Cardiac, Pulmonary, and high-acuity patients who do not require Intensive Care. • Our Unit’s Culture supports staff participation in various committees focused on patient safety and satisfaction. • The fast-paced environment, combined with high patient turnover and acuity, reinforces the need for Nurse-led interventions aimed at improving patient care and outcomes.

4. How It All Began… • We are members of the Progressive Care Unit (PCU) Patient Safety Team. • We began as the Medication Safety sub-Committee • Initial interest in the project focused on improving the Medication Administration process on PCU

5. How did we start? • Our first step was a review of PCU medication administration data. • An informal Research Question was the result… • A Literature Review then followed… • …which helped guide us to our formal Research Question…

6. Would a nurse-led intervention decrease the number of interruptions encountered during medication administration?

7. Now that we have our question… How do we observe the interruptions? • We had to decide: • What part of the Medication Process do we observe? • We decided we needed to observe the ENTIRE process, from beginning to end… • We needed to watch one Nurse, from the moment s/he entered the med room, until the final med was passed to that patient.

8. We know what we want to do… …Now where do we go from here?

9. We Need an OBSERVATION TOOL!

10. We Needed: • One-Page Tool • Real Time • Second to second • Easy to Navigate

11. Excel? • First draft was an excel spreadsheet tool… • Busy • Smallest time increment in minutes • …back to the “drawing board”…

12. MICROSOFT ACCESS!! • Combined everything we needed: • One, attractive, easy-to-read page • Time-Stamped (Second-to-Second) • Easy to Individualize • “One Click is All You Need”!! • …And Here’s How It Looks…

15. But Does It Really Work?(Or, What We’ve Done So Far) Over a period of one week in July, 2011, medication passes were observed on PCU from 7am to 11am. A total of 67 passes were captured during Phase I of the Observation Process, using our tool.

18. Where do we go from Here? Implementation of Nurse-led Intervention Medication Room Etiquette “Respecting the Process”

19. How Will It Look?

20. How Did We Get Support? Staff Pledge Ipledge to follow proper medication administration practices to ensure the safety of my patients, myself , and my fellow health care professionals.

21. Where do we go from Here? • We will implement our intervention for four weeks, beginning this Monday, November 14th. • We will then start Phase II of our Observation Study beginning the week of December 11th. • Final Data Analysis following Data Collection.

22. …It May Be a Long Journey! Will our Data support that our Intervention led to decreased interruptions? Will our Intervention need an adjustment? Might we go Hospital-Wide? Might we Publish? Perhaps other facilities will be able to use our Tool!

23. Thank Youso much !