Characteristics of work interruptions during medication administration.

OBJECTIVE To document characteristics of nurses' work interruptions (WIs) during medication administration. DESIGN A descriptive observational study design was used along with a sample of 102 medication administration rounds. Data were collected on a single medical unit using a unit dose distribution system during fall 2007. METHOD Data collection on WIs relied on direct structured observation. The following WI characteristics were recorded: source, secondary task, location, management strategies, and duration. RESULTS 374 WIs were observed over 59 hours 2 minutes of medication administration time (6.3 WI/hr). During the preparation phase, nurse colleagues (n= 36; 29.3%) followed by system failures such as missing medication or equipment (n= 28; 22.8%) were the most frequent source of WIs. Nurses were interrupted during the preparation phase mostly to solve system failures (n= 33; 26.8%) or for care coordination (n= 30; 24.4%). During the administration phase, the most frequent sources of WIs were self-initiation (n= 41; 16.9%) and patients (n= 39; 16.0%). The most frequent secondary task undertaken during the administration phase was direct patient care (n= 105; 43.9%). WIs lasted 1 min 32 s on average, and were mostly handled immediately (n= 357; 98.3%). CONCLUSIONS The process of medication administration is not protected against WIs, which poses significant risks. CLINICAL RELEVANCE Interventions to reduce WIs during the medication administration process should target nurses and system failures to maximize medication administration safety.