Vol. XXVIII No. 1 JOURNAL OF VASCULAR NURSING PAGE 47

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Research

Column

Review of an Article: Biron, A.,Lavoie-Tremblay, M., Loiselle, C (2009).Characteristics of work interruptionsduring medication administration. J NursScholarsh; 41(4):330-336Kathleen Rich, PhD, RN, CCNS

Work interruptions have been known to be one of the significant

reasons behind nursing medication errors.1 Previous research has

not examined the work interruptions (WI) that occur specifically

during medication administration rounds. The purpose of this study

was to document the rate, sources, secondary tasks undertaken, du-

ration and approaches used by nurses to handle WI during medica-

tion administration rounds. Medication administration rounds were

defined as the duration of time encompassing when a nurse started

and ended the administration of all assigned patient medications due

at a specific time. Work interruptions were defined as a break in the

task activity, as evidenced by a stop of or pause in the task.

A descriptive study design involving direct observation was

used. The setting was a single non-specified patient care unit in

a tertiary university teaching hospital in Quebec, Canada. Regis-

tered nurses were required to have at least six months’ experience

to participate. Medications were kept in one area and a unit-dose

distribution system was in place. A sample size of 100 medication

administration rounds was used. This size was based on a larger

study of medication error predictors by the authors. The primary

author or a trained research assistant observed unit nurses during

medication rounds and used a paper-based observation form for

recording observations. This was done on the 12-hour day shifts,

7 days a week for 3 months. Measurement of inter-observer agree-

ment was performed twice during the study. The agreement level

remained high between the two observers.

Eighteen nurses with an average of 9.86 years’ experience par-

ticipated in the study. The average medication round lasted 34 min-

utes 43 seconds. A total of 374 WI were documented for a rate

average of 6.3 interruptions per hour. During medication prepara-

tion, 53.9% of the nurses were interrupted at least once. The main

From the Cardiovascular Clinical Specialist, La Porte RegionalHealth System.

J Vasc Nurs 2010;28:47.

1062-0303/2010/$36.00

Copyright � 2010 by the Society for Vascular Nursing, Inc.

doi:10.1016/j.jvn.2009.12.002

interruption sources during preparation were other nurses (17.8%)

and system failures (22.8%), such as missing medications. During

medication preparation, nurse interruptions were for personal mat-

ters (36.1%) and to report on a patient’s status (22.2%). WI during

medication administration were primarily self-initiated (16.9%)

and due to patients/families (16.5%). Secondary tasks performed

by the nurses during medication administration included direct pa-

tient care (30.1%) and coordination of care, such as verification of

a scheduled procedure (19.9%). Nurses resolved almost all of the

WI (97.6%) and in a short period of time (1.32 minutes, � 2).

The authors listed several limitations. These included the set-

ting, sample strategy, data collection and design. Use of a conve-

nience sample on a single unit may have led to a sampling bias.

The potential for a Hawthorne effect was also identified. The au-

thors concluded that nurse colleagues were the most frequent

source of work interruptions. Their recommendations were to

change practice by informing the nurses along with examining

different medication-use models. Improving medication system

efficiency was suggested to reduce system failures during medica-

tion preparation. The authors noted that reducing WI through

system-level interventions was required.

The reviewer commends the identification of the above WI fac-

tors by the authors. It would have been very interesting if they had

examined the incidence of medication errors that occurred on this

unit during the same period, especially when it was reported in the

literature review that the odds of a medication error increased by

60% if the WI occurred during medication preparation. A more

complete setting description, such as the number of beds, type of

patients admitted, the patient acuity, patient care model, or

nurse-patient staffing ratios, would be of benefit to the reader. Us-

ing additional statistics to evaluate probability lends support to the

discussion and conclusions presented by the study investigators.

REFERENCE

1. Agency for Healthcare Research and Quality. Quality/Patient

Safety. One-third of a national sample of hospital staff nurses

made an error or near error over a 1-month period Available

at: http://www.ahrq.gov/research/jun05/0605RA27.htm. Ac-

cessed 19 December 2009.