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

Amy McLaughlin, BSN, RN, PCCNHeather Cable, RN

Rutland Regional Medical Center

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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.

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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…

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One-Page Tool

Real Time Second to second

Easy to Navigate

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First draft was an excel spreadsheet tool…

Busy

Smallest time increment in minutes

…back to the “drawing board”…

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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…

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  7/9/2011 7/9/2011 7/9/2011 7/9/2011 7/9/2011 7/9/2011 7/9/2011 7/9/2011    

  7:28:02 AM 7:32:27 AM 7:32:50 AM 7:34:33 AM 7:34:58 AM 7:36:05 AM 7:36:28 AM 7:36:50 AM    

TASKS TRUE   TRUE   TRUE   TRUE      

PHYSICIAN                    

NURSE                    

PATIENT   TRUE       TRUE     0:00:23 0:00:23

OTHER CLINICAL PROFESSIONAL       TRUE         0:00:25  

FAMILY                    

PHARMACY/ OMNICELL                    

COMPUTER                    

TELEPHONE                    

OTHER                    

LNA                    

CASE MANAGER RN                    

SCANNER                    

MED ADMIN PROCESS               TRUE   0:08:48

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.

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Implementation of Nurse-led Intervention

Medication Room Etiquette“Respecting the Process”

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How Will It Look?

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Staff PledgeI pledge to follow proper medication administration practices

to ensure the safety of my patients, myself , and my fellow health care professionals.

How Did We Get How Did We Get Support?Support?

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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!22

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