Using Standardized Workflow and a “No Interruption Zone” to Reduce Nursing Medication Errors

Purpose: This quality improvement project will examine the effect of a standardized workflow and a “no interruption zone” to reduce nursing medication errors in an ambulatory care clinic.
Background and significance: Medication errors are a world-wide health issue because they may have serious negative effects on patients’ lives and cost the healthcare system billions of dollars annually. It is estimated that medication-related deaths range between 40,000 and 98,000 a year in the United States (Khalil, Shahid, & Roughead, 2017). Medication administration errors also occur in ambulatory care clinics and have involved antibiotics, vaccines, chemotherapeutic agents and intravenous infusions, and sample medications. In a report from US Pharmacopeia’s MEDMARXSM program, which was based on 1,837 records from both hospitals and clinics that were submitted between August 1998 and December 2002, the administering phase (49.5%) was the point of care where vaccine-associated errors occurred the most often, followed by the documenting/transcribing phase (20.2%), the dispensing phase (14.8%), the prescribing phase (7%), and the monitoring phase (0.4%); the remaining 8.1% of the reported errors were potential errors (Kuo, 2006). The MEDMARXSM reporting program is voluntary; therefore, these data may under-represent the actual prevalence of medication errors. Ambulatory care nurses are at-risk of medication verification and administration errors, particularly related to interruptions. A variety of interventions to reduce medication errors have been proposed including prohibition of non-essential conversation, phone calls and pages, use of "do not disturb" vests and signage, use of a medication administration checklist, and use of a clearly demarcated "no interruption zone" or physical barrier in medication preparation areas (Prakash, et al., 2014).
Quality improvement interventions: A standardized workflow was developed for the internal medicine clinic (IMC), which consists of scanning every medication given. Once the order is placed the clinical staff administering the medication will pull the medication to be given. They will verify medication with EHR. Once in the room with the patient, the clinical staff will confirm patient name and date of birth with EHR and again verify the medication. The medication is then scanned and administered. If, for some reason a medication won't scan, nurses will complete a verbal 2-person verification. In addition, the area around the PYXIS was identified with signage and brightly colored tape as a “no interruption zone.” Response to non-essential conversation, phone calls, and pages is prohibited within the “no interruption zone.” We will collect data based on medication error-related incident reports June 20, 202, through November 20, 2022, related to associated with distractions/interruption at any point in the process. Results will be based on the comparison of pre-intervention and post-intervention differences over the 6-month period.
Results: Nine medication errors were reported In the IMC between October 14 - June 14, 2022. All were associated with distractions or lack of a consistent process. Post-intervention results will be determined in December 2022.