Minimizing Interruptions During Medication Administration

Cleveland Clinic’s Marymount Hospital recently implemented a program to reduce interruptions during two crucial times each day when routine medications are being administered — at 9 a.m. and again at 9 p.m.

During these times, a light on the unit clerk’s desk is turned on to alert the entire staff that it is “med-pass” time. The unit clerks take messages for all but the most urgent phone calls, and the staff is asked to hold all questions for nurses until they are done with medication administration. Nurses place a sign on their workstations and hang tags on patient doors to alert others that it is med-pass time. Signs are also posted in the medication storage/dispensary areas, labeling them as “no talking” zones.

Results have been impressive — a 72 percent reduction in interruptions. Before, nurses were interrupted an average of 4.28 times during medication administration; that went down to 1.19 interruptions per nurse per medication administration period. The biggest reduction was in the number of nonphysician phone calls. The nursing team hopes to see even further reductions as the program continues.

“This is not just about a light on a desk,” stresses Marymount’s Chief Nursing Officer Barbara Zinner, MSN, RN, NE-BC, who spearheaded the project. “It’s about how we do our work and making med-pass a truly sacred time.”

In an effort to help the nurses on her oncology unit, Marymount nurse manager Stephanie Conard-Scott, BSN, RN, was instrumental in the initiative. “The greatest benefit we’ve seen of this program is that it heightens awareness and empowers the nurse to safely administer medications without unnecessary interruptions from other departments.”

Zinner noted that Marymount did not have significant medication errors prior to the program; actions taken were meant to be proactive, to keep patients safe. It has had an added benefit of increasing nurse satisfaction.

“They really appreciate being given permission to say no to interruptions and focus on their work,” Zinner says. “It shows clinical nurses that other healthcare providers respect what they do.”

Origins

Making med-pass a no-interruption time began as a pilot program on Cleveland Clinic’s main campus about three years ago. Zinner learned about it and asked Michael Okrent, ScD, PMP, of Marymount’s Medical Operations department to study the distractions that nurses face.

The high rate of interruptions he found during med-pass time was “eye-opening,” Zinner says. Okrent also found that “workstations on wheels” used during med-pass were another distraction because they were not always charged when the second shift needed them.

“We did a quality improvement project to make sure they were plugged in during the day so they were ready when needed, and it succeeded,” Okrent says.

Better patient experience

Not only are interruptions frustrating, but during med-pass time they could decrease patients’ perceptions of unit experiences, as this is the time used for educating patients about their medications and answering questions about how to take them and about expected effects and potential side effects.

“It’s hard for nurses to do that if they are being interrupted, so it’s a twofold win,” Zinner says.

All med-surg areas at Marymount implemented the med-pass program. Other hospitals in the Cleveland Clinic health system are evaluating Marymount’s tools and templates, with plans to adopt some or all of its methods.

Photos © Russell Lee