Medication administration errors (MAEs) are a critical and ongoing issue faced by hospitalized patients. According to the National Coordinating Council for Medication Errors Reporting and Prevention (2020), a medication error refers to any preventable event that may lead to inappropriate medication use or harm to the patient while under the control of healthcare professionals, patients, or consumers. These errors can occur in any department of a hospital and during various stages of medication handling, including prescribing, dispensing, preparing, and administration. Nurses, being the last line of defense in the medication process, are often associated with medication errors (Wang et al., 2015). To address the increasing severity of MAEs, healthcare facilities have started implementing safety interventions to eliminate this major patient safety concern.
NURS 3151 Week 6 Foundations of Nursing Research
In the study titled “Quiet, please! Drug round tabards: are they effective and accepted? A mixed-method study,” the authors investigate the effectiveness of using drug round tabards to reduce medication errors. Interruptions and distractions are known to decrease productivity and contribute to medication errors. Drug round tabards are vests worn by nurses during the preparation and administration of drugs, bearing the inscription “do not disturb,” with the aim of reducing interruptions. The authors assess the effectiveness of this intervention through random sampling, mixed-methods, pre- and post-implementation data collection, three observation periods, personal inquiry, and a nurse focus group. The study involved observing a total of 313 medication administrations from three different wards in a Dutch hospital. The findings revealed a significant decrease of 75% in interruptions and 66% in medication errors with the use of the tabards (Verweij et al., 2014). However, during interviews and focus groups, nurses expressed concerns about the discomfort of wearing the tabards and the impression it gives to patients and visitors as being unfriendly.
NURS 3151 Week 6 Foundations of Nursing Research Conclusions
After examining the study, three conclusions can be drawn from the findings. Firstly, the implementation of drug tabards led to a 75% reduction in verbal interruptions during medication administration. While there was a significant reduction in individual interruptions, there was no change in verbal and nonverbal interruptions initiated by patients. Most declines in interruptions were observed during medication rounds at 8 am, 12 pm, and 6 pm. However, there was a slight increase in interruptions during the 8 pm and 10 pm rounds, which could be attributed to nurse fatigue, understaffing, or decreased nurse experience.
Secondly, the reduced interruptions were found to have a positive linear relationship with a significant indication of MAEs. A positive linear relationship implies that as one concept changes, the other concept changes in the same direction (Gray et al., 2017). However, the coefficient of determination was low at 10.4%, suggesting that interruptions could explain only a small portion of the errors. The remaining nine-tenths of errors may be influenced by other unknown factors not addressed in the study (Verweij et al., 2014).
NURS 3151 Week 6 Foundations of Nursing Research
Thirdly, the results from nurse interviews and focus groups revealed mixed emotions and experiences regarding the use of tabards during medication administration. The nurses’ experiences were categorized into three main areas: personal considerations, patient perceptions, and effectiveness considerations (Verweij et al., 2014). Regarding personal considerations, nurses expressed feelings of awkwardness while wearing the tabards and raised hygienic concerns due to their public use. Patient perceptions indicated that patients and visitors may perceive the tabards as unfriendly or unapproachable, whereas nurses want patients and visitors to feel comfortable approaching them and asking questions. Finally, effectiveness considerations showed that most nurses believed the tabards were effective during the day shift but ineffective during the night shift due to a higher number of visitors and insufficient staff (Verweij et al., 2014).
Implications for Practice
First and foremost, this study highlights the significant patient safety issue of medication administration errors and the effectiveness of interventions in reducing these errors. It is evident that modifying nursing practices is the most effective approach to altering interruptions and MAEs (Verweij et al., 2014). Therefore, I suggest that the use of tabards should continue and be extended to include different units within the hospital. This can serve as a means to change nursing behavior and consequently reduce interruptions and MAEs during medication administration.
Next, as part of the admission process, patients and visitors should be educated on the significance and purpose of drug round tabards in reducing interruptions during medication administration. Nurses expressed during the focus group that many patients are unaware of the tabards’ purpose. Additionally, nurses emphasized that patients and visitors should feel free to approach them and ask questions (Verweij et al., 2014). By implementing education about tabards during the admission process, patients and visitors will have sufficient time to understand the purpose of the vests and ask any related questions.
NURS 3151 Week 6 Foundations of Nursing Research
Lastly, nurses raised concerns about the appearance and cleanliness of the tabards. Many felt that the prominent fluorescent yellow color of the vest was off-putting and created a barrier for patients. The focus group also expressed hygienic concerns due to the shared use of the tabards among multiple nurses (Verweij et al., 2014). To enhance compliance in wearing the tabards, nurses should have input in designing, selecting colors, and ensuring proper fit of the vests. Moreover, protocols for cleaning and maintaining the tabards should be established to ensure hygiene not only for the nurses but also for the overall unit.
Conclusion
In conclusion, the use of drug round tabards as an intervention to reduce medication administration errors has proven to be significant for both nurses administering medications and the reduction of medication errors. Despite some limitations in the study, the results of using tabards have demonstrated their usefulness in the healthcare setting. With the increasing number of medication administration errors, the implementation of tabards proves to be an effective strategy in improving patient safety and achieving better outcomes.
References
Gray, J. R., Grove, S.K., & Sutherland, S. (2017). The Practice of Nursing Research (8th ed.). St. Louis, MO: Elsevier. Verweij, L., Smeulers, M., Maaskant, J. M., & Vermeulen, H. (2014). Quiet please! Drug round tabards: Are they effective and accepted? A mixed-method study. Journal of Nursing Scholarship, 46(5), 340. doi:10.1111/jnu.12092 Wang, H., Jin, J., Feng, X., Huang, X., Zhu, L., Zhao, X., & Zhou, Q. (2015). Quality improvements in decreasing medication administration errors made by nursing staff in an academic medical center hospital: A trend analysis during the journey to Joint Commission International. Therapeutics & Clinical Risk Management, 11, 393-406. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.2147/TCRM.S79238“What is a medication error?” (2020). In National Coordinating Council for Medication Errors Reporting and Prevention. Retrieved from https://www.nccmerp.org/about-medication-errors
