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ISE 468 ETM 568 Healthcare Process Improvement. Dr. Joan Burtner, CQE Associate Professor of Industrial Engineering and Industrial Management. Work Interruptions Study. “Characteristics of Work Interruptions During Medication Administration”
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ISE 468 ETM 568 Healthcare Process Improvement Dr. Joan Burtner, CQE Associate Professor of Industrial Engineering and Industrial Management
Work Interruptions Study • “Characteristics of Work Interruptions During Medication Administration” • Biron, A.D., Lavoie-Tremblay, M., and Loiselle, C. G. • Journal of Nursing Scholarship, 2009, 41(4), pp. 330-336 • Montreal, Quebec, Canada 2013
Study Design Overview • Descriptive observational study design • 102 medication administration rounds • Fall 2007 • Direct structured observation of registered nurses • Data collected • Source • Secondary task • Location • Management strategies • Duration 2013
Study Methodology • Single medical patient care unit using a unit dose distribution system • Process studied: Nurses prepare all medications for assigned patients at a specific time and then administer them one patient at a time • Medication preparation phase • Medication administration phase • Approval obtained from hospital institutional review board (IRB) • Paper-based observation grid used to record data • Two observers • Interobserver agreement kappa values 0.78 initial and 0.66 at midpoint of study 2013
Definitions and Categories • Work Interruption (WI) - “A break in the activity being performed to carry out a secondary task.” • Work Sampling of nursing care activities • Direct care – all nursing care activities performed in the presence of the patient or family • Indirect care – all nursing care activities done away from the patient, but on a specific patient’s behalf • Unit-related • Personal • Typical secondary task categories • Direct care, verbal report, communication, coordination • Failure resolution, meetings, administration • Clerical, personal, teaching 2013
Selected Results for 374 WIs • During the medication preparation phase, the most frequent secondary task was failure resolution. • During the administration phase, the most frequent secondary task was direct patient care. • During the medication preparation phase, the most frequent sources of WIs were nurse colleagues (29.3%) and system failures (22.8%). • During the administration phase, the most frequent sources of WIs were self-initiation (16.9%) and patients (16%). . 2013
