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1. Improving Medication Administration Safety in the Clinical Environment.
Improving Medication Administration Safety in the Clinical Environment. ON Improving
Medication Administration Safety in the Clinical Environment.after you find a scholarly
nursing journal article, you will complete a one-two page summary and reflection on the
article. the paper should be completed in APA format and include the following:1.
introduction, level 1, level 2, level 3 headings, and conclusion2. one direct quotes from one
of your references, appropriately cited in the body of your paper3. or one indirect quote( or
paraphrased reference) appropriately cited in the body of your paper4. citations and
references in APA formatImproving Medication Administration Safety in the Clinical
Environment.attachment_1Unformatted Attachment PreviewContinuous Quality
Improvement Improving Medication Administration Safety in the Clinical Environment
Janet Tompkins McMahon ork interruptions create danger at the bedside, particularly
during medication administration. A work interruption can be as simple as a telephone call,
noise, or an invitation to conversation by a member of the healthcare team, patient, or
family member while the nurse is preparing medications. Medication errors are a major
concern for patients and can lead to unnecessary safety risks (Karavasiliadou &
Athanasakis, 2014). Reduction of interruptions and associated errors with medication
administration is essential. W Project Site and Reasons for Change The identified need for
change was reduction of errors and distractions during medication administration. The
current use of a no-interruption zone on a medical-surgical unit was identified by the
project leader as an area for improvement based on repeated observations of nurses’
nonadherence to the zone during eight random visits. Nurses, other unit staff, and
interprofessional team members appeared unaware of or ignored the purpose of the
nointerruption zone. Some institutions have adopted use of medication safety vests for
nurses to wear to alert colleagues and patients of their involvement in medication
administration. According to Williams, King, Thompson, and Champagne (2014), safety
vests, posted signs, highlighted decorative aprons, and sashes have been used to reduce
work interruptions. The project leader decided to incorporate situation awareness (SA)
with the use of a medication safety vest and 374 Work interruptions during medication
administration are a serious problem negatively impacting patient safety. Using a
medication safety vest and signage during medication administration improves situation
awareness, reducing the potential for interruptions. signage on the nursing unit and within
patient rooms (“Do Not Disturb the Nurse during Medication Administration”). SA refers to
a practitioner’s conscious awareness of a circumstance or situation (Stubbings, Chaboyer, &

2. McMurray, 2012). An educational in-service reinforced the purpose and rationale for the
project. Program The project leader, a student in a Doctor of Nursing Practice (DNP)
program, was interested in developing a capstone project for continuous quality
improvement (CQI). She requested a meeting with the chief nursing officer (CNO) and unit
nurse manager to address the observed clinical problem. The CNO encouraged pursuit of
this CQI opportunity. Project planning began after the project leader received approval from
the facility administrator. Clinical nurses on the unit were advised of the project 3 months
before its initiation through communication during staff meetings. The project leader
attended meetings the day before the launch to provide education regarding project
implementation, including creation of SA, use of the medication safety vest and signage, and
completion of surveys about adherence to the nointerruption zone. According to Sitterding,
Ebright, Broome, Patterson, and Wuchner (2014), the need to understand interruptions
with medication administration is necessary. Disposable medication safety vests
(Riskologic, LLC) were donated to the project leader for use by the registered nurses (RNs)
Improving Medication Administration Safety in the Clinical Environment.identified as
responsible for medication administration after the educational session was completed. A
vest labeled Do Not Disturb was used as a visual prompt to people who might approach
nurses during medication administration. “Do Not Disturb the Nurse During Medication
Administration” signage also was placed in medication preparation areas and all 28 patient
rooms. Surveys regarding distractions, use of a medication safety vest and signage, and
evaluation of the project leader’s educational program were included. MADOS Survey RNs
completed a pretest/posttest survey on types of distractions. The Medication
Administration Distraction Observation Sheet (MADOS) identified 10 sources of distractions
and interruptions (Pape, 2003). Janet Tompkins McMahon, DNP, RN, ANEF, is Clinical
Associate Professor of Nursing, Towson University, Towson, MD; and Nurse Educator-
Integration Specialist, A&I Nursing Education. November-December 2017 • Vol. 26/No. 6
Improving Medication Administration Safety in the Clinical Environment Literature
Summary • • • • • • Cooper, Tupper, and Holm (2016) found 63% of medication passes
(n=30) were caused by interruptions during medication administration at a 271-bed
Magnet® facility, resulting in decreased efficiency. Medication errors occur often within
nursing practice compared to other types of errors (Tzeung, Yin, & Schneider, 2013). An
integrative review by Hopkinson and Jennings (2013) found various interventions can be
implemented to reduce work interruptions during medication administration, noting future
research would be beneficial. Keers, Williams, Cooke, and Ashcroft (2013) found slips and
lapses were common during medication administration. Other influences included written
communication errors, perceived workload, and distractions and interruptions. Williams,
King, Thompson, and Champagne (2014) found safety vests, posted signs, and use of
highlighted decorative aprons and sashes reduced work interruptions during medication
administration. According to Sitterding, Ebright, Broome, Patterson, and Wuchner (2014), a
gap in knowledge and understanding of situation awareness exists during medication
administration. Adherence Survey CQI Model Plan, Do, Check, and Act (PDCA) model
(Russell, 2010) Quality Indicator with Operational Definitions & Data Collection Methods •
The number of medication errors on the unit was examined with data • • • pleted and

3. placed in a designated locked box on the nursing unit for the project leader’s collection. To
ensure communication for the project, the anticipated time frame and overall project
information were documented in minutes from the nursing unit meetings each time the
project leader shared additional information. After completion of the 4-week project, the
MADOS survey was administered by the project leader to RNs on both 12-hour shifts. Those
not present for the final meeting again were given the survey in their mailboxes with
instructions to place completed surveys in the designated locked box located on the nursing
unit. extrapolated from the hospital medication variance reporting system. The number of
distractions was evaluated by the Medication Administration Distraction Observation Sheet
(MADOS). The MADOS identified 10 sources of distractions and interruptions (Pape, 2003).
The MADOS was used pre- and post-project. Adherence to use of the medication safety vest
was documented on the Medication Safety Vest Report each day during the 4-week project
period. Effectiveness of the medication safety vest use, signage, educational sessions, and
reference binder was evaluated after the project. A survey tool (Nurses Perceptions of the
Medication Safety Vest, Signage, and Education Survey) also was used. Clinical Setting 28-
bed medical-surgical unit (average daily census 25-28 patients) in a 251bed regional
medical center Program Objectives • Decrease number of medication errors on the
designated nursing unit. • Create situation awareness to reduce distractions and medication
errors during medication administration with use of the medication safety vest and unit
signage. Examples included telephone calls, interactions with patients and visitors, wrong
dose, missing medications, physicians, and external noises. The modified survey tool (used
with permission from the publisher) identified nurses’ perceptions of the reasons and
frequency of distractions during the medication administration. Nurses also were asked to
identify the 10 most frequent distractions (1=most frequent, 10=least frequent). This was
explained to RNs during the in-service by the project leader, and was reinforced on the
MADOS form for RNs to see when following the directions. Descriptive statistics were used
to examine these categorical data. The MADOS survey (Pape, 2003) was provided to all RNs
attending the educational meeting the day before the project began, and distributed in RNs’
mailboxes for those not present at the meeting. These additional surveys were to be com-
November-December 2017 • Vol. 26/No. 6 During the initial meeting about the project, an
adherence survey tool was introduced to RNs. The survey was a new tool developed by the
project leader to evaluate previous adherence to use of the medication safety vest. The
project leader’s DNP committee provided feedback regarding content of the new tool before
its initial use. The nurse unit had designated nursing leaders in place with resource nurses
staffed on every 12-hour shift. Resource nurses (baccalaureate-prepared nurses) were
invited and encouraged to be champions for the project. Champions evaluated medication
safety vest use on 12-hour shifts daily by completing The Medication Safety Vest
Compliance Report. Designated champions collected data every 12hour shift each day for
the project as requested by the project leader during orientation to the pilot study. The
report listed percentage ratings (100%-90%, 89%-80%, 79%70%, 69%-60%, 59% and
below) corresponding to a grade of A, B, C, D, or E, respectively. Champions assigned a letter
grade to RNs administering medications to patients every 12 hours for the 4-week period.
Completed daily reports were placed in designated locked boxes located in the areas

4. identified on the nursing unit during the educational in-services at the nurses’ station.
Perceptions Survey A perceptions survey was discussed and reviewed during staff
meetings, and administered after 375 Continuous Quality Improvement MADOS Survey the
4-week project. The tool captured RN perceptions of the medication safety vest, signage,
and educational sessions. The survey was developed by the project leader with the
assistance and feedback of content experts on the DNP committee. Improving Medication
Administration Safety in the Clinical Environment.Evaluation and Action Plan Data from the
Medication Variance Reporting System (MVRS), which tracks medication errors in the
hospital, were evaluated for 3 months before and 4 weeks after the project. Results of the
MADOS surveys also were reviewed and analyzed. Perceptions of medication safety vest
and signage use, educational session, and reference binder effectiveness were analyzed.
Adherence to safety vest use was evaluated as well. Project results were shared with the
unit nurse manager and RNs as well as the CNO to begin discussions about potential change
based on results. Results and Limitations Results MVRS results identified an 88% decrease
in medication error rates after implementation of the medication safety vest. Nine
medication errors were reported by unit nurses 3 months before the project. Use of 376 M
ed ica tio n W ro ng Do se Em er ge nc y Co nv er sa tio Ex n te rn al No ise s Vi sit or After
Vest M iss ing Ph on e Ot he rP er so nn el Before Vest Ot he rP at ien t 10 8 6 4 2 0 Ph ys ici
an Ranking FIGURE 1. The Frequency of Distractions Ranked on 1-10 Scale Pre/Post Pilot
Survey the medication safety vest and signage contributed to a clinically significant
reduction to one medication error during the 4-week project period. Importantly, the single
error was related to a patient’s cardiac arrest when the safety vest was not in use. Per
MADOS survey results, external noises demonstrated a significant change (p=0.03). A two t-
test was performed on the MADOS results because of the small sample size (see Figure 1).
Perceptions of the project were favorable (n=17). For 82% of RNs, signage in the patient
rooms was always or often effective. Signage in the medication areas was always or often
effective in 89% of cases. The medication safety vest was reviewed favorably 4% of the
time. No negative responses were recorded by RNs. Adherence results for use of medication
safety vests were above average on both shifts (n=42). RNs used the medication safety vest
86% of the time over the 4-week period as evaluated by champions and the project leader.
This result demonstrated above-average use of the medication safety vest during
medication administration (see Figure 2). Field Log Visits The random eight field log visits
by the project leader identified subjective feedback from nurses during the 4-week
medication safety vest use. Visits occurred on all shifts and on weekends. RNs stated they
liked wearing the vest, and noted it worked. Some RNs admitted they would forget to use
the vest during medication administration. Two RNs noted staff from other departments did
not like the vest. They stated interprofessional team members expressed frustration when
they could not interrupt the nurse during medication administration to retrieve patient
information. One RN indicated a patient’s family member asked for a safety vest for the use
of her daughter (an RN at another hospital) because she thought it was a wonderful idea for
patient safety. Two RNs did not want to stop wearing the vest after the project ended; they
noted it worked in decreasing interruptions and helped them become more efficient.
Limitations Limitations included the sample size (n=28), response time, and incomplete

5. sets of MADOS surveys. A sample size should be greater than 30 when using central limit
theorem to allow increased variability and distribution of results (Cooper & Schindler,
2003). In addition, results could have been affected if nurses changed behavior and wore
the vest when the project leader made rounds for the observation and field log. Finally, the
telephone was a potential distraction November-December 2017 • Vol. 26/No. 6 Improving
Medication Administration Safety in the Clinical Environment FIGURE 2. Adherence 50 45
Percentage 40 45% 35 41% 30 25 20 15 7% 10 5 0 A (90-100) B (89-80) C (79-70) D (69-
60) Adherence Grades during the 4-week project time. Because nurses were required to
carry a phone at all times, this distraction could not be eliminated; MADOS results identified
it as the primary distraction. Lessons Learned/ Nursing Implications The timeline to begin
and forecast a project may not be as easy as it appears initially. The project required a
forecasted timeline months in advance to plan the project adequately and communicate
needs with staff at the acute care facility. Any project or quality improvement study
requires critical thinking and careful judgment by the project leader. Institutions have their
own schedules and needs which come first, sometimes requiring reorganization of
anticipated needs to another time or day. Meetings can be cancelled and may not be the
priority for facility staff. Schedules may not match, creating a longer window of anticipation
for implementation. The experience can be improved with enhanced knowledge and
communication of medication error, rationale, types of distractions, and need for practice
changes to improve outcomes with interprofessional efforts. The biggest lesson from the
project involved the need for communication with all stakeholders to 5% 2% E (?59) ensure
success. The project leader must be a strong communicator and organizer. The project
required continuous monitoring as well as written and in-person communication.
Accountability with project expectations also is paramount for success. Use of effective
communication methods for participants reduces knowledge gaps to allow the project to
proceed as planned. In addition, the project leader must be flexible and willing to make
changes with timelines. Not everyone shares the same passion for meeting project goals.
Institutional priorities may not be the project leader’s priorities, so flexibility with planning
and organizational forecasting is critical. Such a project can guide nurse practice changes to
improve patient safety outcomes and reduce medication errors. The SA created through use
of the safety vest contributed to reduced distractions and medication errors. With reduced
distractions while wearing the medication safety vest, RNs could focus more closely on
administering medications. In addition, the interprofessional team became more
independent in obtaining information about patients without interrupting medication
administration. Further investigation or replication of the project would be beneficial to the
nursing profession and for patient safety outcomes. November-December 2017 • Improving
Medication Administration Safety in the Clinical Environment.Vol. 26/No. 6 A positive
change in RNs’ behavior included their request to continue to use the medication safety
vests after the project. RNs identified a desire to address a policy change for using the vest
during medication administration to continue the reduction of potential medication errors
from less distractions on the unit by members of the healthcare team, patients, and families.
Signage used in conjunction with the medication safety vests and SA appeared to be
effective as unit staff asked to keep all signage in patient rooms and medication

6. administration area. To date, “Do Not Disturb the Nurse during Medication Administration”
signage still is used on the unit at the regional medical center. Conclusion The CQI project
demonstrated an evidence-based solution to reduce errors and improve patient safety with
medication administration. Medication errors decreased during the 4 weeks of the project
while nurses wore the safety vest, and with placement of signage on the nursing unit in
patient care areas during medication administration. Use of medication safety vests and
signage is a potential solution for reducing errors and distractions during medication
administration. Creating SA among nurses, other healthcare professionals, patients, and
families using a medication safety vest, signage, and education is vital for quality
improvement. Reduction of medication errors and distractions for nurses during a critical
skill intervention with patient care is advantageous. REFERENCES Cooper, D.R., & Schindler,
P.S. (2003). Business research methods (8th ed.). New York, NY: McGraw-Hill/Irwin.
Cooper, C.H., Tupper, R., & Holm, K. (2016). Interruptions during medication administration:
A descriptive study. MEDSURG Nursing, 25(3), 186-191. Hopkinson, S.G., & Jennings, B.M.
(2013). Interruptions during nurses’ work: A state-of-the-science review. Research in
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medication administration. MEDSURG Nursing, 12(2), 77-94. Russell, C.L. (2010). A clinical
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doi:10.1111/j.13652648.2012.05989.x Tzeung, H.M., Yin, C.Y., & Schneider, T.E. (2013).
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Williams, T., King, M.W., Thompson, J.A., & Champag …Improving Medication Administration
Safety in the Clinical Environment.