Managing Interruptions In Medical Administration: Impact On Medication Errors

The PICO Framework for Framing Research Questions

A research question that is well formulated needs extreme preciseness and specificity that guides the implementation of the project. The PICO (Population, Intervention, Control and Outcomes) format provides a strategy for framing a ‘foreground’ research question (Leung, et al., 2016).

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Population or problem: seeks to address a specific population, demographic information and its key characteristics. From the case, I can identify the nursing population in medical and administrative capacities.

Intervention: In this case, the intervention is explaining ways of managing interruptions on medical errors in hospitals.

Comparator or control: an existing therapy is compared to a new one.

Outcome: The outcome in this case is averting interruptions. Therefore, the research question can be formulated as follows;

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Among nurses (P), is managed interruptions (I) effective in addressing medical errors (O) as compared to risking its impacts (C)?

Research design is the overall strategy that is used to integrate the various study components in a coherent and logical manner (Desborough, et al., 2016). The study adopted a non-participant observational method for nurses conducting rounds of medication to collect data. However, this method is more of being passive than actively being involved in the exercise. It therefore means that the information obtained is unlikely to be reliable owing to this shortcoming of the non-participant observational method. The comparison of data collection methods with other works on a theoretical basis is also questionable. This is because such methods are likely to be outdated. Choosing only two clinical units for the study presents a limited scope for obtaining the relevant information. The methods used to measure the outcomes of the study do not have a completely quantifiable approach. In analyzing the numeric data, the researchers used IBM SPSS statistics.

Sampling is defined as the process of selecting units; representative portion from a population of interest in a research context (Lane, et al., 2016). The study used a non-participant method of observational study and convenience sample. It was made up of two clinical units and five units of medical surgery. Their recruitment was done within a vast metropolitan teaching hospital. A total of 56 medication events were observed. The patient rooms used in the study were single and four-bed oriented. I am dissatisfied that more relevant and wide data were left out by the fact that only two units were involved in the study research. The study was also conducted in only one hospital setting that would probably not reflect the actual picture of the interruptions witnessed in the administration of medication by nurses. Expansive and more relevant information would have enabled the reader of the article to form an objective opinion regarding the impact of interruptions on medication errors and viable ways of managing them. For a good research, there is need to use the most viable sampling and recruitment procedures as dictated by the context of the study.

Research Design and Sampling Methods

Ethical considerations are perceived as critical in every research study (Oad, et al., 2018). These are the standards or norms that define conduct and distinguishes between wrong and right. The ethical standards seek to prevent falsifying or fabrication of data in an effort to promote the pursuit of truth and knowledge which forms the primary goal of a study. The researcher sought for the consent of the participants before engaging them in the observational study. I found this move to be that of goodwill because it promotes the willingness of the participants to provide the relevant information for the research. Explaining the motive of the study at a forum by unit managers is also recommendable. It ensured that the rights of the observed nurses are being respected in the context of their working environment. Before the observation, consent in written form is always obtained (Coggins, et al., 2018). However, I found it interesting that the research nurse was given instructions to intervene in case of a potentially harmful incident was witnessed in the course of the study. I am concerned that the benefits and risks associated with this particular study were not explained to the participants.

Data collection refers to the process of assembling information and measuring it based on variables of interests. It is done in defined systematic manner that enables the researcher to answer research questions, test hypothesis and evaluate the findings. According to the article, the data was collected through a non-participant prospective observational study that involved a convenience sample. A standard observation tool that included nurse identifier, ward details, administered medications, clinical history of patients and interruptions’ data during medication events was developed. I noted that primary and secondary tasks were presented in a brief written description. I found this move recommendable because it supplements the data collection framework in the research. Analysis of data involves summarizing and interpreting obtained information through logical and analytical reasoning to establish trends, patterns or relationships. The data in numeric form was analyzed using IBM SPSS statistics. I found it more reliable in interpreting statistical data. For instance, the frequency of interruptions and other characteristics were described using proportions and descriptive statistics. Re-categorizing of written descriptions into quantifiable categories, further refines the data analysis (Amaral, et al., 2017).

The primary diagnosis of patients comprised musculoskeletal, gastrointestinal conditions (30%), cardiovascular conditions (15%), skin and spinal conditions (21%), renal, urinary, hepatic and endocrine conditions (9%) and other conditions (25%) (n=47). The information was drawn from Nursing Handover Summary documents. However, I feel dissatisfied that the patient characteristics were insufficiently captured because no demographic data like patient gender or age were collected during the study. In such a study, demographic data is critical because it contributes to enhancing the reliability of the findings. One-third of the recorded interruptions emanated from other nurses seeking to share information about workflow and patients. However, the authors of the article do not tell the reader what the other two-thirds represent in these results. I feel the untold remaining proportion should have been mentioned to facilitate an objective understanding by the reader about the sources of interruptions. The authors of the article found it relevant to also identify the importance of the tasks that made nurses to adjourn attending to medical administration. (Kunac, et al., 2014) I found this to be an important ingredient in devising a framework to manage these interruptions. The findings also detail the nature of the secondary tasks.

Ethical Considerations in the Research

The article presents a variety of implications for the practice of health professional. It may not be easy to completely alleviate clinical interruptions, but it is possible to reduce these interruptions. According to the article, one way of achieving this is by minimizing non-patient related interruptions as well as nurse-to-nurse interactions (Westbrook, et al., 2018). However, I feel that pre-assessment should be done before such implementing it to avoid any form of resistance from the nursing staff. It would also compromise their service delivery to patients. It is recommended that consultations be done involving the management and clinicians. The authors note that interruptions emanating from medication preparation and administration result to a significant workload for nurses (Raban & Westbrook, 2014). They suggest the existence of potential for nurse managers to increase the available hours of nursing per patient. However, I doubt the effectiveness of such a move because it would only serve the interests of the nurse manager and make the work of the nurses tedious. There is the need to design a framework that incorporates the clinicians with an aim of identifying the sources together with volumes of interruptions (Manias, et al., 2018). It could be utilized as a strategy of quality improvement in any context in our hospitals across the world. The article’s main focus was to prepare an educational intervention and this may not be applicable in majority of situations experienced in the hospitals as far as interruptions are concerned (Johnson, et al., 2017). Therefore, I found the applicability of the suggested control measures for interruptions somehow challenging and unrealistic. Considering the diverse and unique working environments in the context of health care, realistic methods of managing such interruptions should not be overlooked. The authors have at some point acknowledged that some witnessed interruptions are worth as dictated by the situations which cause them (Hayes, et al., 2015). Such interruptions should be categorized as necessary interruptions which should be widely acceptable in medication preparation and administration. However, there needs to be a clear set out mechanism that seeks to harmonize these interruptions such that the accruing benefits can be realized by both parties; the nurses and patients (Hayes, et al., 2014). This would contribute in enhancing service delivery amidst of the acceptable and harmonized interruptions owing to the common understanding between the hospital management and clinical staff in their respective health care centers (Hayes, et al., 2015). The potential that exists in minimizing the socialization among nurses which result to interruptions is eminent (MareeJohnson, et al., 2018). However, great care should be observed when adopting such measures.

Data Collection and Analysis

References

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Westbrook, J. I., Raban, . M. Z., Walter, . S. R. & Douglas, . H., 2018. Task errors by emergency physicians are associated with interruptions, multitasking, fatigue and working memory capacity: a prospective, direct observation study. BMJ Qual Saf Published Online First.