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Topic Selected:

Medication Errors: Distractions & Interruptions

Assignment Directions

Begin
by selecting a topic in nursing that is of interest to you. Next, use
PICOT to format a possible research question about that topic. Provide 1
possible PICOT research question. Find 1 quantitative or qualitative
peer-reviewed research article related to your nursing topic that was
published within the last 5 years. Reminder: All peer-reviewed research
articles have methods, discussion, and results sections. Upload the
article with your paper in PDF or Word format. This source can be used
again in the Week 4 article assignment if it meets the criteria.

See PICOT Formatting Guide

or pages 249-257 in your book for additional help with formatting your PICOT.

Include the following:

Title page

Provide
a brief description of the topic and background information (see page
37 of your textbook). You can use your text, your peer-reviewed journal
source, or thein

EBP Care Sheet

CINAHL or Nursing Reference Center Database.

Explain
the significance of the topic to nursing practice (see chart on page 37
of your textbook). Background information can be found in journal
articles in the introduction section. Results and conclusions will speak
to significance of the topic. The EBP care sheets may have sources for
you to choose from.

Provide 1 clearly-stated PICOT question.

Include 1 peer-reviewed journal source related to your topic.

The
chosen topic and PICOT will be used for your Week 9 poster assignment.
It will also guide your article searches in Week 4 on which you will
complete appraisals in Week 6.

Your paper should:

Be 3 pages (not including the title page and reference page)

Use current APA 7

th

Edition format to style your paper and to cite your source.

All References Must be Peer-reviewed and within 5 years.

There
will be a 5 point deduction if peer-reviewed research journal article
is not used and a 5 point deduction if the article is not included with
your submission.

Template  for  Asking  PICOT  Questions  
INTERVENTION  
In  ____________________(P),  how  does  ____________________  (I)  compared  to  
____________________(C)  affect  _____________________(O)  within  ___________(T)?    
 
THERAPY  
In  __________________(P),  what  is  the  effect  of  __________________(I)  compared  to  
_____________  (C)  on  ________________(O  within  _____________(T)?  
 
PROGNOSIS/PREDICTION  
In  ______________  (P),  how  does  ___________________  (I)  compared  to  _____________(C)  
influence  __________________  (O)  over  _______________  (T)?  
 
DIAGNOSIS  OR  DIAGNOSTIC  TEST  
In  ___________________(P)  are/is  ____________________(I)    compared  with  
_______________________(C)  more  accurate  in  diagnosing  _________________(O)?  
 
ETIOLOGY  
Are____________________  (P),  who  have  ____________________  (I)  compared  with  those  
without  ____________________(C)  at  ____________  risk  for/of  
____________________(O)  over  ________________(T)?    
 
MEANING  
How  do  _______________________  (P)  with  _______________________  (I)    perceive  
_______________________  (O)  during  ________________(T)?  
 
 
 
 
 
Adapted from the PICOT Questions Template; Ellen Fineout-Overholt, 2006. This form may be used for educational & research purposes without permission.
 
Short  Definitions  of  Different  Types  of  Questions  
 
Intervention/Therapy:  Questions  addressing  the  treatment  of  an  illness  or  disability.  
 
Etiology:  Questions  addressing  the  causes  or  origins  of  disease  (i.e.,  factors  that  produce  or  
predispose  toward  a  certain  disease  or  disorder).  
 
Diagnosis:  Questions  addressing  the  act  or  process  of  identifying  or  determining  the  nature  and  
cause  of  a  disease  or  injury  through  evaluation.  
 
Prognosis/Prediction:  Questions  addressing  the  prediction  of  the  course  of  a  disease.  
 
Meaning:  Questions  addressing  how  one  experiences  a  phenomenon.  
 
Sample  Questions:  
 
Intervention:  In  African-­‐American  female  adolescents  with  hepatitis  B  (P),  how  does  
acetaminophen  (I)  compared  to  ibuprofen  (C)  affect  liver  function  (O)?  
 
Therapy:  In  children  with  spastic  cerebral  palsy  (P),  what  is  the  effect  of  splinting  and  casting(I)  
compared  to  constraint-­‐  induced  therapy  (C)  on  two-­‐handed  skill  development  (O)?  
 
Prognosis/Prediction:    
1)  For  patients  65  years  and  older  (P),  how  does  the  use  of  an  influenza  vaccine  (I)  compared  to  
not  received  the  vaccine  (C)  influence  the  risk  of  developing  pneumonia  (O)  during  flu  season  
(T)?    
2)  In  patients  who  have  experienced  an  acute  myocardial  infarction  (P),  how  does  being  a  
smoker  (I)  compared  to  a  non-­‐smoker  (C)  influence  death  and  infarction  rates  (O)  during  the  
first  5  years  after  the  myocardial  infarction  (T)?  
 
Diagnosis:  In  middle-­‐aged  males  with  suspected  myocardial  infarction  (P),  are  serial  12-­‐lead  
ECGs  (I)  compared  to  one  initial  12-­‐lead  ECG  (C)  more  accurate  in  diagnosing  an  acute  
myocardial  infarction  (O)?  
 
Etiology:  Are  30-­‐  to  50-­‐year-­‐old  women  (P)  who  have  high  blood  pressure  (I)  compared  with  
those  without  high  blood  pressure  (C)  at  increased  risk  for  an  acute  myocardial  infarction  (O)  
during  the  first  year  after  hysterectomy  (T)?  
 
Meaning:  How  do  young  males  (P)  with  a  diagnosis  of  below  the  waist  paralysis  (I)  perceive  
their  interactions  with  their  romantic  significant  others  (O)  during  the  first  year  after  their  
diagnosis  (T)?  
Adapted from the PICOT Questions Template; Ellen Fineout-Overholt, 2006. This form may be used for educational & research purposes without permission.
Week 2 The Clinical Issue and Research Questions Developed Using PICOT
1 of 3
https://canvas.westcoastuniversity.edu/courses/18148/assignments/421101
Start Assignment
Due Sunday by 11:59pm
Points 150
Submitting a file upload
File Types doc, docx, and pdf
PICOT is an acronym used to help develop clinical research questions and guide you in your search for evidence. Finding the right answers
requires the right questions. The PICOT format will help you construct questions that will likely lead to effective searches, the best available
evidence of interventions, and the meaningfulness of patient experiences.
P = Patient population
I = Intervention or issue of interest
C = Comparison of interventions or comparison of interests
O = Outcome
T = Time frame (this element is not always included)*
For example, you may wish to research the effects of interrupted sleep on cognition of ICU patients 65 or older.
Using this PICOT model,
In __________(P), how does __________ (I) compared to _________ (C) influence _________ (O) over ________ (T)?
In ICU patients who are 65 or older, how does interrupted sleep (awakened one time or more in four hours) as compared to uninterrupted sleep
influence the patient’s cognitive ability over 5 days?
Questions of meaningfulness and effectiveness relate to how people experience an intervention or phenomenon.
What is the effectiveness of using a turn schedule (I) versus an audible public address reminder (C) on the incidence of pressure ulcers (O) in
elderly patients in LTAC who require turning (P)?
*Not all studies will have a time frame. This is optional to include as part of your PICOT.
Assignment Directions
Begin by selecting a topic in nursing that is of interest to you. Next, use PICOT to format a possible research question about that topic. Provide
1 possible PICOT research question. Find 1 quantitative or qualitative peer-reviewed research article related to your nursing topic that was
published within the last 5 years. Reminder: All peer-reviewed research articles have methods, discussion, and results sections. Upload the
article with your paper in PDF or Word format. This source can be used again in the Week 4 article assignment if it meets the criteria.
(https://canvas.westcoastuniversity.edu/courses/18148/files/6444531/download?download_frd=1) or pages
See PICOT Formatting Guide
249-257 in your book for additional help with formatting your PICOT.
Include the following:
Title page
Provide a brief description of the topic and background information (see page 37 of your textbook). You can use your text, your peer-reviewed
journal source, or the EBP care sheets in CINAHL or Nursing Reference Center Database.
Explain the significance of the topic to nursing practice (see chart on page 37 of your textbook). Background information can be found in
6/22/2022, 3:59 PM
Week 2 The Clinical Issue and Research Questions Developed Using PICOT
2 of 3
https://canvas.westcoastuniversity.edu/courses/18148/assignments/421101
journal articles in the introduction section. Results and conclusions will speak to significance of the topic. The EBP care sheets may have
sources for you to choose from.
Provide 1 clearly-stated PICOT question.
Include 1 peer-reviewed journal source related to your topic.
The chosen topic and PICOT will be used for your Week 9 poster assignment. It will also guide your article searches in Week 4 on which you
will complete appraisals in Week 6.
Your paper should:
Be 2–3 pages (not including the title page and reference page)
Use current APA format to style your paper and to cite your source.
There will be a 5 point deduction if peer-reviewed research journal article is not used and a 5 point deduction if the article is not included with
your submission.
Review the rubric for further information on how your assignment will be graded.
Week 2: Clinical Issue and Research Questions Developed Using PICOT Rubric
6/22/2022, 3:59 PM
Week 2 The Clinical Issue and Research Questions Developed Using PICOT
3 of 3
Criteria
Ratings
Topic
50 to >43.0 pts
Meets or Exceeds
Expectations
Topic/
Relevance to
Nursing
PICOT
Research
Questions
This criterion
is linked to a
Learning
Outcome
PICOT
Research
Questions
APA and
Mechanics
https://canvas.westcoastuniversity.edu/courses/18148/assignments/421101
Pts
43 to >35.0 pts
Mostly Meets Expectations
35 to >27.0 pts
Below Expectations
A description of the topic is
presented but may be ambiguous
or confusing. Some background
information is provided, but more is
needed for a full explanation. The
significance of the topic to nursing
practice is somewhat explained
and may not be supported with
examples.
A description of the topic is
presented but is ambiguous or
confusing. Some background
information is provided, but more
is needed for a full explanation.
The significance of the topic to
nursing practice is somewhat
explained but is not supported
with examples.
85 to >73.1 pts
Meets or Exceeds Expectations
73.1 to >59.5 pts
Mostly Meets Expectations
59.5 to >45.9 pts
Below Expectations
All research questions are
accurately framed as complete
PICOT questions. PICOT
questions provide a clear and
specific focus for research within
the topic. One peer-reviewed
journal source related to the topic
is included with assignment
submission.
Only some research questions are
framed as PICOT questions, or some
PICOT questions are incomplete.
PICOT questions provide a vague or
unclear focus for research that may
not be within the topic. One peerreviewed journal source is included
but not related to the topic.
Few questions are framed as
PICOT questions, or are
incomplete. PICOT questions
provide a vague or unclear focus
for research that is not within the
topic. One journal source is
included but it is not peerreviewed.
A clear and succinct
description of the topic is
presented. Background
information is relevant and
specific to the topic. The
significance of the topic to
nursing practice is explained
clearly and is supported with
examples.
15 to >12.9 pts
Meets or Exceeds
Expectations
Follows all the requirements
related to format, length,
source citations, and layout.
Written in a clear, concise,
formal, and organized
manner. Responses are
mostly error free.
Information from sources is
paraphrased appropriately
and accurately cited.
27 to >0 pts
Does Not Meet
Expectations
An unclear description of
the topic is presented or
is missing. No
background information is
provided. The
significance of the topic
to nursing practice is not
explained.
50 pts
45.9 to >0 pts
Does Not Meet
Expectations
Research questions
are missing or are not
framed as PICOT
questions. Peerreviewed journal
source is not included.
12.9 to >10.5 pts
Mostly Meets Expectations
10.5 to >8.1 pts
Below Expectations
8.1 to >0 pts
Does Not Meet Expectations
Follows length requirement and
most of the requirements related to
format, source citations, and layout.
Writing is generally clear and
organized but is not concise or
formal in language. Multiple errors
exist in spelling and grammar with
minor interference with readability or
comprehension. Most information
from sources is paraphrased and
cited correctly.
Follows few requirements
related to format, source
citations, and layout. Writing
may be unclear or informal in
language. Multiple errors exist
in spelling and grammar,
interfering with readability or
comprehension. Some
information from sources is
paraphrased and cited
correctly.
Follows few requirements
related to format, source
citations, and layout. Writing
may be unclear or informal in
language. Multiple errors exist
in spelling and grammar,
interfering with readability or
comprehension. Some
information from sources is
paraphrased and cited
correctly.
85 pts
15 pts
Total Points: 150
6/22/2022, 3:59 PM
EVIDENCEBASED CARE
SHEET
Medication Errors: Distraction and Interruptions
What We Know
› The National Coordinating Council for Medication Error Reporting and Prevention (NCC
MERP; a United States-based council consisting of 27 healthcare organizations, including
the American Hospital Association, the American Nurses Association, the Food and
Drug Administration, and The Joint Commission) defines a medication error as “any
preventable event that can cause or lead to inappropriate medication use or patient harm
while the medication is in the control of the health care professional, patient, or consumer.
Such events can be related to professional practice, health care products, procedures,
and systems, including prescribing, order communication, product labeling, packaging,
and nomenclature, compounding, dispensing, distribution, administration, education,
monitoring, and use”(7)
• Medication errors are common occurrences in the healthcare setting, causing injury to
over 1.5 million patients and accounting for 7,000 preventable deaths in the U.S. each
year.(5) Other potential consequences of medication errors are staff distress, increased
health care costs, increased length of hospital stay, and legal ramifications(1,2,8,10)
• Safe administration of medications is one of The Joint Commission’s Medication
ICD-9
995.20
ICD-10
T50.901A
Authors
Arsi L. Karakashian, RN, BSN
Armenian American Medical Society of
California
Tanja Schub, BS
Cinahl Information Systems, Glendale, CA
Reviewers
Sara Richards, MSN, RN
Cinahl Information Systems, Glendale, CA
Alysia Gilreath-Osoff, RN, MSN
Cinahl Information Systems, Glendale, CA
Nursing Executive Practice Council
Glendale Adventist Medical Center,
Glendale, CA
Editor
Diane Pravikoff, RN, PhD, FAAN
Cinahl Information Systems, Glendale, CA
Management standards(4)
› Medication errors can occur at any point during medication use—including prescribing,
transcribing, dispensing, administering, and monitoring—but a disproportionately large
number of errors occur during medication administration, one of the most frequent
activities performed by nurses(1,3,8)
• Medication administration, a risky procedure requiring mental focus, is one of the most
frequently interrupted nursing care activities; distractions (i.e., events that draw or direct
a healthcare provider’s attention somewhere else) and interruptions (i.e., events that stop
the healthcare provider’s current action) have been identified as important contributors
to medication errors. Rates of medication errors are higher in environments with higher
levels of distraction and interruption(2,3,8,10,14)
– Interruptions are common during the medication administration process(6,13)
– Researchers observed 43 nurses on 56 drug rounds and found that they experienced a
median of 5.5 interruptions and 9.6 distractions per hour(6)
– In a study in which 227 nurses were observed administering 4,781 medications,
investigators reported that nurses experienced 57 interruptions per 100
administrations; 87.9% of the interruptions were unrelated to the medication
administration task the nurse was performing(13)
–Other nurses and staff members are the most common sources of interruptions during
medication administration(12)
– Other sources of interruption include patients and patient family members, telephone
calls, and alarms (e.g., from ventilators, telemetry monitors)(2,3)
–Potential distractions in the hospital setting include personal conversations, background
noise, a hectic work day, and a crowded work space(2,3,9)
December 14, 2018
Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2021, Cinahl Information Systems. All rights
reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by
any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice
or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare
professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206
• Distractions and interruptions can lead to medication errors by creating mistakes in any of the six “rights” of medication
administration—the right patient, the right medication, the right dose, the right time, the right route, and the right
documentation(1)
–In a study conducted in five medical-surgical units at two acute care hospitals in the U.S., interruptions occurred during
39% of medication tasks. Nurses most commonly responded to interruptions by halting the medication task deal with
the reason for the interruption (51%) or multitasking (40%); they delayed attending to the interruption until after the
medication task was complete in just 13% of cases(11)
› Some interventions to reduce medication errors related to distraction and interruptions come from other high-risk fields, such
as the airline and nuclear power industries(1,2,3,10)
• The aviation industry’s “sterile cockpit rule” mandates that aircraft personnel avoid engaging in nonessential tasks and
communications during high-risk periods (e.g., takeoff and landing); when applied to a healthcare setting, the “sterile
cockpit rule” might dictate that conversations be focused on delivery of medication, that irrelevant phone calls or pages be
ignored, and that phones in or near the medication rooms be removed(1,2,3)
› Other interventions that aim to limit or eliminate distractions and interruptions to reduce rates of medication errors include
• designating “no interruption zones” around medication preparation areas(1,3)
–In a study in which this concept was implemented in an ICU environment, the rate of interruptions during medication
preparation decreased by 41% over a 3-week period(1)
• posting visible signage (e.g., Do Not Disturb signs) to promote a quiet environment and warn people that the nurse is not to
be interrupted during medication preparation and administration(2,3,8)
–Nurse administrators on a 35-bed pulmonary-medical unit in a large academic medical center began posting two
octagonal reds signs that read “Stop/Medication Administration in Progress/Please Do Not Disturb the Nurse” on each
medication cart. Two months after implementing this strategy, just 31% of nurses reported a reduction in interruptions,
citing failure of staff members to respect the signs as the most common problem(2)
• having nurses wear “non-interruption” attire to designate that they are engaged in medication preparation or administration
and should not be disturbed(1,3)
–In a pilot study in which nurses at Kaiser Hospital in California wore a yellow sash during medication preparation and
administration, the rate of staff interruptions decreased by 50%(3)
• allocating time in the nurses’ schedule specifically for medication-related duties(8)
–The Medication Pass Time Out program was designed to reduce medication errors at Stanford Hospital & Clinics by
designating 1 hour early in a nursing shift for uninterrupted preparation and administration of medications. This led to
an increase in the percent of medication doses administered without interruption from 81% to 99% and an increase in
medication doses administered without errors from 98% to 100%(8)
› Bundled interventions can reduce the rate of interruptions during medication administration, but might not be embraced by
nurses(10,13)
• When nurse administrators implemented a five-partintervention—including the use of sashes, signs, and a checklist
protocol, along with designation of a quiet zone marked off by floor tape and staff member education—at a 600-bed, acute
care hospital, the rate of nurse interruptions during medication administration fell by 84%(10)
• The implementation of a bundled intervention that included wearing a vest during medication preparation and
administration, using strategies to divert interruptions, educating patients and clinicians about the need to avoid interrupting
nurses unnecessarily, and posting reminders (e.g., posters) to avoid interrupting nurses during medication rounds resulted
in a statistically significant reduction of 15 interruptions per 100 medication administrations compared to the rate observed
on a control ward. However, nurses found use of the vests to be time consuming and uncomfortable; just 48% of surveyed
nurses reported that they were in favor of the bundle becoming hospital policy(13)
What We Can Do
› Learn about the contribution of distraction and interruptions in causing medication errors. Share this information with your
colleagues
› Focus on the six “rights” of medication administration, while making every effort to ignore potential disruptors, to reduce
your risk of making medication errors
› Collaborate with your colleagues, supervisor, and continuing education faculty to identify unit-specific and facility-wide
sources of distraction and interruptions that could lead to medication errors; develop and implement plans to minimize or
eliminate these potential disturbances based on your findings
Coding Matrix
References are rated using the following codes, listed in order of strength:
M Published meta-analysis
RV Published review of the literature
SR Published systematic or integrative literature review
RU Published research utilization report
X Practice exemplars, stories, opinions
RCT Published research (randomized controlled trial)
QI Published quality improvement report
GI General or background information/texts/reports
L Legislation
R Published research (not randomized controlled trial)
PP Policies, procedures, protocols
C Case histories, case studies
PGR Published government report
U Unpublished research, reviews, poster presentations or
other such materials
G Published guidelines
PFR Published funded report
CP Conference proceedings, abstracts, presentation
References
1. Anthony, K., Wiencek, C., Bauer, C., Daly, B., & Anthony, M. K. (2010). No interruptions please: Impact of a no interruption zone on medication safety in intensive care units.
Critical Care Nurse, 30(3), 21-29. doi:10.4037/ccn2010473 (R)
2. Federwisch, M., Ramos, H., & Adams, S. C. (2014). The sterile cockpit: An effective approach to reducing medication errors? American Journal of Nursing, 114(2), 47-55.
doi:10.1097/01.NAJ.0000443777.80999.5c (R)
3. Flanders, S., & Clark, A. P. (2010). Interruptions and medication errors: Part I. Clinical Nurse Specialist, 24(6), 281-285. doi:10.1097/NUR.0b013e3181faf78b (RV)
4. The Joint Commission. (2018). Comprehensive accreditation manual: CAMH for hospitals. Oakbrook Terrace, IL: The Joint Commission. (G)
5. Makary, M. A., & Daniel, M. (2016). Medical error—the third leading cause of death in the US. BMJ, 353, i2139. doi:10.1136/bmj.i2139 (GI)
6. McLeod, M., Barber, N., & Franklin, B. D. (2015). Facilitators and barriers to safe medication administration to hospital inpatients: A mixed methods study of nurses’ medication
administration processes and systems (the MAPS Study). PLoS ONE, 10(6), e0128958. doi:10.1371/journal.pone.0128958 (R)
7. National Coordinating Council for Medication Error Reporting and Prevention. (n.d.). About medication errors: What is a medication error? Retrieved December 10, 2018, from
http://www.nccmerp.org/about-medication-errors (GI)
8. Nguyen, E. E., Connolly, P. M., & Wong, V. (2010). Medication safety initiative in reducing medication errors. Journal of Nursing Care Quality, 25(3), 224-230. doi:10.1097/
NCQ.0b013e3181ce3ae4 (R)
9. Odberg, K. R., Hansen, B. S., Aase, K., & Wangensteen, S. (2018). Medication administration and interruptions in nursing homes: A qualitative observational study. Journal of
Clinical Nursing, 27(5-6), 1113-1124. doi:10.1111/jocn.14138 (R)
10. Pape, T. M. (2013). The effect of a five-part intervention to decrease omitted medications. Nursing Forum, 48(3), 211-222. doi:10.1111/nuf.12025 (R)
11. Reed, C. C., Minnick, A. F., & Dietrich, M. S. (2018). Nurses’ responses to interruptions during medication tasks: A time and motion study. International Journal of Nursing
Studies, 82, 113-120. doi:10.1016/j.ijnurstu.2018.03.017 (R)
12. Schoers, G. (2018). Characteristics of interruptions during medication administration: An integrative review of direct observational studies. Journal of Clinical Nursing,
27(19-20), 3462-3471. doi:10.1111/jocn.14587 (SR)
13. Westbrook, J. L., Li, L., Hooper, T. D., Raban, M. Z., Middleton, S., & Lehbom, E. C. (2017). Effectiveness of a ‘Do not interrupt’ bundled intervention to reduce interruptions
during medication administration: A cluster randomised controlled feasibility study. BMJ Quality & Safety, 26(9), 734-742. doi:10.1136/bmjqs-2016-006123 (RCT)
14. World Health Organization. (2016). Medication errors: Technical series on safer primary care. Retrieved December 10, 2018, from
http://apps.who.int/iris/bitstream/handle/10665/252274/9789241511643-eng.pdf;jsessionid=5C73348306645D986804B3D2C38DB32D?sequence=1 (G)

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