Shielding nurses from interruptions reduces med errors

MONTREAL – A new policy of not interrupting nurses when they’re at medication carts or doing their charting has led to a reduction in medication errors of 60 percent at the McGill University Health Centre. The multi-hospital organization has attempted to create a ‘wall of silence’ around nurses who are busy with these tasks.

“You need to picture a zone that’s a boundary and impenetrable,” says Patricia O’Connor (pictured), RN, MScN, Senior Advisor, Patient Engagement, MUHC. O’Connor is also Executive Lead of MUHC’s Transforming Care at the Bedside Program.

O’Connor recently reported on the success of this effort at the International Conference on Patient and Family-Centered Care, in Vancouver. She said audits and interviews with nurses showed that distractions were a key cause of such errors during the dispensing or charting process. The nurses were continually being interrupted, mainly by colleagues.

“So we had to figure out a way to control those interruptions while nurses are getting the medications out of the cart and taking them to the bedside,” O’Connor told the Vancouver Sun. “They have now created an invisible boundary around the med carts. If a nurse is standing there, everyone knows that they can’t come up and talk. It’s a safety zone, an impenetrable boundary while nurses are concentrating on the job at hand.”

She said it’s only one change made as part of a quality improvement mission which doesn’t cost anything, just creative thinking, initiative and follow-through.

MUHC has enhanced safety, quality and the work environment across several areas:

• In psychiatry, the admitting process for acutely ill patients fell from 4.3 hours to one hour – a 75% reduction. Before, each discipline (e.g. doctor, nurse, social worker) conducted their own history. Now, they team up for 45 minutes of joint interviews and 15 minutes for a plan of care, done together with the patient. As O’Connor says, “There’s better efficiency and effectiveness, as everyone has the same information at once.”
• To increase time at the bedside, nurses relocated commonly used equipment and supplies to cut down on “hunting and gathering” down hallways. For one piece of equipment alone, the average time to retrieve it has dropped from almost four minutes to 26 seconds.
• In another case, whiteboards were placed at the foot of beds, so patients and their families can easily see the names of the members of the care team and the plan of care for the day, and write down questions.
• Overall, there’s been an 8% increase in RN time spent in direct and value-added care, and a 50% decrease in waste activities, said O’Connor. There’s also been a 20% increase in the responsiveness of care providers, and an 18% improvement in communication with nurses (as defined by the HCAHPS patient survey tool).

Staff ratings of the initiative are consistently positive e.g. improved work satisfaction, team effectiveness and capacity to lead quality improvement.

“Staff and patient representatives learned about rapid cycle improvement processes and change management skills, allowing them to test innovations and get better results. These improvement methods have been derived from the Toyota production system, and other “best practice” business principles,” said O’Connor.

Since 2010, the project has targeted 45% of clinical areas across six hospitals, and involved over 1,500 nurses and other healthcare providers. In December 2013, Accreditation Canada recognized both the overall initiative, and the specific inter-professional admission process in mental health as Leading Practices.

Initial funding for this project was from the Canadian Foundation for Healthcare Improvement (CFHI) and the Max Bell Foundation, the Newton Foundation, Montreal General Hospital Foundation and the Roasters Foundations, with subsequent support from the Quebec Ministry of Health.