Background. The use of a ‘do not interrupt’ vest during medication administration rounds is recommended but there have been no controlled randomized studies to evaluate its impact on reducing administration errors. We aimed to evaluate the impact of wearing such a vest on reducing such errors. The secondary objectives were to evaluate the types and potential clinical impact of errors, the association between errors and several risk factors (such as interruptions), and nurses’ experiences. Methods. This was a multicenter, cluster, controlled, randomized study (March-July 2017) in 29 adult units (4 hospitals). Data were collected by direct observation by trained observers. All nurses from selected units were informed. A do not "interrupt" vest was implemented in all units of the experimental group. A poster was placed at the entrance of these units to inform patients and relatives. The main outcome was the administration error rate (number of Opportunities for Error [OE], calculated as one or more errors divided by the Total Opportunities for Error [TOE] and multiplied by 100). Results. We enrolled 178 nurses and 1346 patients during 383 medication rounds in 14 units in the experimental group and 15 units in the control group. During the intervention period, the administration error rates were 7.09% (188 OE with at least one error/2653 TOE) for the experimental group and 6.23% (210 OE with at least one error/3373 TOE) for the control group (p=0.192). Identified risk factors (patient age, nurses’ experience, nurses’ workload, unit exposition, and interruption) were not associated with the error rate. The main error type observed for both groups was wrong dosage-form. Most errors had no clinical impact for the patient and the interruption rates were 15.04% for the experimental group and 20.75% for the control group. Conclusions. The intervention vest had no impact on medication administration error or interruption rates. Further studies need to be performed taking into consideration the limitations of our study and other risk factors associated with other interventions, such as nurse’s training and/or a barcode system.
Commentaire du Dr Marius Laurent (PAQS)
- L’effet du port d’une surveste « ne pas déranger » pendant des phases cruciales de distribution de médicament est testé dans quatre hôpitaux français (services adultes et pédiatriques). Les services concernés sont choisis au hasard parmi tous les services soumis à une première phase dite « témoin », ou une formation générale leur est proposée. La seconde phase consiste en l’observation directe de la distribution dans les deux groupes, celui portant une surveste et celui n’en portant pas. Le résultat peut paraître décevant : il n’y a pas moins d’erreurs d’administration même s’il y a une diminution (non significative) des interruptions observées dans le groupe portant la veste. L’absence d’effet observé est peut-être due au fait que les auteurs ont évité de sélectionner des services ou des séquences de soins à risque (préparation de dilutions dans un service de pédiatrie, par exemple). La description très détaillée de l’étude passe toutefois sous silence le contenu et la durée des « sensibilisations », que je devine bien courte, de même que celle des phases d’observation. L’obstacle principal à cette technique est d’obtenir une observance de la directive de ne pas interrompre le porteur, et d’avoir le personnel nécessaire pour que cette directive ait un sens.
Berdot S, Vilfaillot A, Bezie Y, et al. Effectiveness of a ‘do not interrupt’ vest intervention to reduce medication errors during medication administration: a multicenter cluster randomized controlled trial. BMC Nurs 2021;20(1):153. Doi : 10.1186/s12912-021-00671-7.