Drug Round Interruptions, Prince Philip Hospital

Sister Amber Bolt, Manager Ward 1, Sharon Jones QIST Practitioner & Eleanor Pearce QIST Facilitator

Background, Aims and Objectives

Ward 1 nurses were frequently being disturbed during medication rounds resulting in an increased risk of errors and patient harm. Our Improvement Project ran from 11/01/22 until 09/06/22. Our AIM was to reduce the amount of interruptions and errors. A data collection tool was designed to analyse the main causes and themes, 12 PDSA cycles were carried out and a wider culture change was embedded to help people refrain from making unimportant interruptions, give the nursing staff the confidence to say “no” when being interrupted unnecessarily and identify other members of staff who can be interrupted.

PDSA 2/ 10/02/22

Doctors to change the time of their morning ward round so as to not clash with the medication round. At the request of the ward manager doctors have changed their morning ward rounds to 9.30am from 10/02/22

Outcome Measures

Process Measures

Balance Measures

PDSA 3/ 14/02/22

Creation of posters and door handle signs agreed and developed

Delivered to the ward on week commencing 14/02/2022.

Avoid harm to patients by working together on the ward

Identify interruptions during medication rounds

Staff feedback regarding interruption reasons

PDSA 5/ 28/02/22

HCSW to begin observing medication rounds with new audit form.

The view ultimately is to give them a role as Safety Links.

PDSA 12/ 20/05/22

Ward manager meeting with staff to discuss the implementation of reminding staff members and patients that they are on a drug round when disturbed with the assurance that they will speak to them on completion. Also, ward manager to support staff in embedding new culture.

Reflection

The fact that it is the registered nurses responsibility to focus on medication rounds doesn’t mean that other members of staff don’t need to play their part. We learned that it is important for everybody to understand that medication rounds are protected time. This made the nurses feel less stressed and created a better team atmosphere.

We are embedding the cultural changes throughout the Health Board. by spreading and scaling this project across all wards in Prince Philip Hospital. We are also providing training to Newly qualified nurses, Junior Doctors and recently we have been recognised by Swansea University who now use our learning and presentation in their Business School & Nursing school as part of their Medication Safety lectures

Its ok to say “no” to drug round interruptions