The daunting daily task, performed by hundreds of correctional nurses every day, is complicated by distracting noise and frequent interruption. Today we are going to discuss on interruptions an correctional nursing.

A nurse stands at a small window in a small room with shelves around the interior. Lined up at the window, much like a bank teller’s queue, are inmates waiting for their morning pills. An MAR (Medication Administration Record) is in front of the nurse on her side of the window, with pages organized in alphabetical order by patient last name. The nurse must positively identify the patient by photo ID card, organize the medication to be delivered for this patient on this date and time, and collect the pills from various single dose bubble-packs into a paper soufflé cup. She hands the medication to the patient with a paper cup of water. Fortunately for this correctional nurse, the custody officer in charge of the pill line does the oral cavity check to be sure the patient does not ‘cheek’ the medication for sale on the prison black-market. All this happens in less than a minute. This nurse must administer medication to almost 200 inmates in the course of 2 hours.

This medication room in a county jail also doubles as a nurse’s station. The medication nurse is working where other nurses are sharing report and physicians are stopping by to change orders and ask about patient status.

On Interruptions and Correctional Nursing

A recent study published in the Archives of Internal Medicine tracked the toll of interruptions on medication errors by viewing nurses administering medications in 2 hospital settings. Each interruption was associated with a 12.7% increase in clinical error. When three interruptions occurred in the administration of a single medication there was a 38.9% rate of error. Nursing experience played no part in the error rate. It was consistent for new nurses and those with years of experience. This is astounding objective data to support efforts to reduce interruptions in the medication administration process.

Here are some ideas for reducing interruptions in medication administration that might be applicable in the correctional setting:

• Establish Quiet Times when medications are being administered in a public area. Ask staff members to commit to evacuate the area while pill line is in effect.
• Place posters indicating Quiet Time is in session as a visual alert. (No, you can’t keep them up all the time!).
• Have the medication nurse where an item of clothing, such as a brightly colored vest or apron, when administering medications. No staff member can approach a nurse when wearing this vest.
• Educate all staff members to the patient safety basis of uninterrupted medication delivery.
• Educate custody staff and patients of the need to decrease nurse interruptions during medication administration processes.

What do you think? Can we reduce interruptions in medication administration in corrections?

 

Photo Credit: © Dana Heinemann – Fotolia.com

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