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Passing Meds

Kaiser nurses in Oregon don yellow sashes to reduce interruptions

Monday September 8, 2008
<b>Joan Gilroy, RN, wears a yellow sash as she prepares to pass medications. </b>
Joan Gilroy, RN, wears a yellow sash as she prepares to pass medications.
(Photo courtesy of Kaiser Permanente)
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Joan Gilroy, RN, a staff nurse on the med/surg unit at Kaiser Sunnyside Medical Center in Clackamas, Ore., has seen a lot of trends come and go during her five decades in nursing. And when it comes to decreasing distractions while distributing medications in an effort to minimize errors, wearing a yellow sash is an idea whose time has come, she says.

Gilroy is part of an implementation team at the facility that is educating staff about the use of the yellow sashes as "non-interruption" wear, an important part of Kaiser's standardized medication administration protocol dubbed KP MedRite, which Sunnyside is rolling out on four units this year. Nurses don the brightly colored garments emblazoned with "Caution: Medication Administration in Progress" to signal to others that they are dispensing medication and should not be distracted.

"In the old days, the nurse had her medicine tray. People saw that formidable tray, and they didn't interrupt her," she says. But methods for distributing medication have become more streamlined over the years — and much less obvious to observers — while multitasking has become almost a necessity in today's fast-paced world.

"But we need to realize that there are some times that we need to just slow down and do one thing at a time. [Distributing medication] deserves our full focus," she says.

The Right Idea at the Right Time

The idea evolved from a quality forum at Kaiser South San Francisco, where front-line nurses, risk management, and patient safety staff, as well as quality improvement personnel, brainstormed on how to improve the medication administration process.

The staff felt they could reduce their already low rate of errors by somehow minimizing interruptions. "We think our error rate is really very good — it's less than one-half of one percent — but we felt that any one medication error is one too many," says Becky Richards, RN, BSN, MA, adult clinical services director at Kaiser South San Francisco.

The staff administers about 22,000 doses of medication each month.

In researching the project, Richards came across the work of Tess Pape, PhD, RN, CNOR, who had pioneered the idea of having nurses wear a vest or sash as non-interruption wear a few years earlier. Pape has written extensively on the topic, including an article titled "Applying Airline Safety Practices to Medication Administration" in the April 2003 edition of MEDSURG Nursing: The Journal of Adult Health.

Richards also found out that staff at Kaiser's Sidney R. Garfield Health Care Innovation Center were in the midst of developing a process to decrease distraction during medication administration as well and collaborated with them on honing the overall protocol, the KP MedRite process.

KP MedRite requires a nurse to don the sash, check the medication administration record using the five "rights" (the right medication at the right time for the right patient at the right dose by the right route), wash their hands, get the proper medication, turn down the TV or radio in the patient's room, turn up the lights, double-check the patient's identity, discuss the medications with the patient, administer the medication, document the delivery, and wash their hands again before taking off the sash.

Results Overcome Resistance

When first implemented, the flashy attire caused distractions rather than averted them, as curious staff and patients repeatedly interrupted nurses to ask why they were wearing the unusual apparel.

And the nurses were not thrilled about wearing the orange construction vests used originally.

"We were going to abandon the pilot, but what we found at the end of 2006 was for that five- to six-month period of time on those two units, we had a 47% decrease in medication errors just from implementing the pilot on those two units," Richards says.

So they modified the attire, improved communication throughout the hospital to inform everyone not to interrupt nurses wearing the yellow sashes or vests, and implemented the system throughout the hospital in April 2007. One other unit declined to participate, citing their minimal error stats. After 30 days, errors had decreased in every unit, averaging a 20% reduction, convincing the reluctant unit (which had no reduction that month) to adopt the protocol and non-interruption wear.

South San Francisco's results with the KP MedRite and non-interruption wear have been replicated at other Kaiser facilities as well. Kaiser reports an overall 50% reduction in the number of staff interruptions, a 50% increase in the standardization of medication administration, a 15% improvement in the time required to pass medications, and an 18% increase in on-time medication delivery. Kaiser is currently gathering data on error-reduction as well. The Joint Commission is considering the KP MedRite procedure as a best practice for hospitals across the country.

Patients have been positive about the change and have been pleased to have the nurse administer and discuss their medications without interruption. Other disciplines now respect the non-interruption wear, leaving nurses distraction-free while passing medications. Some, such as physicians and pharmacists, Richards says, are even looking into establishing some non-interruption protocols themselves.

Gilroy is looking forward to implementing the program at Sunnyside. With the impressive effect the "non-interruption" wear has had on reducing medication administration errors and the time dispensing meds, yellow sashes and vests just may become as common accouterments to modern nurses' attire as caps were when she started her nursing career.





Anne Federwisch is a freelance writer. To comment, e-mail editorNW@nurseweek.com.