Martin Beckworth wrote an article in The Telegraph, published 29th August 2011, titled “Nurses wear ‘do not disturb’ signs during drug rounds“. Here is my reaction to some of the thoughts presented in this article…
I sometimes feel as if medical staff just can’t win. If a nurse makes an error on a ward round the consequences could be disastrous to the patient, and I’m sure the confounding factor of interruptions would be overlooked as ‘part of the job’, and the nurse in question would be condemned as incompetent. However, here is an example of the profession taking onboard one of the factors that could increase the opportunity for medication error and trying to mitigate against it; by providing a visual cue to those around them that the nurse in question should not be distracted as they are completing a set of tasks that require concentration. Yet they are still criticised.
I totally disagree with Joyce Robins, from the campaign group Patient Concern, who is quoted in the article as saying “If you’re a nurse and you can’t do more than one thing at a time, you’re a pretty hopeless nurse”. I think that if you’re a nurse who understands that certain tasks are risky and need full attention then you are a pretty good nurse. I know I would rather have a nurse who is aware of the opportunity for error caring for me, as opposed to a nurse who is juggling too many balls when carrying out such a potentially high risk task as preparing my medication. Think how many factors there are in getting it right: understanding the medication requirements for the patient, preparing the right drug, strength, dose, administering it to the right patient, and making correct record of it. Then do it again for all other patients. It’s no wonder that mistakes are made if at the same time the person doing all this could be interrupted mid-procedure with a completely unrelated, non-urgent query. Appreciating the fallibility of humans is essential in providing safe care. We all make mistakes, and relying on training and human vigilance is simply not good enough when system changes can be made to mitigate and even prevent an error from occurring in the first place.
I don’t think the tabard system is the only solution, and it will not prevent all medication errors, let alone all interruptions. Indeed the article references a study by the Aberdeen Royal Infirmary that states 95% of rounds were still interrupted, but that the average number of interruptions fell from 6 to 5. However, it doesn’t detail whether the tabard was instrumental in changing the type of interruption (e.g. more relevant to the task), or the time of the interruptions (e.g. between patients).
However, the thought that this is an insult to patients is sad, as if this approach was devised to make patients feel uncared for. The tabard approach is not intended to be an opportunity to detach staff from patients, it’s intended to be a safeguard to protect patients from harm. I’m not claiming that lack of patient contact isn’t an issue, one that is probably compounded by low staffing levels, and lack of resources, all of which potentially compromise patient care and patient safety. However, an approach to try to minimise error at the drug round should not be the focus of an attack on lack of patient contact.
It wouldn’t be presumptuous to think that whilst the health service is feeling some financial restraint that nursing staff are potentially under more pressure, and are therefore more likely to make mistakes? This focus on patient safety should be applauded, not condemned.