Break the cycle of rushing and multitasking.
- Patients experience an average of one medication error per day.
- Many medication errors are related to human factors, including rushing, multitasking, and running on autopilot.
- Mindfulness strategies can help nurses slow down and focus on the specific tasks associated with medication administration.
The same mindfulness we practice for our health and self-care can be translated into a safety strategy. (See Mindfulness defined.) Brief mindfulness interventions, which can help you manage your reactions to stressful situations, are associated with reduced anxiety and errors, and improved team relationships, employee engagement, and quality and safety. This article describes a mindfulness strategy implemented to reduce errors in medication preparation and administration.
During a typical hospital shift, nurses spend a great deal of time managing medications—checking lab values; reviewing orders with providers; locating, preparing, and double-checking medications; providing patient and family education; assessing patients; administering medications via multiple routes; and documenting and monitoring effects. Medication management complexity can increase with patient acuity, an individual nurse’s patient assignments, and medication number and risk level (for example, I.V. opioids, insulin, heparin, and chemotherapy are high-risk medications).
Given this complexity, patients experiencing an average of one medication error per day, as reported by Aspden and colleagues and the Institute of Medicine, isn’t surprising. Many of these errors go unrecognized, even by the nurse, and most don’t result in harm. Common human factors that can result in administration errors include rushing, multitasking, and functioning on autopilot. Nurses interviewed in a medication safety pilot study conducted by Durham and colleagues said they usually were rushing when a near miss or actual error occurred. (See Medication errors and the human factor.)
Role of mindfulness in medication safety
We need to shift from valuing perceived efficiency over safety. For example, in some healthcare settings, “no interruption zones” are created near medication preparation areas, and nurses are empowered to not respond to interruptions from others when they’re focused on medication preparation. Although safety systems are important to help prevent errors, unexpected events can occur that even the most stringent systems, policies, and procedures can’t catch.
Mindfulness strategies can prepare nurses for unexpected events and help them achieve reliable outcomes. They’ll expect error and be vigilant for it, hoping to learn and improve, and they’ll report near misses so they can be analyzed for future prevention. Consider Captain Chesley “Sully” Sullenberger III. He followed protocols but also used cognitive awareness as part of his decision-making when he landed his plane in the Hudson River after both engines were disabled by a bird strike; all 155 people aboard survived.
Mindfulness practices help us switch from operating on autopilot to being aware and taking a thoughtful approach to clinical decision-making and error interception. This state of awareness, coupled with safeguards such as barcode medication administration and independent double checks for the highest risk medications, can reduce preventable error.
To help promote mindfulness as a standard practice, preceptors and nurse leaders can model the strategies for students and demonstrate that they’re a valued behavior.
Teaching nurses a brief mindfulness strategy
As part of Durham’s pilot study, 99 acute and critical care nurses were taught a brief strategy to help them focus on one breath as part of medication safety. The strategy was taught in 30-minute small-group sessions via a meditation exercise. Using elements from Kabat-Zinn’s mindfulness-based stress-reduction program, participants were trained to perform an awareness scan of their body from head to feet and then focus on the sensation of the breath. With that training as the foundation, nurses were instructed to focus on one breath just before preparing medication and again before administering it to help them be fully present for the tasks. Some scholars describe being fully present as “watchfulness” or “a lucid awareness of each experience that presents itself.” The goal of this cognitive state of sustained attention is to help improve nurses’ awareness and behaviors to improve patient safety outcomes. (See Mindfulness checklist.)
When the nurses were first approached about the pilot mindfulness strategy, some were concerned that it would add more work. However, the strategy involves focusing on only one breath, and nurses were reminded that breathing is something they’re already doing.
Break the cycle
Mindfulness practices can help increase nurses’ awareness and cognition and help break the cycle of rushing, multitasking, and running on autopilot. If we approach medication errors as a common reality, mindfulness may help us detect and prevent them, improve the system, and remain vigilant for the unexpected.
Marianne L. Durham is a clinical assistant professor in the Department of Health Systems Science at the University of Illinois at Chicago (UIC) College of Nursing and a faculty advisor at UIC Institute for Healthcare Improvement Open School Chapter in Chicago.
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