Interventions to reduce interruptions to medication administration in a Paediatric Intensive Care Unit
: a qualitative study

  • Rachel Bower

    Student thesis: Doctoral ThesisDoctor of Philosophy

    Abstract

    Background: Globally safe prescribing and medication practices are vital as they are one of the most widely used interventions in healthcare (Elliott et al., 2021) and are associated with an increased risk of errors (Cousins et al., 2007). Interruptions are cited as a leading cause of medication error, with numerous interventions being implemented that aim to reduce their frequency, although evidence of their effectiveness is limited (Raban and Westbrook, 2014). Increased medication error rates in Paediatric Intensive Care Units (PICU) were highlighted by Alghamdi et al. (2019) due to the unpredictable physiology, complex routines and frequent use of high-risk medications. However, there are limited studies that have assessed the effectiveness of these interventions within PICU and have failed to understand their impact on the wider multidisciplinary team (MDT) and parents/carers.
    Aim: The aim of this study was to understand how, when and in which context interventions to reduce interruptions to medication administration in the PICU were effective.
    Methods: The design of this qualitative study included four stages: [i] a Realist Review of current literature (n=25); [ii] Survey of Practice (n=11) and MDT interviews (n=14); [iii] interviews with parents/carers (n=19); and [iv] a synthesis of findings. The realist review identified and explored the contexts and mechanisms that were associated with the effectiveness of interventions to reduce interruptions to the medication administration process. The data from Stage 2 and 3 was initially analysed using a thematic approach. Following this, a Realist lens was applied to identify the specific contexts and mechanisms in PICU that affect the effectiveness of interventions to reduce interruptions to medication administration. Finally, the synthesis critically explored the data to understand the relationships and influences between the three datasets. Concluding the synthesis was the formation of context, mechanism and outcome configuration (CMOC) illuminating the interactions within the overall picture.
    Findings: The Realist Review findings identified contexts, including leadership and culture, education and engagement, and the need to understand interruptions, that triggering mechanisms that included needing to isolate the task, empowerment and trust within the team. Whilst the MDT findings revealed key contexts such as the patient and PICU environment, these were noted to trigger mechanisms that stimulated feelings, as well as the balance between focus and risk . Whereas the parent/carer findings explored contexts concerning parental knowledge and experience which stimulated mechanisms such as feeling safe and protecting their child. The overall synthesis of these findings identified the importance that interventions to reduce interruptions to medication administration comprehend the impact of maintaining patient safety in PICU, understand the medication workload, the challenge of isolating the administration process and the requirement to deliver a consistent process.
    Conclusion:This thesis has illuminated the complex, interrelated, and key contexts and mechanisms that affect the effectiveness of interventions to reduce interruptions to medication administration in PICU. Furthermore, novel findings concerning the conflict and challenges that may be generated when these interventions are implemented have been identified. Collectively this study/thesis makes a novel and contemporary contribution to understanding of this phenomena which can inform future development of effective interventions to reduce interruptions to medication administration in PICU.
    Date of AwardMay 2022
    Original languageEnglish
    Awarding Institution
    • Coventry University
    SupervisorJane Coad (Supervisor), Joseph Manning (Supervisor) & Theresa Pengelly (Supervisor)

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