Observation On Interruption Of ICU Nursing Medication Process And Formulation On Intervention Indicators

Objective:To observe the occurrence frequency,source,type and outcome of interruption events in ICU nurses' medication process.Through evidence-based and Delphi expert consultation method,compile the intervention items for interruption of ICU nurses' medication process to explore effective management methods for interruption of ICU nurses' medication process,and lay a foundation for nursing interruptions.Methods:Through consulting experts in discipline fields formed a perfect research plan and establish a research group.The final research was divided into two parts: observation part and intervention framework construction part.(1)The observation part used the "ICU medication interruption event observation table" to observe the nursing interruptions that occurred during the medication process of ICU nurses in two tertiary hospitals in Shanxi province.Mainly observed the treatment of doctor's orders,drug preparation and drug delivery execution.Finally,we calculated the results of the observation.(2)The intervention framework construction part initially constructed an item pool of interruption intervention indicators for ICU nurses' medication process through literature retrieval and expert interviews,and then conducted two rounds of Delphi expert consultation according to the initially constructed item pool to complete the addition,deletion and revision of indicators.After the second round,the average method was used to calculate the weight of indicators to form the final intervention framework for interruption events of ICU nurses' medication process.The preliminary intervention scale was used to investigate the head nurses in ICU of general hospital to test the reliability and validity of the scale.Results:1.Observation section(1)This part we were totally observed 34 ICU nurses for 648 hours,and observed3,433 interruption events of medication nursing process,with a frequency of 5.30 times/h.The highest proportion sources of interruption events in ICU nursing medication process were doctors(22.8%),nursing colleagues(21.9%)and patients(20.1%).Intrusive type(47.5%)was the most common type in ICU.The largest number of ICU nurses would start the second task immediately after receiving the interrupted task(42.0%);The outcome of interruption of nursing medication in ICU was mostly negative(87.5%).(2)No medication errors were observed in this research.2.Construction of intervention framework(1)Finally we included 16 experts.The expert authority coefficient of two rounds were 0.71 and 0.73 respectively,and degrees of expert authority were acceptable.Kendall's W test results showed that the first,second and third indexes of the second round were0.431,0.355 and 0.478,which were acceptable for expert consistency.The recoveries of the two rounds of questionnaires were 93.8% and 100% respectively,and questionnaires were effective.8 experts and 2 experts put forward constructive suggestions such as revising the language and deleting the contents.Finally,we determined 6 first-class indexes,17 second-class indexes and 49 third-class indexes.After the second round of Delphi,we finally reached the average number of item scores as the weight of each index,and used multiplication to calculate the combined weight of the second and third-class indexes.(2)We conducted a preliminary survey of 127 nursing heads in the ICU of 21 regional general hospitals nationwide using the initially developed intervention scale.The correlation coefficient method was used to filter the entries.One entry with low score was deleted,leaving 48 entries.The test reliability and validity were good.Conclusion:1.The interruption rate of nursing medication in ICU was relatively high,especially the treatment of doctor's advice and the implementation of medication;Physicians,nursing colleagues and patient factors were the main sources of interruption in the nursing process in ICU.Most nurses start their second job immediately after they are interrupted.We should give targeted prevention.Most of the interruption of ICU nursing medication process in ICU could cause negative outcomes,so it is very important to improve the safety of ICU medication to control its unnecessary occurrence2.Through the preliminary experiment the intervention items for the interruption of medication process for ICU nurses were established,including 6 first-level items,17second-level items and 48 third-level items.Through the reliability analysis,it was concluded that the scale had good reliability and validity.The results showed that we need form a complete guide to take institutionalize interventions,safety culture,work collaboration,capacity building,risk management and personnel management,to reduce the incidence of ICU nursing medication process interruption and the error rate.