The authors conducted a quasi-experimental study to study the impact of a No Interruption Zone (NIZ)
In an ICU environment, where patient care is complex and uncertain, distractions and interruptions during medication preparation can affect medication safety. The main objective of this study was to evaluate the effect of a ‘No Interruption Zone’ (NIZ) on the number of interruptions that occurred during the medication administration phase in a medical ICU and a surgical ICU setting.
The study used a pre-post quasi-experimental pilot design. The data collection was direct undisguised observation, conducted by a fellow ICU nurse, to look at the effect of NIZ on the number of interruptions at the centralized and decentralized medication areas in the two ICUs. The observations were carried out during the peak medication administration phase (8 a.m. – 10 a.m.; 4 p.m. -6 p.mm) and were carried out for two-hour intervals. The entire study period was four weeks, pre-post NIZ implementation.
After the baseline data collection (phase 1) a red duct tape was placed around each of the centralized and decentralized medication preparation areas (NIZ) (phase 2). During the 4th week (phase 3) the data collection-using observation method was resumed to measure and compare the incidences of interruptions pre- and post- the NIZ implementation.
The authors observed a total of 218 occurrences (31.8%) of interruptions pre-NIZ implementation phase and 179 interruptions (18.8%) post-NIZ implementation -- for a statistically significant decrease of 40.9%. A full 100% of all the post-NIZ interruptions were initiated by external factors. The NIZ is a way to implement the policies associated with the sterile cockpit into the healthcare setting. After the three-week observation period, a significant decrease (40.9%) in interruptions had occurred. Though preliminary, these results suggest a beneficial effect of an NIZ on reducing the incidence of interruptions during critical tasks of medication preparation.
The authors list the following limitations: 1) The study was conducted in two ICU settings; hence, the findings might not be generalizable to other settings; 2) Sampling inadequacies, as the data collection was carried out only for a limited time period both pre-post NIZ implementation; 3) Affect of the observer on the observed; 4) Observer bias; the observer had knowledge of only what she observed and not about the psychological distractions of the observed staff that might effect the accuracy of the study findings.