Red Zone Medication Safety Initiative, by Jennifer Engel, Beverly M. Small, and Ruth
Brediger.
[ALARM SOUNDING] [CELL PHONE RINGING, MOM ANSWERS AND STARTS
CONVERSATION] [ANOTHER NURSE WALKS IN AND INTERRUPTS BEDSIDE
NURSE ASKING FOR UPDATE ON THE PATIENT] Jen, can you give me an update on your patient
for report tonight?
She's doing well.
We're just ... her.
And really nothing major going on today.
[BABY CRYING] How are the parents doing?
The parents are great.
[PAGER PHONE RINGS] 8 South.
This is Jen.
Oh, she's doing OK.
She just got an echo this morning.
Yeah, overall she's doing pretty well.
She's very stable.
No, I don't think she's quite ready to get ... yet.
OK.
I will.
I'll call you as soon as I hear from them.
[TELEVISION NOISE] [AN ARRAY OF DISTRACTING NOISES]
Medication errors are a preventable cause of morbidity, mortality, and escalating health
care costs and therefore are a continued concern across the spectrum of health care.
A major contributing factor to medication errors is distraction at the bedside.
Distractions come from the abundance of technology at the bedside, as well as frequent interruptions
during medication administration and verification.
In 2008, the Cardiac ICU at Boston Children's Hospital developed a nurse-led interprofessional
group to create and implement a program-wide quality improvement process for medication
safety.
To better understand the relationship between distraction and medication administration
safety, we organized a nurse-led interprofessional committee to identify factors that led to
medication errors, created strategies to reduce these errors, and implemented a distraction-free
practice in the Cardiac ICU.
The committee included nursing leadership, pharmacy personnel, and physicians.
We identified four overriding principles with the goal of creating a distraction-free practice
and decreasing medication errors.
The four safety principles aimed to empower the health care team involved in ordering,
dispensing, and administering medications; ensure the cognitive workspace is free of
distractions and interruptions; create a work environment characterized by teamwork and
effective communication; educate families about the importance of a distraction-free
medication process.
The Red Zone Committee developed several tools and strategies to support our distraction-free
practice.
We developed a logo indicating distraction-free areas.
We created Red Zone badges that included the distraction-free symbol and a common language
script for nurses to use with patients and families.
We placed signs and floor decals with the Red Zone symbol in front of the medication
Pyxis stations and medication rooms.
We provided education for all staff to minimize interruptions and distractions to health care
providers during medication, administration, and ordering.
And posters were placed in each patient room, waiting area, and in welcome packets to inform
patients and families and ask for their support.
Here are some scenarios showing examples of our Red Zone tools and use in our daily practice.
Example Scenario 1: Good morning, family and staff.
To provide a safe environment during nursing report, we're asking for a distraction-free
time from now until 7:30.
Thank you.
Baby boy Smith is a three-month-old, three-kilo patient who came in on Monday for an ASD repair
with Dr. Amani.
He did very well post-operatively--
Hey, Jen.
I just need to get ready for rounds.
Can you tell me how baby boy Smith's night was?
We're actually in the middle of Red Zone for nursing report.
Do you mind coming back in just a few minutes?
What's Red Zone?
The Red Zone allows for distraction-free time for us to exchange important patient information
so we don't forget anything if we're interrupted.
Oh, OK.
Sorry for interrupting.
I'll come back when you're done.
Thank you so much.
So as I was saying, he did very well on Monday and is now ready for the floor.
Example Scenario 2: Good morning.
Good morning.
My name's Jen.
I'm going to be taking care of Jacksyn today.
How are you guys?
We're good.
Good.
I'm just going to take a few minutes to double check some of her medications, so I'll be
in the Red Zone in distraction-free time.
But I'll let you know as soon as I'm done to answer any questions.
OK?
Alright, great.
Jen, did she get her Diuril last night?
Oh, you know, I'm just still in the middle of checking some of her medications in distraction-free
time.
I'm happy to answer that question as soon as I'm done, though, OK?
Thank you.
Thanks.
Jen, did she pee enough last night?
Oh, you know what?
I just don't want to make any mistakes with checking her medication.
So just for Jacksyn's safety, I need to focus in distraction-free time for just a few minutes.
Absolutely.
Sorry.
Thank you so much for understanding.
Great.
Looks like all of her drips look good.
I'm also out of distraction-free time, so I can answer any of your questions.
What were you asking about?
Did she get her Diuril dose last night?
She did.
She got her Diuril by 8 o'clock, and she had a really good response from it.
And how much did she pee?
She was negative about 140 overall, so that's great.
We're really happy with how much she's making urine.
Thank you very much.
Sure.
She's doing really well overall.
We're really pleased with how Jacksyn is recovering.
Thank you.
Alright.
Example Scenario 3: Hi, Jen.
How are you?
I'm totally dying to see you, because I wanted to show you pictures from the weekend.
They came out awesome.
Oh, I would love to see them, Vicky.
I'm just in the middle of the Red Zone right now, getting out some meds.
Can I catch you at break?
Yeah, sounds good.
Thanks.
Thank you so much.
The Red Zone Medication Safety Initiative allows the nurse safe and protected space
and time to perform high-risk activities without interruptions or distractions.
Distraction-free time also includes your shift report and safety checks at the beginning
of your shift.
You may ask for distraction-free time to focus at any time.
Just remind your families and staff that you are performing an important task, and for
patient safety you need distraction-free time to focus.
After the implementation of the Red Zone Medication Safety Initiative, the Cardiac Intensive Care
Unit saw a significant decrease in medication errors.
We had about a 30% reduction in the first year and over 70% reduction in the next four
years.
Strategies to reduce distractions and interruptions at the bedside have now been adopted throughout
the institution as the hospital has successfully created a culture of safety and high reliability.
The Red Zone Medication Safety Initiative successfully reduced medication errors by
creating a distraction-free practice which utilizes various tools and strategies.
Bringing awareness to the health care providers about distractions at the bedside was a critical
step in empowering staff to adopt the Red Zone strategies.
We continue to assess the success of this initiative in medication safety, but have
also expanded this distraction-free practice to other patient care activities to reduce
risk of patient harm.
Thank you for allowing me to share our experiences with the Red Zone Medication Safety Initiative
in the Cardiac Intensive Care Unit at Boston Children's Hospital.
I hope these tools and principles will allow you to develop your own safer nursing practices.
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