Background: Medication administration in acute care settings is a critical time when potentially fatal errors threaten patient safety. Researchers have shown that unsafe systems lead to the majority of medication errors. The advancement of technology has been touted to help reduce the risk of error during medication administration, yet errors still occur. Environmental factors can play a huge role in precipitating medication errors during administration. Distractions on the patient care unit can be numerous and interruptions during the administration of medication have been recognized as factors affecting safe medication administration. Foreground: During quality improvement observation rounds it was noted interruptions and distractions were occuring during medication administration. On the post-surgical unit, nurses experienced an average of 11.66 interruptions and/or distractions per medication administration round. The use of computers on wheels to deliver the medications to the patients using bar code medication administration place the nurse in the busy hallway during medication pass. Conclusion: This project raised awareness on how errors can happen when nursing staff are interrupted or distracted during medication administration. It further demonstrated how a team effort along with other protocols and the wearing of a visible symbol by nurses can help prevent interruptions and distractions during medication administration. Future research needs conducted regarding the integration of bar code medication administration (BCMA) into practice setting to prevent unplanned safety issues.
