To use an evidence-based design process, you have to know what the best available evidence is. But research is published faster than anyone can read it. In this blog series, The Center for Health Design’s research team will provide insight into a few healthcare design research matters through a snapshot of 10 studies published since the 2016 Healthcare Design Expo & Conference. Serving as a sneak peek of an upcoming session at the 2017 HCD Expo, the blogs will identify why this research matters and help readers ride the waves of an ocean of research without drowning.

The research
A study by Saskia Huckels-Baumgart and colleagues recently published online in the Journal of Patient Safety offers findings to suggest separate medication preparation rooms reduce interruptions and errors.

Why does it matter?
Past research has considered the impact of “no interruption zones” marked on the floor of units (or by nurses wearing vests to indicate not to interrupt them). Anecdotally, many organizations suggest this type of solution is not sustainable, as human nature takes over if there’s no physical separation. While not always required, separate medication preparation rooms are a best practice to both reduce interruptions and provide security, but the relationship of a separate prep room to specific outcomes had not previously been published.

How was the study done?
The study used a pre- and post-intervention condition associated with newly designed patient units with separate medication prep rooms. The study was conducted in two units (medical and surgical) in a 900-bed teaching hospital in Switzerland. Using both structured observation of nurses during medication preparation and nurse self-reports of daily medication errors, the researchers identified the number of interruptions and self-reported errors in a two-month period before the move and a two-month period after the move (following a period of adjustment to the new units). The researchers note that the same nurses participated before and after the change. Staffing and medication administration processes (paper-based) also remained the same.

What was learned?
The findings included statistically significant reductions in interruptions and errors. For example, the overall mean rate of interruptions was reduced from 51.8 to 30 interruptions per hour. The reductions in interruptions per hour were statistically significant on each ward, as well. From a practical perspective, the researchers found a medium to large “effect size”—that is, the magnitude of the difference.

As the patient load differed in the wards before and after, the researchers also evaluated the mean interruptions per drug and per drug per hour. These were also significantly different overall and on each ward.

When evaluating the duration of interruptions and prep time, the research team found the average length of the interruption and prep time was not significantly different overall or in each ward. However, the average prep time without interruption was significant (1.4 minutes before and 2.5 minutes after). When separated by ward type, this latter comparison was only statistically significant in the medical ward. The overall average medication error rate was reduced from 1.3 errors per day to 0.9 error per day. The reduction in average error rate was statistically significant overall and in the medical ward.

Are the results definitive?
Understanding limitations and the combined body of knowledge can help establish whether findings are consistent and generalizable. The researchers cite several limitations including the specific setting of an academic institution using two unit types, the potential bias of nurses knowing they are being observed (the Hawthorne effect), and the general lack of reliability in self-reported incidence rates. The authors provide their view on how these conditions were mitigated.

There are additional limitations a reader might consider. There were no additional plans, pictures, or dimensions provided by the authors for the new configuration of the med prep room or patient care units before and after construction. Lighting and noise were also not measured, which may have influenced outcomes. There was no control unit to offer insight about any other changes that may have influenced the reduction of medication errors within the organization.

The takeaway
This study looks at a specific design intervention to improve the medication administration process in two patient care units and its positive effect on error and interruption outcomes. In the context of other studies that have been conducted in pharmacies, studies that consider numerous simultaneous interventions, and studies that identify the cognitive capabilities and limitations of those preparing and dispensing medication, this study adds to our understanding of the benefits of a separate medication prep room and offers a good starting point for future studies.

Due to the complexity of healthcare safety, always keep in mind that any built environment design intervention should be considered in the context of organizational policies and procedures (model of care, workflow, task identification, etc.), and the users of the intervention (demographics, education for awareness, experience, etc.).

Interested in the topic? Visit The Center for Health Design Knowledge Repository for more. Ellen Taylor, PhD, AIA, MBA, EDAC, is vice president for research at The Center for Health Design. She can be reached at etaylor@healthdesign.org. 

Summary of: Huckels-Baumgart, S., Baumgart, A., Buschmann, U., Schüpfer, G., & Manser, T. (2016). "Separate Medication Preparation Rooms Reduce Interruptions and Medication Errors in the Hospital Setting: A Prospective Observational Study." Journal of Patient Safety, in press.