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Improving patient safety using the sterile cockpit principle during medication administration: a collaborative, unit-based project


Amanda M. Fore
Department of Veterans Affairs
National Center for Patient Safety
24 Frank Lloyd Wright Drive
Suite M 2100
Ann Arbor
MI 48106-0486


Aim  To implement the sterile cockpit principle to decrease interruptions and distractions during high volume medication administration and reduce the number of medication errors.

Background  While some studies have described the importance of reducing interruptions as a tactic to reduce medication errors, work is needed to assess the impact on patient outcomes.

Methods  Data regarding the type and frequency of distractions were collected during the first 11 weeks of implementation. Medication error rates were tracked 1 year before and after 1 year implementation.

Results  Simple regression analysis showed a decrease in the mean number of distractions, (β = −0.193, = 0.02) over time. The medication error rate decreased by 42.78% (= 0.04) after implementation of the sterile cockpit principle.

Conclusions  The use of crew resource management techniques, including the sterile cockpit principle, applied to medication administration has a significant impact on patient safety.

Implications for nursing management  Applying the sterile cockpit principle to inpatient medical units is a feasible approach to reduce the number of distractions during the administration of medication, thus, reducing the likelihood of medication error. ‘Do Not Disturb’ signs and vests are inexpensive, simple interventions that can be used as reminders to decrease distractions.