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Decreasing Nonemergent Nurse interrupting During Peak Medication Administration Time Utilizing "The Golden Hour"

3 min readMelvin Bacchus, Jr., MSN-HCSM, BSN, CCRN, LSS-GB, Nurse Manager, Critical Care Service Line, VA North Texas Health Care System and Tanizia Sims, BSN, RN, PCCN, LSS-YB, Critical Care Service Charge Nurse, VA North Texas Health Care System

A nurse driven process that has a mutual benefit of improving performance outcomes along with the nurse’s experience.

Negative Impacts on Medication Administration the Impetus for Innovation

The path to the innovation came from the negative impacts on medication administration time management.  Distractions interfered with the nurse's ability to focus, and increased fear of making a medication error during the medication administration process at the bedside.  Later, headlines dominated social media about a nurse being charged and convicted by a jury after a medication error. Then, the conversation around enhancing safety of the medication administration process became a priority.  Our 20-bed critical care telemetry unit’s active evidence-based practice (EBP) workgroup continuously looks for ways to innovate and improve patient and staff safety and satisfaction.

Frequent Interruptions a Regular Occurrence

Frequent interruptions were a regular occurrence for nursing staff while at the bedside reviewing and administering medications with their patients. Stopping and restarting steps during the medication administration process was routine and was very concerning since this is the last process before patients can be harmed by a medication error. Lots of the interruptions were due to frequent nonemergent calls, nonmedication related conversations, or other healthcare professionals coming to the bedside to assess the patient. The EBP workgroup included nursing management, novice and veteran nurses of the unit on both day and night shifts that shared angst toward medication administration and desired improvement.

A colorful assortment of various shaped medications in pill blister packs is laying on a surface, creating a collage of colorful pills.

Applying the Golden Hour

The Golden Hour is a nurse driven process that has a mutual benefit of improving performance outcomes along with the nurse’s experience by removing barriers disrupting the medication administration cycle.  The voluntarily completed nurse questionnaire provided data directly from the unit nurses at the bedside on their feelings and perspective of the medication administration process. This included results about their ability to focus during medication administration, anxiousness about making a medication error, and feeling rushed during medication administration. The Frequency of Distraction Tool was created during data collection.  Each time the nurse was interrupted and their ability to focus was affected, the nurse reported it using the tool. This gave real time data on the amount of nurse interruptions that occurred. The findings of the Golden Hour can be used to guide a standardized process to boost medication administration safety.

Our Best Advice

Great advice and support the group received was from Dr. Lisa Webb PhD, RN, CEN who consistently was a voice of motivation.  A quote that I distinctly associate her with is, "If at first you don't succeed TRY AGAIN!".  


Sims, Tanizia BSN, RN, LSS-YB; Narayanan, Pushpa BSN, RN, CMSRN; Alex, Annie MSN, RN; Bacchus Jr, Melvin J. MSN-HCSM, BSN, CCRN, LSS-GB. Decreasing Nonemergent Nurse Interruptions During Peak Medication Administration Time Utilizing "The Golden Hour". Journal of Nursing Care Quality 39(2):p 99-101, April-June 2024. | DOI: 10.1097/NCQ.0000000000000750.

Images sourced from Adobe Creative Cloud

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