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Patient group sparks debate over 'do not disturb' tabards

  • 18 Comments

A patients’ campaign group has criticised the increasing use of “do not disturb” tabards by nurses as a method of reducing medication errors during drug rounds.

The tabards and other distinctive clothing are used in a number of hospitals during drug rounds to reduce the risk of interruption from staff and patients, which can lead to medication errors such as the wrong dose being given or a patient getting medicine intended for another patient.

East Kent Hospitals University NHS Foundation Trust is the latest to introduce them, but has been criticised for doing so by charities in the national media.

Speaking to Nursing Times, Joyce Robins, from Patients Concern, said the tabards sent out completely the wrong message to patients.

“It looks as if you’re saying, even if it’s not what you intended, don’t bother me – I’m too important. There is a bit of a feeling that nursing isn’t as caring as it used to be and things like this add to that,” she said.

“Many patients are very intimidated by being in hospital and maybe this is the first nurse you have seen for hours so you’re going to try and push your concerns.”

Ms Robbins suggested nurses could carry out a ward round ahead of the drug round to deal with any other requests from patients and so avoid subsequent interruptions.

However, senior nurses said the tabards could potentially help nurses, as long as they were part of wider measures that included having sufficient staff on the ward at the right time.

National Patient Safety Agency director of patient safety Suzette Woodward, herself a nurse, said evidence that tabards had a major impact on reducing interruptions was currently “not convincing”, but she said this did not mean it was the wrong solution.

She added: “The wearing of tabards needs to be seen as part of the bigger picture. They should be supported by regular nurse rounds for patients… and reviews of breaks to ensure that there are enough nurses other than the nurse doing the drug round available to help patients and other colleagues at these specific times.”

Royal College of Nursing chief executive and general secretary Peter Carter agreed staffing levels were crucial. He said: “Medication rounds can be complex and we would support measures which ensure that staff are able to concentrate when carrying out this task on a busy ward.

“However, let us be very clear: schemes like this must never become a cheaper substitute for having enough fully trained staff on every ward,” he said.

Follow the debate we’re having about tabards on twitter.

  • 18 Comments

Readers' comments (18)

  • As usual it boils down to not enough staff to enable the do not disturb apron to work. It was tried on my ward last year by a couple of nurses it did not work still many interuptions and of course patients did not understand why they were being worn. Never enough other nurses to pass on other tasks to. The trial lasted a week.

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  • Oh, I think it is a great idea but not necessarily for nursing as reports on usage have shown.

    If I could get my hands on one of these I would wear it at all times no matter where I work although I may have to replace the task with some other wording. I would steal it and wear it on public transport and around the home all day long and during my leisure time as well and possibly even in bed on certain nights! Another solution would have to be found for the telephone though. It might also stop all the chattering on the tennis court and help concentration and winning more points.

    Seriously, this does not seem to be the answer to the drug round problems and the only solution seems blatantly obvious to all except the budget holders (who only seem to understand more immediately visible up front cuts whilst making more insidious false economies), that more staff are needed in order to improve standards of care overall and leave nurses to concentrate on their tasks in order to cut down on serious errors.

    it is obvious that no stressed human being with constant interruptions and doing too much multitasking can work effectively, efficiently and error free. Ask the psychologists, neuropsychologists, neuropsychiatrists and everybody else who has studied this field and brain function! but then expecting non-clinical managers to search for information and understand evidence based facts from research reports is probably going one step too far.

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  • I do not see the reason why this is such a big issue or fuss. This method has been in existence in my sister's ward for more than 2 years now and it has worked tremedously. Their audit shows little or no drug error since the commencement of this 'do not disturb' sign during drug round; as it was reported that interruptions during drug rounds was on top of the list for drug errors.

    I for one, will support this if introduced in my place of work. Every nurse can tell of the psychological and mental stress involved if there is any indication that he/she made a drug error. And i believe, it is this same patient group that will scream crucify him/her if a nurse made an error. And their fitness to practice questioned.

    So why not embrace means of preventing/minimising a preventable problem and see the outcome before condemning it?

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  • There are two issues here I think. It has been proven by many studies that these tabards do not work, I agree. When the tabards are worn, people STILL interupt you, other staff, Doctors, HCAs, especially patients and patients families. For once Peter Carter is right, these tabards are NOT a replacement for correct staffing levels and never should be, and the managers should realise that we simply need more staff. It is essential that we have time to concentrate when we are doing a med round, but that NEEDS enough staff to take over to be able for one person to essentially take themselves away from everything else.

    But whilst this isn't the best way to go about things, this is the best option we have at the moment, since getting more staff in will never be an option unless we strike to demand it; and believe me, we NEED something like it, even if it is not the best option, because quite frankly medication errors are far too easily made when you are constantly interrupted and badgered, and we are potentially putting our PIN and our career on the line every time we do a round, not to mention potentially causing harm to a patient because of a tiny mistake, because the risks of making a mistake are so high with those bloody interruptions. So yes, I agree that these tabards are not the best option, I would rather have more staff myself, but whilst they are the ONLY option available to us, I'll take it.

    So this is one case where the patients groups and people like Joyce Robbins need to quite frankly shut up. I agree that it is not an ideal message, but THEY need to understand the pressures of the job we do. Sometimes that HAS to take priority over patient satisfaction and 'their concerns'. Their safety is more important right? I mean, Joyce Robbins suggested "nurses could carry out a ward round ahead of the drug round to deal with any other requests from patients and so avoid subsequent interruptions." This shows that she or these patient groups don't have a damn clue! We would LOVE to! I would do that every chance I got, if I could! But guess what, there isn't enough staff to do that! If we do an extra round, something else will get missed, only little things like IVs, setting up meds, wound care, you know, the important stuff!

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  • Relatives, patients & many staff just do not see the importance of allowing a nurse to focus completely on doing a drugs round ... tabard or no tabard.

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  • whatever innovations are suggested there will always be a group of people who will squawk about it because they have different ideas. You simply cannot please everybody and people like Madame joyce robins truc chose has probably never worked as a nurse on a stressful ward and appears not to appreciate all the difficulties and technicalities and therefore does not have a valid opinion to offer!

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  • Saw this via @NursingTimes and wanted to comment from the perspective of a pharmacist who is heavily involved in medicines administration patient safety: the tabards work but only where there are 1) enough other nurses to provide continued patient care and 2) where all staff members have been briefed as to their importance, particularly that its message applies equally to them as well as patients.

    However in the real world you can only hope for the latter of the two requirements and even this requires effort, so I would ask those affected to reflect on whether they’re using their ward skill mix effectively in delivering medicines administration: what tasks should remain nurse-led and what could be safely delegated as described in standard 17 of the NMC Meds-Management Standards?

    Pharmacists have undergone similar reflection over the years, sometimes uncomfortably, with pharmacy technicians now doing much that used to be ‘our’ domain and similar could be said for the doctor roles now competently fulfilled by nurses. I fully appreciate the accountability /responsibility situation in this instance but on the other-hand everyone’s stretched, you can’t do everything, and as Mike said, it doesn’t take much for error to occur with potentially serious consequences for all involved.

    There’s no magic, one-size-fits-all solution, but a tabard – and I’d argue skill-mix use - is a useful first step in a PDSA cycle series that could free up nursing time, reduce medicines error and keep staff happier in their role.
    So if you’ve not done so, please chat to your pharmacy department to see what support they can give you!

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  • "Anonymous | 31-Aug-2011 12:01 pm

    Relatives, patients & many staff just do not see the importance of allowing a nurse to focus completely on doing a drugs round ... tabard or no tabard"

    Indeed, unless it is theirs or their relatives medication you are administering. People are selfish. The expect you to be able to cater for their every whim, and don't like it when things like this mean they may have to wait. This goes especially for the general type of person you seem to get in the Daily Mail's readership. A read of the comment section of their website gives you a general idea of their philosiphy on life.

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  • James Andrews well said, I absolutely agree, and it is good to get a pharmacists point of view on this too.

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  • The media, patient information and rights groups do appear to be taking things a little out of context.

    No one, tabard or not is going to ignore patients or relatives while doing a drug round. It doesn't mean that patients are going to get neglected either.

    It's trying to draw attention to the fact drugs rounds are a very important element of patient care. They are also very dangerous and need full attention and care.

    After all the media, patient information and rights groups would be shouting even louder if their relative was poisoned, over dosed or God forbid killed by a 'small drugs error'.

    No one has the right to say nurses should be able to fit 'the drugs' in around everything else ie answering question and queries, putting patients on bed pans, feeding patients and a million other things while remaining even tempered and sweet natured . . .

    Why do people think the 6am drugs round has all been done away with. You need to be able to concentrate on the drugs!!


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