How do nurses respond to interruptions during medication administration? A time-and-motion study in a Chinese hospital

To discover nurses’ response strategies to medication administration interruptions and examine their responses across different contextual factors. Interruptions during medication tasks are common in nursing practice and may jeopardize patient safety. However, there is limited empirical evidence about how nurses respond to interruptions during medication administration. A time-motion study. A prospective time-motion study was conducted between October 2023 and April 2024 in a 2600-bed academic teaching hospital in Northwest China. Thirty-seven registered nurses (RNs) were observed for 204 h during medication tasks (i.e., Preparation, Discussion, Administration, Documentation, Health education, Materials disposal). We measured the proportions of time spent in different time blocks, interruption rates, and characteristics. We cataloged specific response strategies used by RNs. A total of 2,091 interruptions were observed, with an average frequency of 10.25 interruptions per hour and a mean duration of 41.9 s. Most interruptions (84.0%) occurred from 7:30 to 12:00. Most interruptions (63.9%) came from healthcare providers, medication preparation was the most frequently interrupted process(32.3%). The top two intent of interruption were reminding (34.5%) and questioning (34.2%). Nurses responded to 85.7% of interruptions immediately; only 14.3% of interruptions were blocked(7.2% postponed and 7.1% rejected). The response strategies were significantly associated with the primary task, source, intent of interruption, interruption types and nurses’ working experience at the level of statistical significance. Medication interruptions occur frequently, and nurses’ response strategies for interruptions are influenced by multiple factors. Understanding these dynamics can improve safety and efficiency in clinical environments. Findings suggest managers should optimize morning medication workflows by implementing protective zones and asynchronous communication systems to reduce interdisciplinary interruptions. Management must also empower nurses to exercise clinical judgment and prioritize tasks, enabling them to safely evaluate and defer non-critical interruptions based on real-time patient needs. Not applicable. The healthcare team members (staff registered nurses, nurse self, and other health professional providers) are the majority source of interruptions, and 62% of interruptions during medication tasks are attributed to communication, within this subset, only 38% were related to professional communication. Provides detailed empirical evidence about nurses’ specific response strategies to various types of interruptions during medication tasks in a Chinese hospital, demonstrating that nurses promptly respond to 85.7% of interruptions by task-switching or multitasking. Nurses’ response strategies are significantly influenced by both the type of primary task and the type and intent of the interruption, suggesting a complex decision-making process in managing interruptions during medication administration. The results showed a significant difference between the interruption handling strategies of nurses with more than 10 years of experience and those with less experience, and the rate of positive effect in self-interruptions is higher than other sources of interruptions (OR: 2.84, 95%CI = 2.23, 3.61).