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

J Nurs Manag. 2013 Jan;21(1):106-11. doi: 10.1111/j.1365-2834.2012.01410.x. Epub 2012 May 28.


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, P = 0.02) over time. The medication error rate decreased by 42.78% (P = 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.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Attention
  • Humans
  • Medication Errors / prevention & control*
  • Medication Errors / statistics & numerical data
  • Nursing Staff, Hospital / organization & administration
  • Patient Safety / statistics & numerical data*
  • Quality Improvement* / organization & administration
  • Workload