Should Nurses Wear ‘Do-Not-Disturb’ Tabards?

Recent concerns raised by a little known patient organisation about ‘do-not-disturb’ tabards worn by nurses on drug rounds triggered a number of articles in the UK’s national press and a wave of comments on Twitter and on the Nursing Times web site The main suggestions are:

  • that patients would feel nurses wearing ‘do-not-disturb’ tabards were unapproachable
  • that tabards reduce the amount of time allocated by nurses to patient care
  • that tabards are symptomatic of a decline in nursing standards
  • that reusable tabards are unhygienic and a potential source of cross-infection

As a major supplier of single use ‘do-not-disturb’ tabards to the NHS GV Health clearly have an interest in the continued use of tabards. But as an ethically responsible company we do not wish to engage in business which is not in the best interests of nurses, patients and the NHS generally.

Tabards were introduced by hospitals following concerns over the numbers of prescribing errors made by nurses on hospital drug rounds. These concerns are not new. As long ago as 2006 the Healthcare Commission urged hospitals to improve how they prescribed and dispensed drugs as it published league tables of how all 173 NHS trusts in England performed in the area. The figures revealed more than 40,000 medication errors in one year in hospitals in England and Wales.

Research by the National Patient Safety Agency also revealed that although about 80% of mistakes caused no harm in 15% of cases there was low harm and in around 5% moderate or severe harm to patients was caused. This equates to a total of over 2,000 moderate or severe cases of harm to patients through drug errors in a year.

The need to reduce interruptions was quickly identified as a key factor in reducing prescribing errors. As a result a number of studies were initiated to assess ways of improving things.

One such study* was undertaken at Colchester General Hospital, Essex. Colchester Hospital University NHS Foundation Trust (CHUFT) is a busy 600-bed acute district general hospital with 1200 nurses on 30 wards, serving a local population of 370,000.

Significant drug administration errors were occurring and root cause analyses implicated distraction to nurses during the “drug (administration) round” as a key factor. Interruptions during the drug round also led to prolonged delays in administration of medicines, resulting in sub-optimal care of the patients.

Following preliminary investigations a 3 month trial using red ‘do not disturb’ tabards was undertaken. The main findings of this trial were:

  • using tabards resulted in a 71% reduction in interruptions
  • reducing interruptions lead to a significant decrease the number of medication incidents
  • the reduction in time taken for drug rounds resulted in patients receiving their medication in a more timely manner
  • as a result of taking less time on drug rounds trained nurses had more time to undertake other nursing activities

These findings are significant because in addition to reducing errors greatly they demonstrate that tabards enable trained nurses to increase the time they allocate to patient care and are not therefore symptomatic of declining standards of nursing care.

This study did not address the issue of increased infection risk. This results primarily from infrequent laundering of tabards, which occurs because of cost concerns. The tabards used in the Colchester study were reusable fabric ones which require frequent laundering.

GV Health supply only single use polythene disposable tabards which avoid the need for laundering and thereby eliminate risks from cross-infection.

Disposable tabards have an additional advantage over fabric of significantly lower costs, when the price of regular laundering is taken into account. In a trial at a leading UK general hospital the costs of disposable tabards were found to be 60% lower than reusable ones: 17.5 pence per use as against over 40 pence per use for reusable tabards.

* GV Health were not involved in any way in this study. The tabards used during the study are not a type supplied by GV Health.

Download a copy of the Colchester General Hospital study (PDF)

More about GV Health disposable drug round tabards