Respect the belt - Saul E. Bilboat, RN and Thomas Gruffi, a Medical Student at Metropolitan Hospital Center.

A wardrobe change among the nursing staff at Metropolitan Hospital Center has transformed the way they dispense medication to patients.

Tina Royal, who has been a registered nurse in the Surgery Unit at Metropolitan for over two years, used to spend up to two hours on a single dispensing rotation. Now she wears a yellow belt, and it takes her half the amount of time.

“I was constantly interrupted while trying to dispense medications to my patients,” Royal said. “Before the yellow belts, physicians would ask me to do anything from prep a patient for surgery, help load a patient onto a stretcher or answer a ringing phone. Now they know to find another nurse without a yellow belt for those tasks. It allows me to concentrate on what I am doing so that I don’t make mistakes.”

The yellow belt, which is worn across the chest and waist, signals to physicians, other staff and even patients that a nurse is in the process of dispensing medications and therefore in a “Quiet Zone” and should not be distracted or interrupted. A poll done last year among the nursing staff concluded that they believed the number one source of errors while dispensing medication to be distractions. In response to the poll, the nursing staff launched the “Quiet Zone” pilot to secure an environment designed for safe dispensing and to eliminate distractions and interruptions during the process. After several weeks of implementation the rate of distractions went from 35% to 0%.

“When we initially started wearing the yellow belts the physicians and patients would call us school crossing guards because of the bright and reflective nature of them,” said Francis St. Louis, an RN in the Medical Unit at Metropolitan. “Now they respect the belts and what they mean. The patients are the biggest fans because they know they are getting the undivided attention of a nurse.”

According to the Patient Safety office at Metropolitan, educating everyone from the nurses to physicians and patients and even the housekeeping staff was crucial in making the program a success. Education for nurses on how to follow the proper protocol while dispensing medication also helped reduce errors. The training requires nurses to review a checklist of items they are expected to follow, which includes verifying orders, not engaging in conversation and checking the seven rights of medication administration -- right patient, right drug, right dose, right time, right route, right person and right documentation.

“At first we only focused on educating the nurses, physicians and other staff, said Jocelyn Perez, Director of Nursing in Psychiatry at Metropolitan. “Soon we realized that we needed to educate the patients as well to ultimately make this program a success. Now patients will actually remind nurses to wear the yellow belts if they see them without it during their rotation. It has become almost second nature at the hospital.”

The training and Implementation wasn’t easy according to some of the nursing staff, since hospitals constantly have new physicians on rotation and new patients admitted daily. So in order to educate physicians and other staff, the patient safety office team attends new staff orientation and places posters throughout the facility for a constant reminder of what the yellow belts meant. They also have huddles at the end of the day to help fine tune concerns or problems and develop best practices for the project.

“I first heard about the yellow belts during new employee orientation,” said Gustavo Churrango, an M.D. at Metropolitan. “It made complete sense to me when I saw it in action. It works because they have staggered the nurses’ rotation schedules so there is always a nurse that we can go to for information and help so there’s no need to interrupt those who are distributing medication.”

Metropolitan Hospital began the “Quiet Zone” program with 32 nurses between two units and used another control unit with 18 nurses to compare outcomes. Now they have over 110 nurses across 9 units wearing the yellow belts. The project won the People’s Choice Award at HHC’s Patient Safety Conference this year and because of the success at Metropolitan, Bellevue Hospital Center has launched a similar pilot.