Interruptions pose a significant safety hazard for health care providers performing complex tasks, such as signout or medication administration. However, as prior research has pointed out, many interruptions are necessary for clinical care, making it difficult for safety professionals to develop approaches to limiting the harmful effects of interruptions. Reviewing the literature on interruptions from the psychology and informatics fields, this study identifies several key variables that influence the relationship between interruption of a task and patient harm. The authors provide several recommendations, based on human factors engineering principles, to mitigate the effect of interruptions on patient care. A case of an interruption leading to a medication error is discussed in this AHRQ WebM&M commentary.

This study found that a program designed to minimize interruptions during medication administration successfully reduced self-reported medication administration error rates.

This review article examined the impact of interruptions in critical care and medication dispensing settings.

This article describes the causes of medication errors in the operating room and discusses prevention strategies, including using read-back techniques and reducing interruptions.

This study investigated whether type of credentials affected rates of medication errors and found no significant difference. However, the authors noted that nurses were interrupted more often during medication administration.

This survey of pharmacy technicians identified interruptions and insufficent staffing as sources of errors.