Narrow Results Clear All
Search results for "Interruptions and distractions"
- Interruptions and distractions
- Medical Complications
Cases & Commentaries
- Spotlight Case
- Web M&M
by Kristin E. Sandau, PhD, RN, and Marjorie Funk, PhD, RN; April 2019
An elderly woman with a history of dementia, chronic obstructive pulmonary disease, hypertension, and congestive heart failure (CHF) was brought to the emergency department and found to meet criteria for sepsis. Due to her CHF, she was admitted to a unit with telemetry monitoring, which at this institution was performed remotely. When the nurse came to check the patient's vital signs several hours later, she found the patient to be unresponsive and apneic, with no palpable pulse. A Code Blue was called, but the patient died. Although the telemetry technician had recognized progressive bradycardia and called the hospital floor several minutes before the code, he was placed on hold because the nurse was busy with another patient. While he was holding, he observed worsening bradycardia, eventually transitioning to asystole, and tried to redial the unit, but no one answered.
Dallas, TX: Facilities Guidelines Institute; 2018.
These updated guidelines include design changes, such as the adoption of private rooms to reduce medical error, interruptions, and hospital-acquired infections. The 2018 edition was developed as a 3-volume set covering hospitals, outpatient facilities, and residential health, care, and support facilities. Each provides information on design elements that enhance safety. The material also includes risk assessments to identify space concerns that could lead to unsafe conditions.
Special or Theme Issue
Rogers WA, ed. J Exp Psychol Appl. 2011;17:191-302.
Journal Article > Study
Lucero RJ, Lake ET, Aiken LH. J Clin Nurs. 2010;19:2185-2195.
Interruptions and other work system failures often prevent nurses from completing essential patient care tasks. This study, a secondary analysis of data from a seminal article, found that failure to complete nursing care was linked to an increased risk of a broad range of adverse events. This finding is corroborated by another recent study that tied interruptions during medication administration to an increased risk of medication errors. While inadequate nurse staffing ratios increase safety risks, this study reinforces the necessity of also transforming nurses' work environment in order to reduce preventable adverse events.