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Search results for "Interruptions and distractions"

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  • Interruptions and distractions
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Cases & Commentaries

What Happened on Telemetry?

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  • Spotlight Case
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  • 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.

Journal Article > Commentary

Perchance to think.

Ofri D. N Engl J Med. 2019;380:1197-1199.

Production pressure, fatigue, and distraction can diminish effective decision-making. This commentary offers insights from an ambulatory care physician regarding how the busy work environment contributes to shortcuts that can lead to burnout, errors, and patient harm.

Journal Article > Commentary

Does a unit shift report "blackout" period improve patient safety?

Olmstead J. Nurs Manage. 2019;50:8-10.

Mistakes during handoffs from the emergency department (ED) to inpatient units can diminish patient safety. This commentary summarizes how one hospital sought to to avoid miscommunications and disruptions by blocking admission of ED transfers during shift report. However, researchers found that blocking patient transfers did not result in improvements. The project did devise a standardized handoff process that was ultimately employed across the organization as a patient safety strategy.

Journal Article > Commentary

The "hemolyzed" physical examination—situational challenges to accurate bedside diagnosis.

Sargsyan Z. JAMA Intern Med. 2019;179:465-466.

Effective bedside interactions can enhance patient–clinician relationships. This commentary offers insights from a physician regarding the importance of clinician mindfulness about potential impact of environmental conditions on bedside physical examinations. The author emphasizes how noise, distraction, and production pressures contributed to a delayed diagnosis.

Patient Safety Primers

Nursing and Patient Safety

Nurses play a critical role in patient safety through their constant presence at patient's bedside. However, staffing issues and suboptimal working conditions can impede nurses' ability to detect and prevent adverse events.

Journal Article > Study

Provider interruptions and patient perceptions of care: an observational study in the emergency department.

Schneider A, Wehler M, Weigl M. BMJ Qual Saf. 2019;28:296-304.

Distractions and interruptions have been shown to adversely affect patient safety, but some interruptions may have a positive impact and actually improve care. In this observational study focused on interruptions of doctors and nurses in a single emergency department (ED), researchers found a positive association between interruptions initiated by patients and patient perceptions of ED care quality and efficiency.

Journal Article > Commentary

'Cyberloafing' in health care: a real risk to patient safety.

Ross J. J Perianesth Nurs. 2018;33:560-562.

The health care environment is rife with distractions during cognitive, clinical, and communication processes that increase the potential for error. This commentary focuses on how mobile communication technologies contribute to distractions in health care workers. The author suggests raising awareness of the risks associated with personal communication technology use to reduce problem behaviors and encourage heightened focus on patients. A past WebM&M commentary discussed a task interruption due to texting.

Journal Article > Study

Adverse effects of computers during bedside rounds in a critical care unit.

Dhillon NK, Francis SE, Tatum JM, et al. JAMA Surg. 2018;153:1052-1053.

In this prospective study, researchers found that decreasing the number of computers on wheels during rounds in a single surgical intensive care unit was associated with a significant reduction in simultaneous conversations and improved ability to hear patient presentations. The authors conclude that participants may be more engaged during rounds when information is obtained from presentations rather than having the electronic medical record readily available on a computer.

Journal Article > Commentary

Effective approaches to control non-actionable alarms and alarm fatigue.

Winters BD. J Electrocardiol. 2018;51:S49-S51.

Alarm fatigue can affect clinician performance and well-being. This commentary examines the problem of alarm fatigue, factors that contribute to nuisance alarms, and successful reduction strategies such as bundled approaches that include computer analytic techniques and human factors engineering. A WebM&M commentary discussed harm that can result from alarm fatigue.

Journal Article > Study

Understanding the types and effects of clinical interruptions and distractions recorded in a multihospital patient safety reporting system.

Kellogg KM, Puthumana JS, Fong A, Adams KT, Ratwani RM. J Patient Saf. 2018 Jul 7; [Epub ahead of print].

Using incident reporting data from a multihospital reporting system over a 3-year period, researchers sought to identify safety events related to interruptions. About 43% of interruption events were reported by nurses, compared to 15% by pharmacists and 7% by physicians. Interruptions most commonly involved a medication-related task.

Journal Article > Study

Reduced effectiveness of interruptive drug–drug interaction alerts after conversion to a commercial electronic health record.

  • Classic

Wright A, Aaron S, Seger DL, Samal L, Schiff GD, Bates DW. J Gen Intern Med. 2018;33:1868–1876.

Clinical decision support systems are widely utilized to improve patient safety by alerting providers to potential medication errors and other safety concerns. However, these alerts are frequently overridden by clinicians and contribute to alert fatigue. Researchers sought to assess the impact of a transition from a legacy electronic health record system to a commercial system on provider reactions to drug–drug interaction alerts in the ambulatory setting. There was a sixfold increase in the burden of interruptive alerts with adoption of the commercial system, and clinician acceptance for the most severe interaction alerts decreased from 100% to 8.4%. The authors suggest that the timing of alerts in the workflow process, user-interface design factors, and the inability to distinguish between more and less severe drug interactions all contributed to the decline in provider acceptance after adoption of the new system. A previous WebM&M commentary discussed a case in which a patient experienced an adverse drug event after a clinician overrode a prescribing alert.

Journal Article > Study

A standardized handoff simulation promotes recovery from auditory distractions in resident physicians.

Matern LH, Farnan JM, Hirsch KW, Cappaert M, Byrne ES, Arora VM. Simul Healthc. 2018;13:233-238.

Training resident physicians to use structured handoff tools reduces errors in the care of hospitalized patients. Researchers developed a handoff simulation incorporating the types of noise and distractions that are ubiquitous in hospitals. After training, distracted residents provided the same quality handoff as those able to communicate in a quiet place.

Cases & Commentaries

Air on the Side of Caution

  • Web M&M

Jamie M. Robertson, PhD, MPH, and Charles N. Pozner, MD; April 2018

A clinical team decided to use a radial artery approach for cardiac catheterization in a woman with morbid obesity. It took multiple attempts to access her radial artery. After catheter insertion, she experienced pain and pressure in her arm and chest. Review of the angiogram demonstrated the presence of an air embolism in the left coronary artery, introduced during the catheter insertion. Due to the difficulty of the procedure, the technician had failed to hold the syringe at the proper angle and introduced an air bubble into the patient's vessel.

Journal Article > Review

Why we need a single definition of disruptive behavior.

Petrovic MA, Scholl AT. Cureus. 2018;10:e2339.

Disruptive behavior affects patient safety, clinician burnout, and staff retention. This review discusses the scope of the term "disruptive behavior" to illustrate the lack of a consistent definition of such behavior. The authors submit that a single definition is needed to develop effective policy and research programs for responding to and addressing the problem.

Journal Article > Study

Medication administration and interruptions in nursing homes: a qualitative observational study.

Odberg KR, Hansen BS, Aase K, Wangensteen S. J Clin Nurs. 2018;27:1113-1124.

Interruptions during nurse medication administration can precipitate medication errors. This qualitative study sought to characterize medication administration interruptions in a nursing home. Interruptions were passive (background noises), active (conversations), or technological (use of electronic tools). A previous WebM&M commentary discussed harm that resulted from interrupting a nurse.

Book/Report

Guidelines for Design and Construction.

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.

Journal Article > Study

Task errors by emergency physicians are associated with interruptions, multitasking, fatigue and working memory capacity: a prospective, direct observation study.

Westbrook JI, Raban MZ, Walter SR, Douglas H. BMJ Qual Saf. 2018;27:655-663.

This direct observation study of emergency physicians found that interruptions, multitasking, and poor sleep were associated with making more medication prescribing errors. These results add to the evidence that clinical environments prone to interruptions may pose a safety risk.

Journal Article > Study

Night-time communication at Stanford University Hospital: perceptions, reality and solutions.

Sun AJ, Wang L, Go M, Eggers Z, Deng R, Maggio P, Shieh L. BMJ Qual Saf. 2018;27:156-162.

Interruptions can lead to errors, particularly when providers are sleep deprived. This retrospective cross-sectional study of pages sent to overnight general surgery and internal medicine physicians found that 27.7% were nonurgent. The authors assert that nonurgent paging contributes to alarm fatigue and suggest potential solutions.

Journal Article > Review

Technological distractions—part 1 and part 2.

Kane-Gill SL, O'Connor MF, Rothschild JM, et al; Society for Critical Care Medicine Alarm and Alert Fatigue Task Force. Crit Care Med. 2017;45:1481-1488, 2018;46:130-137.

These paired systematic reviews examined alert fatigue in the intensive care unit. The first systematic review found several strategies to reduce alerts including prioritizing alerts, developing multipart rules instead of simple alerts, and customizing commercial platforms with end-user input. The second systematic review found that alarm best practices from high reliability industries are not adhered to in intensive care unit settings.

Journal Article > Review

Intervening in interruptions: what exactly is the risk we are trying to manage?

Gao J, Rae AJ, Dekker SWA. J Patient Saf. 2017 Sep 25; [Epub ahead of print].

Interruptions can contribute to medication errors, but efforts to reduce interruptions may result in unintended consequences. The authors suggest that designing interventions around high reliability and resilience principles can address risks and increase the likelihood of lasting improvements.

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