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Search results for "Interruptions and distractions"

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  • Interruptions and distractions
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Journal Article > Commentary

Distractions in the anesthesia work environment: impact on patient safety? Report of a meeting sponsored by the Anesthesia Patient Safety Foundation.

van Pelt M, Weinger MB. Anesth Analg. 2017 Jun 9; [Epub ahead of print].

Distractions and interruptions are prevalent in health care delivery. This conference report reviews types of distractions in anesthesiology, their likelihood to introduce significant risks into care processes, and strategies to help manage distractions.

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

Impact of interruptions, distractions, and cognitive load on procedure failures and medication administration errors.

Thomas L, Donohue-Porter P, Stein Fishbein J. J Nurs Care Qual. 2017 Apr 26; [Epub ahead of print].

Interruptions and distractions can contribute to medication administration errors. This direct observation study found that interruptions and distractions are frequent during nursing medication administration, which increased cognitive load. These results demonstrate how interruptions affect nursing safety.

Journal Article > Study

Nursing interruptions in a trauma intensive care unit: a prospective observational study.

Craker NC, Myers RA, Eid J, et al. J Nurs Adm. 2017;47:205-211.

Interruptions are a known patient safety hazard. This direct observation study demonstrated that intensive care unit nurses were interrupted about every 20 minutes. Interruptions by physicians were of longer duration and were more likely to result in the nurse moving to another activity. The authors conclude that further study is needed to determine the clinical significance of interruptions in the intensive care unit setting.

Journal Article > Study

Effectiveness of a 'Do not interrupt' bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study.

Westbrook JI, Li L, Hooper TD, Raban MZ, Middleton S, Lehnbom EC. BMJ Qual Saf. 2017 Feb 23; [Epub ahead of print].

This randomized controlled trial had nurses on four hospital wards wear "do not interrupt" vests during medication administration. The rate of interruptions the intervention nurses experienced was compared to the rate in four control wards that did not have nurses wear vests. Although the intervention reduced non–medication-related interruptions, nurses reported that the vests were time consuming and uncomfortable; less than half would support continuing the intervention. This study demonstrates the need to design and test sustainable interventions to improve patient safety.

Journal Article > Study

Ordering interruptions in a tertiary care center: a prospective observational study.

Dadlez NM, Azzarone G, Sinnett MJ, et al. Hosp Pediatr. 2017;7:134-139.

Interruptions are known to contribute to medication errors. This direct observation study found that resident physicians and physician assistants experienced 57 interruptions per 100 medication orders. The authors suggest that inpatient health systems should implement strategies to reduce interruptions during medication ordering.

Cases & Commentaries

The Hazards of Distraction: Ticking All the EHR Boxes

  • Spotlight Case
  • CME/CEU
  • Web M&M

Anthony C. Easty, PhD; February 2017

A few weeks after falling and hitting her head, a woman with metastatic cancer was admitted to the hospital for observation after a brain scan showed a subdural hematoma with a midline shift. Repeat imaging showed an enlarging hematoma, which required surgical evacuation. The admitting provider had mistakenly prescribed blood thinner for venous thromboembolism prophylaxis (contraindicated in the setting of subdural hematoma) by clicking the box in the electronic health record admission order set.

Journal Article > Study

Data-driven implementation of alarm reduction interventions in a cardiovascular surgical ICU.

Allan SH, Doyle PA, Sapirstein A, Cvach M. Jt Comm J Qual Patient Saf. 2017;43:62-70.

Reducing the number of alarms can help alleviate alarm fatigue and the associated patient safety hazards. In this study, researchers successfully implemented a number of interventions which led to a 61% decrease in average alarms per monitored bed in a cardiovascular surgical intensive care unit and a reduction in cardiorespiratory events.

Journal Article > Study

Separate medication preparation rooms reduce interruptions and medication errors in the hospital setting: a prospective observational study.

Huckels-Baumgart S, Baumgart A, Buschmann U, Schüpfer G, Manser T. J Patient Saf. 2016 Dec 21; [Epub ahead of print].

Interruptions are known to contribute to medication administration errors. This pre–post study found that nurses experienced fewer interruptions and made fewer medication errors following the introduction of a separate medication room. These results demonstrate how changing the work environment can promote safety.

Journal Article > Commentary

Implementing No Interruption Zones in the perioperative environment.

Wright MI. AORN J. 2016;104:536-540.

Noise in the operating room can contribute to miscommunication, stress, and fatigue. This commentary describes a project that established a designated quiet space in an outpatient surgical setting to decrease opportunities for distraction in perioperative care and provided education regarding the importance of noise reduction.

Journal Article > Review

Disruptive behaviour in the perioperative setting: a contemporary review.

Villafranca A, Hamlin C, Enns S, Jacobsohn E. Can J Anaesth. 2017;64:128-140.

Disruptive clinician behavior has a negative effect on teamwork that could contribute to patient harm. Examining the literature on disruptive behavior in the operating room, this review identified intrapersonal, organizational, and interpersonal factors that facilitate disruptive conduct and discussed its impact on teams, clinicians, patients, and organizations. The authors recommend strategies to address disruptive behaviors among clinicians such as documenting standards of behavior.

Journal Article > Review

Traditions of research into interruptions in healthcare: a conceptual review.

McCurdie T, Sanderson P, Aitken LM. Int J Nurs Stud. 2017;66:23-36.

Interruptions are prevalent in health care delivery settings. This review discusses epidemiology, quality improvement, cognitive systems engineering, and applied cognitive psychology as prominent research traditions examining interruptions in health care. The authors suggest that a more integrated approach that combines perspectives from these research traditions could enhance design of interventions to reduce interruptions.

Journal Article > Study

A work observation study of nuclear medicine technologists: interruptions, resilience and implications for patient safety.

Larcos G, Prgomet M, Georgiou A, Westbrook J. BMJ Qual Saf. 2017;26:466-474.

Prior research demonstrates that interruptions in health care can compromise patient safety. In this study, researchers observed interruptions experienced by nuclear medicine technologists in their work environment and found that some interruptions were helpful. In addition, technologists had developed personal strategies to optimize for safety.

Cases & Commentaries

Cognitive Overload in the ICU

  • Spotlight Case
  • CME/CEU
  • Web M&M

Vimla L. Patel, PhD, and Timothy G. Buchman, PhD, MD; July/August 2016

Admitted to the intensive care unit (ICU) with acute respiratory distress syndrome due to severe pancreatitis, an older woman had a central line placed. Despite maximal treatment, the patient experienced a cardiac arrest and was resuscitated. The intensivist was also actively managing numerous other ICU patients and lacked time to consider why the patient's condition had worsened.

Journal Article > Commentary

Two sides to every story: the Dual Perspectives Method for examining interruptions in healthcare.

McCurdie T, Sanderson P, Aitken LM, Liu D. Appl Ergon. 2017;58:102-109.

Interruptions are common in care settings and can introduce safety hazards into health care processes. This commentary describes an observational method to explore factors that contribute to interruptions from various perspectives to better understand the reasons for interruptions and design strategies to manage them. A past PSNet perspective discussed an approach to reduce interruptions.

Journal Article > Study

Medication double-checking procedures in clinical practice: a cross-sectional survey of oncology nurses' experiences.

Schwappach DLB, Pfeiffer Y, Taxis K. BMJ Open. 2016;6:e011394.

Chemotherapy medications can cause severe patient harm if incorrectly dosed or administered. This cross-sectional survey of oncology nurses revealed that most chemotherapy double-checking is conducted jointly rather than independently. Of note, many nurses reported being interrupted to engage in a double-check.

Journal Article > Study

Use of personal electronic devices by nurse anesthetists and the effects on patient safety.

Snoots LR, Wands BA. AANA J. 2016;84:114-119.

Personal electronic devices such as smartphones are now ubiquitous, and many clinicians use them for both work and personal purposes. Although considered a necessity, these devices can serve as a distraction, which could compromise patient safety. This review found that many certified registered nurse anesthetists and anesthesiologists acknowledge using personal electronic devices in the operating room despite knowledge of the potential risks. Currently, no formal guidelines exist regarding what constitutes inappropriate use of such devices in the operating room. The authors call for further research in order to develop policies to balance the risks and benefits of personal electronic devices. A WebM&M commentary discusses a case where an interruption due to receiving a text message on a smartphone led to a serious medication error.

Journal Article > Study

Nursing strategies to increase medication safety in inpatient settings.

Bravo K, Cochran G, Barrett R. J Nurs Care Qual. 2016;31:335-341.

Medication administration errors are common and are often associated with interruptions. This study reviews data from a recent study on medication safety in critical access hospitals and recommends organizational strategies to improve the safety of medication administration.

Journal Article > Study

Evaluating the effect of distractions in the operating room on clinical decision-making and patient safety.

Murji A, Luketic L, Sobel ML, Kulasegaram KM, Leyland N, Posner G. Surg Endosc. 2016;30:4499-4504.

Interruptions and distractions are well-recognized sources of error. Distractions in the operating room are common. In this randomized crossover study, researchers observed residents performing a virtual salpingectomy and subjected them to time periods in which they received pages versus quiet phases without interruptions. The majority of residents made at least one unsafe clinical decision while trying to multitask, further supporting that interruptions and distractions adversely impact patient safety.

Journal Article > Study

Why do we still page each other? Examining the frequency, types and senders of pages in academic medical services.

Carlile N, Rhatigan JJ, Bates DW. BMJ Qual Saf. 2017;26:24-29.

Despite the ubiquity of smartphones, the vast majority of physicians still rely on one-way pagers for communication. This study analyzed the frequency and content of pages on an internal medicine service at a teaching hospital and compared the data to a similar study performed in 1988. Physicians received an average of 22 pages per day, of which 76% were deemed clinically relevant by independent reviewers and 82% required a response. This represented a nearly 50% increase in the volume of pages compared to 1988. Doctors on regionalized services (where patients were admitted to a common unit) received significantly fewer pages than those caring for patients on nonregionalized services, implying that regionalized services may aid face-to-face communication. As interruptions have been shown to negatively affect patient safety, the authors advocate for developing secure two-way methods of communication (such as secure text messaging) for nurses and physicians in order to improve the efficiency of communication around clinical issues.

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