When interrupted, nurses more likely to make mistakes

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When you get interrupted in the middle of something, it can be hard to regain your train of thought—which can be annoying if you’re knitting and lose count of stitches, for example, or you’re wandering through the office and lose track of whom you’d been headed to speak with. But when you’re interrupted while measuring medication for patients, the consequences can be more dire—as patient safety advocates point out, some 200,000 people die each year from medical mistakes and preventable infections. Perhaps it’s not surprising then that, in addition to issues like miscommunication during hospital hand-offs or lack of sleep increasing preventable errors, distractions can have a negative impact as well. A new study published this week in the Archives of Internal Medicine finds that, perhaps unsurprisingly, when interrupted while dosing out medication, nurses are more likely to make mistakes.

Researchers at the University of Sydney studied 98 nurses while they prepared and administered medications to more than 4,000 patients between September 2006 and March 2008. For a total of 505 hours during this period, investigators noted any interruptions that nurses encountered while dealing with medication, and also tracked two types of mistakes: procedural, which included things like not reading medication labels or failing to fully read a patient chart, and clinical, which included actually giving patients the wrong dose or wrong medication. For all administrations of medication studied, researchers noted that fewer than one fifth of cases were mistake-free. Nurses were interrupted more than half the time (53%), and researchers noted procedural errors in nearly three quarters (74.4%) of administrations, and clinical errors in a quarter of all cases.

When they parsed the data to examine how interruptions factored into these figures, they found that each distraction was associated with a 12.1% increase in procedural mistakes and a 12.7% increase in clinical errors. Examining only cases in which nurses weren’t interrupted, they noted that both procedural and clinical mistakes dropped—to 69.9% and 25.3% respectively. In contrast, when nurses were interrupted three times while attempting to administer medication, mistakes increased, with 84.6% of cases including procedural errors, and nearly 40% of cases (38.9%) including clinical failures.

The study authors point out that the risk for major errors increased significantly the more that nurses were interrupted. With no interruptions, the risk for a serious mistake was 2.3%; when nurses were interrupted four times while preparing or administering medication, that risk increased to 4.7%.

While it’s understandable that some interruptions will, of necessity, take place during a nurse’s work day, the authors suggest that such high levels of interruption—distractions were noted in 53% of cases in this study—and the resulting increase in errors associated with them, point to a need for efforts to better enable nurses to focus on the task at hand. They write: “The converging evidence of the high rate of interruptions occurring during medication preparation and administration adds impetus to the need to develop and implement strategies to improve communication practices and to reduce unnecessary interruptions within ward environments.”

To that end, they suggest that simple measures such as installing white boards in hospital wards to prominently display commonly needed information (thus reducing the risk of interruption by a colleague looking for such info while a nurse is preparing medication) or having nurses wear special “do not interrupt” vests while preparing or giving patients medication, could go some distance toward minimizing mistakes. They also suggest that reconsidering how the physical space of a hospital ward is organized could play a role in reducing errors.

Whatever the potential solution, the authors say that this is indeed a problem, and one that requires additional research to solve. Echoing a 2008 patient safety assessment (PDF) from the U.S. Agency for Health care Research and Quality, the authors say that the need for a solution is paramount, as the incidence of preventable medical errors is “truly staggering.”