5.22.2010

Nurse, Interrupted ...

A new study from down under finds that interrupted nurses are more likely to make errors. Seems like we could assume that was true but nice to see it quantified.  It doesn't seem to matter how much experience you have, if you get interrupted, you increase your chance of making a mistake in medication preparation, aseptic technique and other critical jobs. From Medscape:

"Experimental studies suggest that interruptions produce negative impacts on memory by requiring individuals to switch attention from one task to another," write Johanna I. Westbrook, PhD, from the University of Sydney in Sydney, Australia, and colleagues. "Returning to a disrupted task requires completion of the interrupting task and then regaining the context of the original task."  
For each interruption, there was a 12.1% increase in procedural failures and a 12.7% increase in clinical errors, with the association between interruptions and clinical errors independent of hospital and nurse characteristics. More than half (53.1%) of all administrations were interrupted (95% confidence interval [CI], 51.6% - 54.6%), and nearly three quarters of total drug administrations (74.4%; n = 3177) had at least 1 procedural failure (95% CI, 73.1% - 75.7%).  
Nurse experience did not protect against clinical errors and was actually associated with a higher rate of procedural failure. The frequency of the interruptions was associated with increased severity of the error. The estimated risk for a major error was 2.3% when there were no interruptions vs 4.7% when there were 4 interruptions (95% CI, 2.9% - 7.4%; P < .001). 
 "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. While it is clear that some interruptions are central to providing safe care, there is a need to better understand the reasons for such high interruption rates." 
 The question, however, is what can we do to reduce interruptions? In the emergency room especially, it's a difficult place for doctors and nurses to work without interruption. The patients are unstable and dynamic. Frequent updates are needed. So what do we do?

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