What Are Interruption Errors In Nursing
Interruptions and Medication Errors
Stephanie Graber
St. Catherine University
Abstract
Healthcare settings can be hectic, demanding, time-constrained environments. Within these environments, nurses are expected to perform tasks that often require their undivided attention. However, nurses are frequently interrupted, which can distract their attention and add to the complexity of their work and affect patient safety. This paper systemically reviews the peer-reviewed literature on interruptions in hospital settings to determine the effects of interruptions and the correlation to medication errors. Based on research, patient safety is at risk relating to medication administration errors due to interruptions and distractions. …show more content…
Practice Question
Healthcare settings can be hectic, demanding, time-constrained environments. Within these environments, nurses perform complex task that often require their undivided attention. Interruptions such as phone calls, pages, other health care profession requests, equipment failure, alarms, patients, and patient families disrupt nurses throughout their day and potentially interfere with their already demanding workload. Interruptions are likely a contributing factor to medication errors.
Medication errors remains one of the most common causes of unintended harm to patients (Roughead & Semple, 2009).
Medication administration is one of a nurse’s greatest responsibilities because mistakes, accidents, or omissions can result in devastating consequences for both patients and nurses (Popescu, Currey, & Botti, 2011). Whether medication administration occurs in hospitals, clinics, or home health care facilities, a nurse takes on a very important role in the safe preparation and administration. Medication administration and evaluation are fundamental nursing responsibilities. Nurses need to have the knowledge of medication actions and effects (Potter, Perry, Stockert, & Hall, 2013). The United States National Council of State Boards of Nursing (NCSBN) (2004) reported that 50% of nurses surveyed were involved in patient care errors, with 75% of errors being medication …show more content…
errors.
The National Coordinating Council for Medication Error and Prevention (NCCMERP) defines medication errors as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of health professional, patient, or consumer” (as cited in Karavasiliadou & Athanasakis, 2014, p. 33). There can be different contributing factors in medication errors. Medication errors can be linked or caused by patients, health professionals, environmental factors, and actual medications (Popescu et al., 2011). During the process of medication delivering factors such as distractions and interruptions can have a significant impact on medication safety and errors.
The practice problem was that interruptions during medication preparation and administration can produce negative impacts on memory by requiring nurses to switch attention from one task to another.
It has been argued that any distraction or interruption during medication administration can result in errors. The practice question was, “does the number of interruptions a nurse experiences during medication administration correlate with medication errors?”
Evidence
The evidence I examined on the contribution to medication administration errors related to interruptions and distractions included a search of the following electronic databases: MEDLINE, CINAHL, PubMed, and Cochrane Library. The majority of the evidence has been published recently, within the past five years, reflecting a recent interest in the topic. Most of the evidence has come from hospital settings.
Search terms used during the process included the following: medication errors, medication safety, drug safety, patient safety, interruptions, distractions, registered nurse, healthcare, error prevention, and
nursing.
Inclusion and exclusion criteria were applied to identify eligible publications through title analysis followed by abstract and then full text examination. English language publications reporting empirical data on causes of medication administration errors relating to interruptions were included. Articles were included if the domain was urban hospitals involving registered nurses. Reference lists of included articles were hand searched for additional studies. Studies were exclude if they did not report data on the specifics of interruptions related to medication errors, included clinics, outpatient facilities, and surgery centers, and were not available in full text. Once all database searches were finalized, duplicates citations were identified and excluded. These search strategies yielded a total of 40 articles. For the purpose of this paper 3 articles were included.
Work Interruptions and Their Contribution to Medication Administration Error, an article published in the Workviews on Evidence-Based Nursing Journal, was a descriptive study included in this review. A total of 23 studies were considered for analysis. A rate of 6.7 work interruptions occurred per hour based on 14 studies that reported on work interruptions and observation time. Nurses themselves initiated most interruptions through face-to-face interactions. One non-experimental quantitative study addressed that interruptions are a contributing factor to medication administration errors (Biron, Loiselle, & Lavoie-Tremblay, 2009). Overall, distractions and interruptions interfere with administrating medications, potentially causing errors. All data in this review was extracted by a single reviewer, which could be seen as a limitation. This could be viewed as a limitation because the data extraction process may lead to bias.
Another article included in this review was, Causes of Medication Administration Errors in Hospitals: a Systemic Review of Quantitative and Qualitative Evidence. This review included a total of 54 studies. Of these studies, 17 found that interruptions and distractions were a cause of medication administration errors. Major distractions included face-to-face conversations with co-workers or patients, telephone conversations, and medical rounds. Medication errors or near errors included wrong drug, wrong time, and wrong dose calculations (Keers, Williams, Cooke, & Ashcroft, 2013). Limitations of this review include self-reporting methods such as log books, administration reports, interviews and questionnaires. These can be seen a limitations leading to social desirability bias and potentially may lead to modified reporting of medication administration errors. Direct observation may also lead to susceptibility of bias due to the Hawthorne effect.
The last study included in this review was published in Archives of Internal Medicine. Published in 2010, Association of Interruptions with an Increase Risk and Severity of Medication Administration Errors included 98 registered nurses who were observed preparing and administrating 4,271 medications at 2 major hospitals in Sydney, Australia. These medications were administered to 720 patients over 505 hours from September of 2006 through March of 2008. During this time interruptions occurred in 53.1% of all administrations. Proportions of procedural failures increased with interruptions. Commencing at a baseline, procedural failure rate was 69.6% with medication administrations with no interruptions, rising to 76.7% with one interruption. With two interruptions, procedural failure rate rose to 78.7%, followed by 84.6% with three, and 92.2% with four or more interruptions. There was also an increase in clinical errors related to interruptions. For administrations with no interruptions there was a clinical error rate of 25.3%. With one interruption the clinical error rate was 22.5%, with two there was a 24.4% clinical error rate, with three 38.9%, and with four or more interruptions there was an error rate of 30.4% (Westbrook, Woods, Rob, Dunsmuir, & Day, 2010). Nurses were not observed during the night or weekends, therefore the results for work at these times are unknown, which could be a limitation. Also, it is possible the nurses in this study changed behaviors while being observed because they were aware that they were being observed to identify problems. The effect of this possible bias may have led to an underestimation of error rates.
Although the evidence seems to be slightly limited, interruptions to nurses’ contributes to medication administration errors. Furthermore, these findings are supported by three reviews of the literature: one found that distractions and interruptions interfere with administrating medications, potentially causing errors; interruptions were perceived as causing medication errors in the second review; and the third indicated that with an increase in interruptions there was an increase in procedural failure and clinical errors including medication errors.
Translation
The evidence indicated that patient safety is at risk relating to medication administration errors due to interruptions and distractions. Interruptions represent a risk to medication errors that needs to be assessed and managed in healthcare settings. Based on the evidence I would recommend educating nurses on exactly how interruptions correlate with medication administration errors. I also believe innovative interventions to minimize interruptions such as quiet zones are needed and should be encouraged by nurses in the hospital settings to prevent medication administration errors.
Summary
During this research process a challenge was finding articles that specifically addressed interruptions as a cause to medication errors; there are many continuing factors that can lead to medication errors. Based on the research found there is an opportunity to investigate particular interventions to decrease interruptions during medication administration leading to improvement in patient safety. With expanding knowledge in prevention of medication administration errors, nurses will be better equipped to prevent medication errors from occurring. There is research focusing on preventable measures because medication errors are a danger in nursing care quality (Lin & Ma, 2009). In the hectic, demanding, and time-constrained hospital environments the reduction in interruptions during medication administration needs to be a high priority in order to ensure the safest and highest quality of patient care.
References
Biron, A. D., Loiselle, C. G., & Lavoie-Tremblay, M. (2009). Work interruptions and their contribution to medication administration errors: An evidence review. Worldviews on Evidence-Based Nursing, 6(2), 70-86. doi:10.1111/j.1741-6787.2009.00151.x
Karavasiliadou, S., & Athanasakis, E. (2014). An inside look into the factors contributing to medication errors in the clinical nursing practice. Health Science Journal, 8(1), 32-44.
Keers, R.N., Williams, S.D., Cooke, J., Ashcroft, D.M. (2013). Causes of medication administration errors in hospitals: A systemic review of quantitative and qualitative evidence. Drug Safety, 36, 1045-1067. doi:10.1007/s40264-013-0090-2
Lin, Y., & Ma, S. (2009). Willingness of nurses to report medication administration errors in southern taiwan: A cross-sectional survey. Worldviews on Evidence-Based Nursing, 6(4), 237-245. doi:10.1111/j.1741-6787.2009.00169.x
National Council of State Boards of Nursing (NCSBN). (2004). Spring 2002 practice and professional issue (PPI) survey. Retrieved December 6, 2014, from http://www.ncsb.org/862.htm.
Popescu, A., Currey, J., & Botti, M. (2011). Multifactorial influences on and deviations from medication administration safety and quality in the acute medical/surgical context. Worldviews on Evidence-Based Nursing, 8(1), 15-24. doi:10.1111/j.1741-6787.2010.00212.x
Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2013). Fundamentals of nursing (8th ed.). St. Louis, MO.: Mosby.
Roughead, E. E., & Semple, S. J. (2009). Medication safety in acute care in Australia: Where are we now? part 1: A review of the extent and causes of medication problems 2002-2008. Australia & New Zealand Health Policy (ANZHP), 6, 12-12. doi:10.1186/1743-8462-6-18
Westbrook, J. I., Woods, A., Rob, M. I., Dunsmuir, W. T. M., & Day, R. O. (2010). Association of interruptions with an increased risk and severity of medication administration errors. Archives of Internal Medicine, 170(8), 683-690. doi:10.1001/archinternmed.2010.65
Stephanie Graber
St. Catherine University
Abstract
Healthcare settings can be hectic, demanding, time-constrained environments. Within these environments, nurses are expected to perform tasks that often require their undivided attention. However, nurses are frequently interrupted, which can distract their attention and add to the complexity of their work and affect patient safety. This paper systemically reviews the peer-reviewed literature on interruptions in hospital settings to determine the effects of interruptions and the correlation to medication errors. Based on research, patient safety is at risk relating to medication administration errors due to interruptions and distractions. …show more content…
Practice Question
Healthcare settings can be hectic, demanding, time-constrained environments. Within these environments, nurses perform complex task that often require their undivided attention. Interruptions such as phone calls, pages, other health care profession requests, equipment failure, alarms, patients, and patient families disrupt nurses throughout their day and potentially interfere with their already demanding workload. Interruptions are likely a contributing factor to medication errors.
Medication errors remains one of the most common causes of unintended harm to patients (Roughead & Semple, 2009).
Medication administration is one of a nurse’s greatest responsibilities because mistakes, accidents, or omissions can result in devastating consequences for both patients and nurses (Popescu, Currey, & Botti, 2011). Whether medication administration occurs in hospitals, clinics, or home health care facilities, a nurse takes on a very important role in the safe preparation and administration. Medication administration and evaluation are fundamental nursing responsibilities. Nurses need to have the knowledge of medication actions and effects (Potter, Perry, Stockert, & Hall, 2013). The United States National Council of State Boards of Nursing (NCSBN) (2004) reported that 50% of nurses surveyed were involved in patient care errors, with 75% of errors being medication …show more content…
errors.
The National Coordinating Council for Medication Error and Prevention (NCCMERP) defines medication errors as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of health professional, patient, or consumer” (as cited in Karavasiliadou & Athanasakis, 2014, p. 33). There can be different contributing factors in medication errors. Medication errors can be linked or caused by patients, health professionals, environmental factors, and actual medications (Popescu et al., 2011). During the process of medication delivering factors such as distractions and interruptions can have a significant impact on medication safety and errors.
The practice problem was that interruptions during medication preparation and administration can produce negative impacts on memory by requiring nurses to switch attention from one task to another.
It has been argued that any distraction or interruption during medication administration can result in errors. The practice question was, “does the number of interruptions a nurse experiences during medication administration correlate with medication errors?”
Evidence
The evidence I examined on the contribution to medication administration errors related to interruptions and distractions included a search of the following electronic databases: MEDLINE, CINAHL, PubMed, and Cochrane Library. The majority of the evidence has been published recently, within the past five years, reflecting a recent interest in the topic. Most of the evidence has come from hospital settings.
Search terms used during the process included the following: medication errors, medication safety, drug safety, patient safety, interruptions, distractions, registered nurse, healthcare, error prevention, and
nursing.
Inclusion and exclusion criteria were applied to identify eligible publications through title analysis followed by abstract and then full text examination. English language publications reporting empirical data on causes of medication administration errors relating to interruptions were included. Articles were included if the domain was urban hospitals involving registered nurses. Reference lists of included articles were hand searched for additional studies. Studies were exclude if they did not report data on the specifics of interruptions related to medication errors, included clinics, outpatient facilities, and surgery centers, and were not available in full text. Once all database searches were finalized, duplicates citations were identified and excluded. These search strategies yielded a total of 40 articles. For the purpose of this paper 3 articles were included.
Work Interruptions and Their Contribution to Medication Administration Error, an article published in the Workviews on Evidence-Based Nursing Journal, was a descriptive study included in this review. A total of 23 studies were considered for analysis. A rate of 6.7 work interruptions occurred per hour based on 14 studies that reported on work interruptions and observation time. Nurses themselves initiated most interruptions through face-to-face interactions. One non-experimental quantitative study addressed that interruptions are a contributing factor to medication administration errors (Biron, Loiselle, & Lavoie-Tremblay, 2009). Overall, distractions and interruptions interfere with administrating medications, potentially causing errors. All data in this review was extracted by a single reviewer, which could be seen as a limitation. This could be viewed as a limitation because the data extraction process may lead to bias.
Another article included in this review was, Causes of Medication Administration Errors in Hospitals: a Systemic Review of Quantitative and Qualitative Evidence. This review included a total of 54 studies. Of these studies, 17 found that interruptions and distractions were a cause of medication administration errors. Major distractions included face-to-face conversations with co-workers or patients, telephone conversations, and medical rounds. Medication errors or near errors included wrong drug, wrong time, and wrong dose calculations (Keers, Williams, Cooke, & Ashcroft, 2013). Limitations of this review include self-reporting methods such as log books, administration reports, interviews and questionnaires. These can be seen a limitations leading to social desirability bias and potentially may lead to modified reporting of medication administration errors. Direct observation may also lead to susceptibility of bias due to the Hawthorne effect.
The last study included in this review was published in Archives of Internal Medicine. Published in 2010, Association of Interruptions with an Increase Risk and Severity of Medication Administration Errors included 98 registered nurses who were observed preparing and administrating 4,271 medications at 2 major hospitals in Sydney, Australia. These medications were administered to 720 patients over 505 hours from September of 2006 through March of 2008. During this time interruptions occurred in 53.1% of all administrations. Proportions of procedural failures increased with interruptions. Commencing at a baseline, procedural failure rate was 69.6% with medication administrations with no interruptions, rising to 76.7% with one interruption. With two interruptions, procedural failure rate rose to 78.7%, followed by 84.6% with three, and 92.2% with four or more interruptions. There was also an increase in clinical errors related to interruptions. For administrations with no interruptions there was a clinical error rate of 25.3%. With one interruption the clinical error rate was 22.5%, with two there was a 24.4% clinical error rate, with three 38.9%, and with four or more interruptions there was an error rate of 30.4% (Westbrook, Woods, Rob, Dunsmuir, & Day, 2010). Nurses were not observed during the night or weekends, therefore the results for work at these times are unknown, which could be a limitation. Also, it is possible the nurses in this study changed behaviors while being observed because they were aware that they were being observed to identify problems. The effect of this possible bias may have led to an underestimation of error rates.
Although the evidence seems to be slightly limited, interruptions to nurses’ contributes to medication administration errors. Furthermore, these findings are supported by three reviews of the literature: one found that distractions and interruptions interfere with administrating medications, potentially causing errors; interruptions were perceived as causing medication errors in the second review; and the third indicated that with an increase in interruptions there was an increase in procedural failure and clinical errors including medication errors.
Translation
The evidence indicated that patient safety is at risk relating to medication administration errors due to interruptions and distractions. Interruptions represent a risk to medication errors that needs to be assessed and managed in healthcare settings. Based on the evidence I would recommend educating nurses on exactly how interruptions correlate with medication administration errors. I also believe innovative interventions to minimize interruptions such as quiet zones are needed and should be encouraged by nurses in the hospital settings to prevent medication administration errors.
Summary
During this research process a challenge was finding articles that specifically addressed interruptions as a cause to medication errors; there are many continuing factors that can lead to medication errors. Based on the research found there is an opportunity to investigate particular interventions to decrease interruptions during medication administration leading to improvement in patient safety. With expanding knowledge in prevention of medication administration errors, nurses will be better equipped to prevent medication errors from occurring. There is research focusing on preventable measures because medication errors are a danger in nursing care quality (Lin & Ma, 2009). In the hectic, demanding, and time-constrained hospital environments the reduction in interruptions during medication administration needs to be a high priority in order to ensure the safest and highest quality of patient care.
References
Biron, A. D., Loiselle, C. G., & Lavoie-Tremblay, M. (2009). Work interruptions and their contribution to medication administration errors: An evidence review. Worldviews on Evidence-Based Nursing, 6(2), 70-86. doi:10.1111/j.1741-6787.2009.00151.x
Karavasiliadou, S., & Athanasakis, E. (2014). An inside look into the factors contributing to medication errors in the clinical nursing practice. Health Science Journal, 8(1), 32-44.
Keers, R.N., Williams, S.D., Cooke, J., Ashcroft, D.M. (2013). Causes of medication administration errors in hospitals: A systemic review of quantitative and qualitative evidence. Drug Safety, 36, 1045-1067. doi:10.1007/s40264-013-0090-2
Lin, Y., & Ma, S. (2009). Willingness of nurses to report medication administration errors in southern taiwan: A cross-sectional survey. Worldviews on Evidence-Based Nursing, 6(4), 237-245. doi:10.1111/j.1741-6787.2009.00169.x
National Council of State Boards of Nursing (NCSBN). (2004). Spring 2002 practice and professional issue (PPI) survey. Retrieved December 6, 2014, from http://www.ncsb.org/862.htm.
Popescu, A., Currey, J., & Botti, M. (2011). Multifactorial influences on and deviations from medication administration safety and quality in the acute medical/surgical context. Worldviews on Evidence-Based Nursing, 8(1), 15-24. doi:10.1111/j.1741-6787.2010.00212.x
Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2013). Fundamentals of nursing (8th ed.). St. Louis, MO.: Mosby.
Roughead, E. E., & Semple, S. J. (2009). Medication safety in acute care in Australia: Where are we now? part 1: A review of the extent and causes of medication problems 2002-2008. Australia & New Zealand Health Policy (ANZHP), 6, 12-12. doi:10.1186/1743-8462-6-18
Westbrook, J. I., Woods, A., Rob, M. I., Dunsmuir, W. T. M., & Day, R. O. (2010). Association of interruptions with an increased risk and severity of medication administration errors. Archives of Internal Medicine, 170(8), 683-690. doi:10.1001/archinternmed.2010.65