Reducing medication errors in nursing practice part 5

Interruptions and distractions

Higher medication error rates are associated with greater levels of interruptions during medication administration (Westbrook et al 2010). Indeed, interruptions at this stage are one of the main contributing factors to errors (Mayo and Duncan 2004, Deans 2005, Hopp et al 2005, Ulanimo et al 2007, Westbrook et al 2010, Ozkan et al 2011).

Definitions

Interruptions: in this context, an interruption is a halt in the primary activity being performed – medicine administration – to carry out a secondary task, resulting in nurses having to manage a number of tasks simultaneously (Mrayyan et al 2007, Petrova 2010, Ozkan et al 2011).

Distractions: something which takes a nurse’s attention away from their primary task. For example, noise can be ignored or processed concurrently with the primary task. However, it may also contribute to errors and act as a precursor to an interruption (McFarlane and Latorella 2002).

• Medication administration includes components of both skill-based and knowledge-based task requirements.
• Skill-based tasks require attention to be focused on the activity being performed, to ensure successful completion (Reason 1990). Interruptions that divert attention can hamper skill-based performance (Reason 1990), while knowledge-based tasks rely on conscious analytical processes that can be disturbed by competing demands for cognitive resources, fatigue and distractions such as noise (Wickens and Hollands 2000).
• When a number of patient activities occur simultaneously, nurses are involved in complex decision making to prioritise activities. Many competing activities have the potential to result in distractions and interruptions that can interfere with a primary task and may contribute to errors. Nurses are often required to choose between attending to, ignoring and delaying attending to distractions when undertaking medication administration. This may result in the nurse anticipating potential distractions, prioritising one task over another or delegating a secondary task (Popescu et al 2011).
• The most common source of interruption is from another nurse requiring face-to-face communication (Hedberg and Larsson 2004, Spencer et al 2004, Alvarez and Coiera 2005, Popescu et al 2011). Such interruptions frequently occur during direct patient care activities, and the activity interrupted most often is that of medication administration (Hedberg and Larsson 2004).
• Common locations for interruptions to occur are medication rooms and open spaces where nurses may be viewed as being more accessible (Hedberg and Larsson 2004, Bennett et al 2006). Areas that allow for conversation result in higher levels of distraction and interruption (Popescu et al 2011).
• Other sources of distraction and interruption include patients (Hedberg and Larsson 2004, Lyons et al 2007), technical sources (for example, alarms) and operational failure (for example, the unavailability of a medication or infusion device required for medicine administration) (Hedberg and Larsson 2004, Tucker and Spear 2006). Operational failure regularly results in drugs being omitted or administered late (Popescu et al 2011).

Steps to avoid interruption and distractions

• Minimising the frequency of interruptions may limit the number of medication errors. The NPSA (2012) recommends that institutions develop policies and procedures to minimise interruptions during administration of medicines.
• Solutions to minimising interruptions include:
  • The creation of interruption-free zones of work (thus limiting casual conversations in certain work areas).
  • Wearing ‘Do not disturb’ safety vests or armbands and using ‘Do not disturb’ signs to indicate the need for interruption-free work (Pape et al 2005, Biron et al 2009).
• Other suggestions include the allocation of specific times during shifts when nurses can administer medication free from clerical interruptions and postponing non-urgent patient care tasks (Savvato and Efstratios 2014).
• Any intervention that leads to fewer distractions could ultimately enable nurses to focus more on the task that they are performing, complete the task in good time and create less work-related stress and greater job satisfaction (Pape et al 2005). Therefore, nurses should learn to recognise the potential for making errors during medication administration and take active steps to avoid distractions and interruptions (Palese et al 2009).
• Nurses should learn to recognise when it is appropriate to be interrupted – for example, to attend to a patient alarm or a patient whose condition is deteriorating – and when it is preferable to defer the interruption – for example, responding to clerical enquiries. This requires exercising critical thinking and making appropriate clinical judgements, which are fundamental responsibilities of the professional nurse (Jones and Treiber 2010).
• Nurses should also be made aware of their potential to distract and interrupt other nurses and work towards minimising such occurrences.

Complete time out activity 4

Consider what activities can be sources of interruption during medication administration. Describe strategies that could be used to reduce the frequency of such interruptions. Outline a number of strategies that could result in fewer distractions for other nurses.

Once completed your time out activity is saved and stored in "My Modules”.

Learning points

1. Higher medication error rates are associated with greater levels of interruptions during medication administration and distractions such as noise.
2. Medication administration includes components of both skill-based and knowledge-based task requirements. Skill-based tasks require attention to be focused on the activity being performed, to ensure successful completion. Knowledge-based tasks rely on conscious analytical processes that can be disturbed by competing demands for cognitive resources, fatigue and distractions such as noise.
3. The common sources of interruption are: nurses involving in complex decision making and to prioritise activities with number of patients’ activities occurring simultaneously. Other interruptions can come from nursing staff requiring face-to-face communication occurring during patient care activities.
4. The unavailability of a medication or infusion device required for medicine administration attribute to technical sources, while operational failure regularly results in drugs being omitted or administered late.
5. Steps to avoid interruptions and distractions:
   • The NPSA recommends that institutions develop policies and procedures to minimise interruptions.
   • Creation of interruption-free zones at work.
   • Allocation of specific times during shifts for administering medication
6. Nurses should learn to recognise the potential for making errors during medication administration and take active steps to avoid distractions and interruptions.