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Kos TM, Haaksman S, Regli L, van Doormaal TPC, Colombo E. Effect of Intraoperative Mixed-Reality use on Nonsurgical Team Members in the Neurosurgical Operating Room: An Explorative Study. World Neurosurg 2023; 180:e219-e225. [PMID: 37739174 DOI: 10.1016/j.wneu.2023.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES Mixed-reality (MxR) implementation in the neurosurgical operating room (OR) is emerging, but the impact of this technology on the nonsurgical OR staff has not been investigated yet. The purpose of this study is to evaluate the nonsurgical OR team's perception of the impact of intraoperative MxR use. METHODS The evaluation occurred in a neurosurgical institution implementing MxR perioperatively on a daily basis for 15 months. The questionnaire measuring the impact of MxR consisted of 5 binary questions and 4 subquestions measured on a 7-point Likert scale. RESULTS Fifteen nonsurgical staff members of a neurosurgical OR team were interviewed. Most (85%) of the cohort stated that MxR changed their perception of the surgery, improving understanding of the spatial orientation (median 6, interquartile range 5-7) and of the pathology dimensions (6, 5.5-7). One participant (7%) was of the opinion that MxR disrupted the OR workflow. The majority (60%) stated that use of the holograms improved efficiency in the OR. The participants were neutral about the potential role of MxR to improve communication among different OR team members (4, 2-5) and overall teamwork (4, 2-5). CONCLUSIONS The use of 3-Dimensional interactive holograms of neurosurgical cases in the nonsterile intraoperative phase was not perceived as distractive, and neither was OR flow disruption by members of the nonsurgical OR staff. MxR was considered an adjunct to improve OR efficiency. A thorough understanding of the impact of MxR's implementation on the nonsurgical staff could lead to targeted improvement of the MxR use and, potentially, to increasing the quality of the teamwork.
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Affiliation(s)
- T M Kos
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - S Haaksman
- Department of Neurosurgery, University Hospital Zurich, Zürich, Switzerland
| | - L Regli
- Department of Neurosurgery, University Hospital Zurich, Zürich, Switzerland
| | - T P C van Doormaal
- Department of Neurosurgery, University Hospital Zurich, Zürich, Switzerland
| | - E Colombo
- Department of Neurosurgery, University Hospital Zurich, Zürich, Switzerland
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Grealish L, Ranse K, Todd JA, Armit L, Billett S, Collier L, Bail K, Moyle W. Barriers and enablers to embedding fundamental nursing care for older patients-Implications of a mixed methods study for nursing leadership. J Adv Nurs 2023; 79:1162-1173. [PMID: 35285976 DOI: 10.1111/jan.15194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 01/04/2022] [Accepted: 02/15/2022] [Indexed: 11/27/2022]
Abstract
AIMS To understand the enablers and barriers for delivering fundamental care to hospitalized older patients. DESIGN Explanatory sequential mixed methods design, with qualitative data used to elaborate quantitative results. METHODS Set in one medical and one surgical unit of a tertiary hospital in southeast Queensland, Australia. Observations of nursing practice using the Work Sampling Technique were conducted over two 2-week periods in 2019. Data were analyzed and presented to groups of nurses who appraised the findings of the observations. RESULTS There were 1176 and 1278 observations of care in the medical unit over two time periods and 1380 and 1398 observations over the same period in the surgical unit. Fundamental care activities were recorded in approximately 26% (i.e. medical) and 22% (i.e. surgical) of all observations. Indirect care was highest, recorded in 41% (i.e. medical) and 43% (i.e. surgical) of observations. Nurses prioritized the completion of reportable activities, which is perceived as a potential enabler of fundamental care. Potential barriers to fundamental care included frequent delays in indirect care and difficulty balancing care requirements across a group of patients when patients have high fundamental care needs. CONCLUSION The cultural acceptance of missed nursing care has the potential to erode public confidence in health systems, where assistance with fundamental care is expected. Relational styles of nurse leadership should focus on: (1) making fundamental care important work in the nurses' scope thereby offering an opportunity for organizational change, (2) promoting education, demonstrating the serious implications of missed fundamental care for older patients and (3) investigating work interruptions. IMPACT Fundamental care is necessary to arrest the risk of functional decline and associated hospital-acquired complications in older patients. However, nurses commonly report fundamental care as missed or omitted care. Understanding the challenges of implementing fundamental care can assist in the development of nurse leadership strategies to improve older patients' care. Fundamental care was observed between 22% (i.e. surgical) and 26% (i.e. medical) of all observations. Nurses explained that they were focused on prioritizing and completing reported activities, experienced frequent delays when delivering indirect care and found balancing care requirements across groups of patients more challenging when patients had fundamental care needs. Clinical nurses working in acute health services with increasing populations of older patients can lead improvements to fundamental care provision through relational leadership styles to demonstrate how this work is in nurses' scope of practice, promote education about the serious implications of missed fundamental care and investigate the root cause of work interruptions.
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Affiliation(s)
- Laurie Grealish
- Menzies Health Institute Queensland, Australia.,School of Nursing & Midwifery, Griffith University, Australia.,Gold Coast Health, Australia
| | - Kristen Ranse
- Menzies Health Institute Queensland, Australia.,School of Nursing & Midwifery, Griffith University, Australia
| | | | | | - Stephen Billett
- School of Education and Professional Studies, Griffith University, Australia
| | | | | | - Wendy Moyle
- Menzies Health Institute Queensland, Australia.,School of Nursing & Midwifery, Griffith University, Australia
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Koch A, Schlenker B, Becker A, Weigl M. Operating room team strategies to reduce flow disruptions in high-risk task episodes: resilience in robot-assisted surgery. ERGONOMICS 2022:1-14. [PMID: 36285451 DOI: 10.1080/00140139.2022.2136406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
In healthcare work settings, flow disruptions (FDs) pose a potential threat to patient safety. Resilience research suggests that adaptive behavioural strategies contribute to preventing cognitive overload through FDs at crucial moments. We aimed to explore the nature and efficacy of operating room (OR) team strategies to prevent FDs in robot-assisted surgery. Within a mixed-methods design, we first asked surgical professionals, which strategies they apply, and secondly, identified behavioural strategies through direct observations. Findings were analysed using content analysis. Additionally, FDs were assessed through live observations in the OR. The sample included four interviewed experts and 15 observed surgical cases. Sixty originally received strategies were synthesised into 17 final OR team strategies. Overall, 658 FDs were observed with external FDs being the most frequent. During high-risk episodes, FDs were significantly reduced (p < 0.0001). The identified strategies reveal how OR teams deliberatively and dynamically manage and mitigate FDs during critical tasks. Our findings contribute to a nuanced understanding of adaptive strategies to safeguard performance in robot surgery services. Practitioner Summary: Flow disruptions (FDs) in surgical work may become a severe safety threat during high-risk situations. With interviews and observations, we explored team strategies applied to prevent FDs in critical moments. We obtained a comprehensive list of behavioural strategies and found that FDs were significantly reduced during a specific high-risk surgical task. Our findings emphasise the role of providers' and teams' adaptive capabilities to manage workflow in high-technology care environments.
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Affiliation(s)
- Amelie Koch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU, Munich, Germany
- Institute for Patient Safety, University Hospital, University of Bonn, Bonn, Germany
| | - Boris Schlenker
- Department of Urology, University Hospital, LMU, Munich, Germany
| | - Armin Becker
- Department of Urology, University Hospital, LMU, Munich, Germany
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU, Munich, Germany
- Institute for Patient Safety, University Hospital, University of Bonn, Bonn, Germany
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Yu EJ, Lee EN. Development and Validation of a Nursing Work Interruption Scale. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13487. [PMID: 36294067 PMCID: PMC9602459 DOI: 10.3390/ijerph192013487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
Work interruption disturbs nurses' flow of thinking, diminishes work efficiency, induces burnout, and causes errors that can threaten patients' lives. Therefore, it is important to identify the causes and measure the extent of work interruption. This study developed a self-report scale and established its validity and reliability for use in hospital settings. Through literature review and in-depth interviews with nurses, we identified two components and developed 25 preliminary items. These items were reviewed by nursing experts for content validity and pilot tested among 20 hospital nurses; subsequently, a 16-item preliminary instrument was finalized. A total of 359 questionnaires were included in the final analysis, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed. Two factors and 12 items were derived from two rounds of EFA, with a cumulative percentage of variance of 55.73%. Construct validity was established through CFA. The predictive validity and internal consistency reliability of the developed scale were also established. Thus, the 12-item Work Interruption Measurement Scale for Nurses comprising two domains (human and environmental factors) was developed. This scale can be useful in assessing work interruption experienced by nurses and for developing and assessing the effectiveness of interventions pertaining to nurses' work interruption.
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Affiliation(s)
- Eun-Jeong Yu
- Nursing Department, Busan Institute of Science and Technology, Busan 6639, Korea
| | - Eun-Nam Lee
- College of Nursing, Dong-A University, Busan 49201, Korea
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Mobeen A, Shafiq M, Aziz MH, Mohsin MJ. Impact of workflow interruptions on baseline activities of the doctors working in the emergency department. BMJ Open Qual 2022; 11:bmjoq-2022-001813. [PMID: 36096543 PMCID: PMC9472165 DOI: 10.1136/bmjoq-2022-001813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Workflow interruptions are common in the emergency department (ED) of the hospitals for physicians, leading to an increased risk of errors. Purpose This study aims to understand the baseline activities of the ED doctors and how these are affected by workflow interruptions. Methods The study was conducted in two phases to collect the doctor’s perspective (through questionnaire survey) and observer’s perspective (through workflow observation study) about ED doctors’ baseline activities and workflow interruptions. Two different perspectives were obtained to make the insights clearer and more valuable. The point of view of the 223 doctors working in ED of the hospitals was recorded through a questionnaire survey. In the second phase, the observer’s point of view (authors) was obtained through a workflow observation study, and 13 doctors were observed for 160 hours. Results Direct communication with patients (37.1%) and ‘documentation and prescription’ (22.7%) were found to be the most frequent activities. The most common interruptions were visual and auditory distractions, rumination (mind-wandering) and intrusion (by co-workers). Also, the time consumed on indirect patient care (6.6%) was higher than direct patient care (4. 2%). Interruptions increase the chances of errors by making it hard for a doctor to resume a primary task after facing interruptions. Conclusion Interruptions increase the chances of errors and make it difficult for the doctors to resume primary tasks (after facing such incidents).
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Affiliation(s)
- Asyia Mobeen
- Industrial Engineering Department, University of Engineering and Technology, Taxila, Pakistan
| | - Muhammad Shafiq
- Department of Industrial Engineering and Management, University of the Punjab, Lahore, Pakistan
- Supply Chain and Project Management Center, University of the Punjab, Lahore, Pakistan
| | - Muhammad Haris Aziz
- Department of Mechanical Engineering, University of Sargodha, Sargodha, Punjab, Pakistan
| | - Muhammad Junaid Mohsin
- Industrial Engineering Department, University of Engineering and Technology, Taxila, Pakistan
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Zhu X, Hu Y, Wang L, Li D, Wu X, Xia S, Cheng S. An Observational Study of Physicians' Workflow Interruptions in Outpatient Departments in China. Front Public Health 2022; 10:884764. [PMID: 35757627 PMCID: PMC9215343 DOI: 10.3389/fpubh.2022.884764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Workflow interruptions are frequent in hospital outpatient clinics. Eventually, not only reducing the work efficiency and quality, but also further threatening patient safety. Over the last 10–15 years, research on workflow interruptions in inpatient care has increased, but there is a lack of research on the interruptions in outpatient clinics. The present study aimed to study the differences in physicians' workflow interruptions among outpatient departments in the tertiary hospital in China. Methods In a tertiary hospital, a standardized observational study of 32 doctors' workflow in outpatient department of four typical clinical specialties was conducted. The record of workflow interruptions was based on a self-made observation instrument after verifying its reliability and validity. Linear regression methods were used to assess outpatient characteristics as predictors of the number of interruptions. The Kruskal-Wallis test was used to analyze the difference about the duration of interruptions among specialties, and the Chi-Square Test was used to examine the sources of interruptions among different specialties, to determine whether interruption source is associated with specialty. Results The number of patients was the significant independent predictor of the number of interruptions (p < 0.001). In terms of work tasks being interrupted, the highest interruption rate occurred when physicians were asking health history: 19.95 interruptions per hour. The distribution of interruption sources among the four clinical specialties were statistically different (X2 = 16.988, p = 0.049). Conclusion The findings indicate that physicians' workflow interruptions are connected with many contents in the work system. Further emphasis should be placed on the effective application of hospital management measures in an interrupted environment to promote a safe and efficiency outpatient care.
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Affiliation(s)
- Ximin Zhu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinhuan Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liuming Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dehe Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyue Wu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shixiao Xia
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Siyu Cheng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Scharf J, Vu-Eickmann P, Angerer P, Müller A, in der Schmitten J, Loerbroks A. Work-Related Intervention Needs of Medical Assistants and How to Potentially Address Them according to Supervising General Practitioners: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031359. [PMID: 35162382 PMCID: PMC8835399 DOI: 10.3390/ijerph19031359] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022]
Abstract
Work stress is common among health care professionals and this observation also holds true for general practitioners (GPs) and their medical assistance staff in Germany. Therefore, prior studies have examined the work-related intervention needs of medical assistants (MAs). We sought to explore potential interventions that may help to address these needs according to GPs’ views. Between December 2018 and April 2019 GPs were recruited via physician networks and through personal visits in general practices. Information on the nature and prevalence of 20 work-related intervention needs of MAs was presented to GPs. GPs then participated in a qualitative interview to reflect on the MAs’ needs. Qualitative content analysis according to Mayring was carried out using MAXQDA. A total of 21 GPs participated and perceived many of the needs as justified. The least understanding was expressed for requests of MA related to occupational aspects that were already known prior to hiring. The responsibility to address needs was often assigned to the German health policy. GPs expressed though that they considered addressing the need for better leadership style as their own responsibility as supervisors. Furthermore, professional training was discussed as one opportunity to raise the recognition and remuneration of MAs. Measures to address the work-related intervention needs of MAs and to thereby improve the working conditions of MAs were discussed with GPs.
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Affiliation(s)
- Jessica Scharf
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University of Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany; (J.S.); (P.V.-E.); (P.A.)
| | - Patricia Vu-Eickmann
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University of Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany; (J.S.); (P.V.-E.); (P.A.)
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University of Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany; (J.S.); (P.V.-E.); (P.A.)
| | - Andreas Müller
- Institute of Psychology, Work and Organizational Psychology, University of Duisburg-Essen, Universitätsstr. 2, 45141 Essen, Germany;
| | - Jürgen in der Schmitten
- Institute of General Practice, University of Duisburg-Essen, Pelmanstr. 81, 45131 Essen, Germany;
| | - Adrian Loerbroks
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University of Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany; (J.S.); (P.V.-E.); (P.A.)
- Correspondence: ; Tel.: +49-211-81-08032
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Olin K, Göras C, Nilsson U, Unbeck M, Ehrenberg A, Pukk-Härenstam K, Ekstedt M. Mapping registered nurse anaesthetists' intraoperative work: tasks, multitasking, interruptions and their causes, and interactions: a prospective observational study. BMJ Open 2022; 12:e052283. [PMID: 35045998 PMCID: PMC8772415 DOI: 10.1136/bmjopen-2021-052283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 01/05/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Safe anaesthesia care is a fundamental part of healthcare. In a previous study, registered nurse anaesthetists (RNAs) had the highest task frequency, with the largest amount of multitasking and interruptions among all professionals working in a surgical team. There is a lack of knowledge on how these factors are distributed during the intraoperative anaesthesia care process, and what implications they might have on safety and quality of care. OBJECTIVE To map the RNAs' work as done in practice, including tasks, multitasking, interruptions and their causes, and interactions, during all phases of the intraoperative anaesthesia work process. METHODS Structured observations of RNAs (n=8) conducted during 30 procedures lasting a total of 73 hours in an operating department at a county hospital in Sweden, using the Work Observation Method By Activity Timing tool. RESULTS High task intensity and multitasking were revealed during preparation for anaesthesia induction (79 tasks/hour, 61.9% of task time spent multitasking), anaesthesia induction (98 tasks/hour, 50.7%) and preparation for anaesthesia maintenance (86 tasks/hour, 80.2%). Frequent interruptions took place during preoperative preparation (4.7 /hour), anaesthesia induction (6.2 /hour) and preparation for anaesthesia maintenance (4.3 /hour). The interruptions were most often related to medication care (n=54, 19.8%), equipment issues (n=40, 14.7%) or the procedure itself (n=39, 14.3%). RNAs' work was conducted mostly independently (58.4%), but RNAs interacted with multiple professionals in and outside the operating room during anaesthesia. CONCLUSION The tasks, multitasking, interruptions and their causes, and interactions during different phases illustrated the RNAs' work as done, as part of a complex adaptive system. Management of safety in the most intense phases-preparing for anaesthesia induction, induction and preparing for anaesthesia maintenance-should be investigated further. The complexity and adaptivity of the nature of RNAs' work should be taken into consideration in future management, development, research and education.
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Affiliation(s)
- Karolina Olin
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
- Administration Centre, Tyks and Hospital District of Southwest Finland, Turku, Finland
| | - Camilla Göras
- Faculty of Medicine, School of Education, Health and Social Studies, Örebro University, Orebro, Sweden
- Center for Clinical Research Dalarna, Falun, Sweden
- Department of Anaesthesia and Intensive Care Unit, Falu Hospital, Falun, Sweden
| | - Ulrica Nilsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Maria Unbeck
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Anna Ehrenberg
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Karin Pukk-Härenstam
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
- Astrid Lindgren's Children's Hospital, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Mirjam Ekstedt
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
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Yeganeh S, Torabizadeh C, Bahmani T, Molazem Z, Doust HY, Dehnavi SD. Examining the views of operating room nurses and physicians on the relationship between professional values and professional communication. BMC Nurs 2022; 21:17. [PMID: 35031042 PMCID: PMC8759190 DOI: 10.1186/s12912-021-00778-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose Professional communication and professional values are two basic concepts in operating rooms and should be studied more closely in view of the nature of work and the high circulation of patients in operating rooms. Methods The present work is a descriptive-analytic study with a cross-sectional design. The sample was 603 operating room physicians and personnel selected from the public hospitals of Shiraz. The data collection instruments were the 41-item professional communication questionnaire and the 26-item professional values scale. Results The results showed that the operating room nurses and physicians perceived the status of professional communication and professional values to be satisfactory. As for professional communication, the participants’ perception of the domains of mutual respect and trust (p ≤ 0.001), teamwork (p ≤ 0.001), ethical competence (p ≤ 0.017), and workplace conflicts (p ≤ 0.001) was significant. As for professional values, only the dimension of care (p ≤ 0.016) was perceived to be significant. Moreover, a significant positive relationship was found to exist between professional communication and professional values (p ≤ 0.001). Conclusion Considering the significance of the concept of professional communication and its connection with professional values, it is recommended that operating room personnel and physicians receive systematic education about professional communication and the harms of destructive attitudes as part of their academic education and afterwards.
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Affiliation(s)
- Sedigheh Yeganeh
- School of Nursing, Gerash University of Medical Sciences, Gerash, Iran
| | - Camellia Torabizadeh
- Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tayebeh Bahmani
- Department of Operating Room, School of Allied Medical Sciences, Fasa University of Medical Sciences, Fasa, Iran.
| | - Zahra Molazem
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Intraoperative dynamics of workflow disruptions and surgeons' technical performance failures: insights from a simulated operating room. Surg Endosc 2022; 36:4452-4461. [PMID: 34724585 PMCID: PMC9085674 DOI: 10.1007/s00464-021-08797-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/17/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Flow disruptions (FD) in the operating room (OR) have been found to adversely affect the levels of stress and cognitive workload of the surgical team. It has been concluded that frequent disruptions also lead to impaired technical performance and subsequently pose a risk to patient safety. However, respective studies are scarce. We therefore aimed to determine if surgical performance failures increase after disruptive events during a complete surgical intervention. METHODS We set up a mixed-reality-based OR simulation study within a full-team scenario. Eleven orthopaedic surgeons performed a vertebroplasty procedure from incision to closure. Simulations were audio- and videotaped and key surgical instrument movements were automatically tracked to determine performance failures, i.e. injury of critical tissue. Flow disruptions were identified through retrospective video observation and evaluated according to duration, severity, source, and initiation. We applied a multilevel binary logistic regression model to determine the relationship between FDs and technical performance failures. For this purpose, we compared FDs in one-minute intervals before performance failures with intervals without subsequent performance failures. RESULTS Average simulation duration was 30:02 min (SD = 10:48 min). In 11 simulated cases, 114 flow disruption events were observed with a mean hourly rate of 20.4 (SD = 5.6) and substantial variation across FD sources. Overall, 53 performance failures were recorded. We observed no relationship between FDs and likelihood of immediate performance failures: Adjusted odds ratio = 1.03 (95% CI 0.46-2.30). Likewise, no evidence could be found for different source types of FDs. CONCLUSION Our study advances previous methodological approaches through the utilisation of a mixed-reality simulation environment, automated surgical performance assessments, and expert-rated observations of FD events. Our data do not support the common assumption that FDs adversely affect technical performance. Yet, future studies should focus on the determining factors, mechanisms, and dynamics underlying our findings.
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Rahul G. S, Soumonetra C, Bishal P, Aishani G, Ananya R. K, Janis MA. Personality, cognitive flexibility, and motivation among medical professionals during covid-19 pandemic: a correlational study. I-MANAGER’S JOURNAL ON NURSING 2022; 12:1. [DOI: 10.26634/jnur.12.1.18435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
Abstract
The recent COVID-19 pandemic has posed unprecedented challenges to healthcare professionals worldwide, by bringing changes in both their personal and professional lives. Motivation has become a driving factor along with cognitive flexibility during such demanding situations. Little importance has been given to the personality dimension while assessing these aspects, especially in the Indian context. The principal aim of this paper is to understand the relationship between personality, cognitive flexibility, and motivation among medical professionals during the COVID-19 Pandemic. A correlational research design was used to conduct the research, and a snowball sampling technique was used to collect the data from a sample size of 204 medical professionals, consisting of 101 nurses and 103 doctors, working as frontline workers. The variables were assessed using the Neo Five-Factor Inventory, the Cognitive Flexibility Inventory, the Work Extrinsic and Intrinsic Motivation Questionnaire. A nonparametric test of correlation was used. The research findings revealed that among medical professionals, certain personality factors, cognitive flexibility, and motivation share a significant relationship. Cognitive flexibility and motivation were found to be significantly correlated. There was no significant difference in cognitive flexibility and motivation among doctors and nurses. There was a significant difference in neuroticism between the groups. The findings will help in gaining a clearer insight into the needs of medical professionals in India, by facilitating the development of appropriate training interventions for medical professionals to be better equipped for similar crisis situations in the future.
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Nees MA, Sampsell NG. Simple auditory and visual interruptions of a continuous visual tracking task: modality effects and time course of interference. ERGONOMICS 2021; 64:879-890. [PMID: 33428536 DOI: 10.1080/00140139.2021.1873424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
Research has produced conflicting evidence regarding whether performance of an on-going visual task is disrupted more by an interruption from a visual or an auditory alert. Tasks and alerts studied to date have been complex or idiosyncratic. This experiment examined how the modality of simple alerts-visual icons or auditory tones-affected performance of an on-going visual task. Participants (58 females and 4 males) tracked a visual target while performing a choice reaction time task in response to alerts. Visual alerts were more harmful to performance of the tracking task. Dual task workload was lowest with an auditory alert, provided there was not noise present. Interruptions affected tracking task performance for around 1500 ms. Results supported the predictions of Multiple Resources Theory and showed no evidence of auditory preemption. In practical applications for which an on-going visual task is interrupted, auditory alerts may be less disruptive and may reduce perceived workload. Practitioner Summary: Many practical scenarios involve on-going visual tasks that are interrupted by simple alerts requiring a simple response. Auditory alerts may be less disruptive than visual alerts and may reduce perceived workload. A conservative estimate is that the effects of even simple interruptions will last a minimum of 1500 ms. Abbreviations: ANOVA: analysis of variance; LSD: least significant difference; TLX: task load index.
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Affiliation(s)
- Michael A Nees
- Department of Psychology, Lafayette College, Easton, PA, USA
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Zhou XJ, Dang YY, Wang X, Yang WZ, Lu W, Zhang JH. Factors Influencing Nurses' Work Interruption in Wuhan Isolation Wards During the COVID-19 Pandemic. Med Sci Monit 2021; 27:e929851. [PMID: 34181636 PMCID: PMC8252892 DOI: 10.12659/msm.929851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Through January 2021, the novel coronavirus (COVID-19) continued to create significant pressure on medical staff who have worked to treat patients with the disease and control its spread. This study aimed to increase understanding of the situation and influencing factors of nurses’ work interruption in Wuhan’s isolation ward during the COVID-19 pandemic. Material/Methods A self-designed general situation questionnaire and work interruption questionnaire were used to survey 160 nurses from Beijing, Chongqing, and Jilin who worked during the COVID-19 pandemic in Wuhan in March 2020. The questionnaire could only be answered once by each nurse via a WeChat account. The submitted answers were verified by 2 researchers. Results The results showed that the rate of interruption of work among nurses in the isolation ward was 25%, and the rate of nurses experiencing a negative experience was 96.9%. The results of univariate analysis showed that the following factors were related to the work interruption of the nurses in the isolation ward (all P<0.05): emergency public incident training; emergency public incident treatment experience; knowledge of COVID-19 pneumonia; hours worked per shift in the quarantine area; and negative physiologic experience. Logistic regression analysis showed that negative experience, hours worked per shift, and emergency public incident training were the independent factors influencing work interruption among nurses in the isolation wards. Conclusions The incidence of interruption of work among nurses in the isolation ward was 25%. Negative experiences, long working hours per shift, and lack of emergency public incident training made the nurses more prone to work interruption.
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Affiliation(s)
- Xiao-Juan Zhou
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China (mainland)
| | - Yuan-Yuan Dang
- Department of Neurosurgery, The Seventh Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Xia Wang
- Nursing Department, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China (mainland)
| | - Wen-Zhang Yang
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China (mainland)
| | - Wei Lu
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China (mainland)
| | - Jian-Hua Zhang
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China (mainland)
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Front-Line Human Resource Time-Use for Early Infant HIV Diagnosis: A Comparative Time-Motion Study at Centralized and Point-of-Care Health Facilities in Zimbabwe. J Acquir Immune Defic Syndr 2021; 84 Suppl 1:S70-S77. [PMID: 32520918 DOI: 10.1097/qai.0000000000002364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Point-of-care (POC) assays for early infant diagnosis of HIV (EID) increase access to testing, shorten time to results, and expedite initiation of antiretroviral therapy when compared with laboratory-based assays. However, there is a significant gap in our understanding of its human resource impact at the facility level. This study evaluates front-line health workers' (HWs') time associated with EID. SETTING Using time-motion methodology, we collected time-use data on EID tasks performed by HWs at 3 EID facility types in Zimbabwe-5 POC hubs, 9 POC spokes, and 11 facilities that used centralized laboratories. METHODS Data collectors observed 30 EID processes and 30 HWs' provided self-reported time. Comparisons of mean differences of HWs' time-use between centralized and POC EID were performed with a 2-sample t test with unequal variances. RESULTS Observed average total labor time per EID test at POC facilities was 28 minutes, 22 seconds [95% confidence interval (CI): 22:51 to 35:48], which was equivalent to the average preresult time at facilities using centralized EID. HWs performed other tasks while the machine processed samples. Observed average preresult time (counseling to sample preparation) was 18 minutes, 6 Supported by seconds (95% CI: 13:00 to 23:42) for POC compared with 27 minutes, 48 seconds (95% CI: 23:48 to 32:50) for facilities using centralized laboratories. The mean difference of 9 minutes, 42 seconds (95% CI: 03:04 to 16:18) was statistically significant. The differences in self-reported average total labor time per EID test between HWs at facilities using centralized laboratories or POC were not statistically significant. CONCLUSION Use of POC assays did not incur additional human resource time compared with sending dried blood spots to a centralized laboratory for EID.
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Sarkar S, Vance A, Ramesh B, Demestihas M, Wu DT. The Influence of Professional Subculture on Information Security Policy Violations: A Field Study in a Healthcare Context. INFORMATION SYSTEMS RESEARCH 2020. [DOI: 10.1287/isre.2020.0941] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Influence of Professional Subculture on Information Security Policy Violations: A Field Study in a Healthcare Context
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Affiliation(s)
- Sumantra Sarkar
- School of Management, Binghamton University, State University of New York, Binghamton, New York 13902
| | - Anthony Vance
- Fox School of Business, Temple University, Philadelphia, Pennsylvania 19122
| | | | | | - Daniel Thomas Wu
- Emergency Medicine, Emory University Hospital, Emory University School of Medicine, Atlanta, Georgia 30303
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Różańska A, Gruszka A. Current research trends in multitasking: a bibliometric mapping approach. JOURNAL OF COGNITIVE PSYCHOLOGY 2020. [DOI: 10.1080/20445911.2020.1742130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Bonafide CP, Miller JM, Localio AR, Khan A, Dziorny AC, Mai M, Stemler S, Chen W, Holmes JH, Nadkarni VM, Keren R. Association Between Mobile Telephone Interruptions and Medication Administration Errors in a Pediatric Intensive Care Unit. JAMA Pediatr 2020; 174:162-169. [PMID: 31860017 PMCID: PMC6990809 DOI: 10.1001/jamapediatrics.2019.5001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Incoming text messages and calls on nurses' mobile telephones may interrupt medication administration, but whether such interruptions are associated with errors has not been established. OBJECTIVE To assess whether a temporal association exists between mobile telephone interruptions and subsequent errors by pediatric intensive care unit (PICU) nurses during medication administration. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was performed using telecommunications and electronic health record data from a PICU in a children's hospital. Data were collected from August 1, 2016, through September 30, 2017. Participants included 257 nurses and the 3308 patients to whom they administered medications. EXPOSURES Primary exposures were incoming telephone calls and text messages received on the institutional mobile telephone assigned to the nurse in the 10 minutes leading up to a medication administration attempt. Secondary exposures were the nurse's PICU experience, work shift (day vs night), nurse to patient ratio, and level of patient care required. MAIN OUTCOMES AND MEASURES Primary outcome, errors during medication administration, was a composite of reported medication administration errors and bar code medication administration error alerts generated when nurses attempted to give medications without active orders for the patient whose bar code they scanned. RESULTS Participants included 257 nurses, of whom 168 (65.4%) had 6 months or more of PICU experience; and 3308 patients, of whom 1839 (55.6%) were male, 1539 (46.5%) were white, and 2880 (87.1%) were non-Hispanic. The overall rate of errors during 238 540 medication administration attempts was 3.1% (95% CI, 3.0%-3.3%) when nurses were uninterrupted by incoming telephone calls and 3.7% (95% CI, 3.4%-4.0%) when they were interrupted by such calls. During day shift, the odds ratios (ORs) for error when interrupted by calls (compared with uninterrupted) were 1.02 (95% CI, 0.92-1.13; P = .73) among nurses with 6 months or more of PICU experience and 1.22 (95% CI, 1.00-1.47; P = .046) among nurses with less than 6 months of experience. During night shift, the ORs for error when interrupted by calls were 1.35 (95% CI, 1.16-1.57; P < .001) among nurses with 6 months or more of PICU experience and 1.53 (95% CI, 1.16-2.03; P = .003) among nurses with less than 6 months of experience. Nurses administering medications to 1 or more patients receiving mechanical ventilation and arterial catheterization while caring for at least 1 other patient had an increased risk of error (OR, 1.21; 95% CI, 1.03-1.42; P = .02). Incoming text messages were not associated with error (OR, 0.97; 95% CI, 0.92-1.02; P = .22). CONCLUSIONS AND RELEVANCE This study's findings suggest that incoming telephone call interruptions may be temporally associated with medication administration errors among PICU nurses. Risk of error varied by shift, experience, nurse to patient ratio, and level of patient care required.
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Affiliation(s)
- Christopher P. Bonafide
- Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jeffrey M. Miller
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - A. Russell Localio
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Amina Khan
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Healthcare Quality and Analytics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Adam C. Dziorny
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Division of Pediatric Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Mark Mai
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Division of Pediatric Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Shannon Stemler
- Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Nursing, Christiana Care Health System, Newark, Delaware
| | - Wanxin Chen
- Department of Mathematics, Temple University, Philadelphia, Pennsylvania
| | - John H. Holmes
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Vinay M. Nadkarni
- Division of Pediatric Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Ron Keren
- Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Center for Healthcare Quality and Analytics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Deputy Editor, JAMA Pediatrics
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Case Study: More Patient Safety by Design - System-based Approaches for Hospitals. Adv Health Care Manag 2019. [PMID: 32077657 DOI: 10.1108/s1474-823120190000018001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Since the publication of the report "To Err Is Human: Building a Safer Health System" by the US Institute of Medicine in 2000, much has changed with regard to patient safety. Many of the more recent initiatives to improve patient safety target the behavior of health care staff (e.g., training, double-checking procedures, and standard operating procedures). System-based interventions have so far received less attention, even though they produce more substantial improvements, being less dependent on individuals' behavior. One type of system-based intervention that can benefit patient safety involves improvements to hospital design. Given that people's working environments affect their behavior, good design at a systemic level not only enables staff to work more efficiently; it can also prevent errors and mishaps, which can have serious consequences for patients. While an increasing number of studies have demonstrated the effect of hospital design on patient safety, this knowledge is not easily accessible to clinicians, practitioners, risk managers, and other decision-makers, such as designers and architects of health care facilities. This is why the Swiss Patient Safety Foundation launched its project, "More Patient Safety by Design: Systemic Approaches for Hospitals," which is presented in this chapter.
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Westbrook JI, Li L, Shah S, Lehnbom EC, Prgomet M, Schofield B, Cresswell K, Slee A, Coleman JJ, McCloughan L, Sheikh A. A cross-country time and motion study to measure the impact of electronic medication management systems on the work of hospital pharmacists in Australia and England. Int J Med Inform 2019; 129:253-259. [DOI: 10.1016/j.ijmedinf.2019.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 06/11/2019] [Accepted: 06/16/2019] [Indexed: 10/26/2022]
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Göras C, Olin K, Unbeck M, Pukk-Härenstam K, Ehrenberg A, Tessma MK, Nilsson U, Ekstedt M. Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study. BMJ Open 2019; 9:e026410. [PMID: 31097486 PMCID: PMC6530509 DOI: 10.1136/bmjopen-2018-026410] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The work context of the operating room (OR) is considered complex and dynamic with high cognitive demands. A multidimensional view of the complete preoperative and intraoperative work process of the surgical team in the OR has been sparsely described. The aim of this study was to describe the type and frequency of tasks, multitasking, interruptions and their causes during surgical procedures from a multidimensional perspective on the surgical team in the OR. DESIGN Prospective observational study using the Work Observation Method By Activity Timing tool. SETTING An OR department at a county hospital in Sweden. PARTICIPANTS OR nurses (ORNs) (n=10), registered nurse anaesthetists (RNAs) (n=8) and surgeons (n=9). RESULTS The type, frequency and time spent on specific tasks, multitasking and interruptions were measured. From a multidimensional view, the surgical team performed 64 tasks per hour. Communication represented almost half (45.7%) of all observed tasks. Concerning task time, direct care dominated the surgeons' and ORNs' intraoperative time, while in RNAs' work, it was intra-indirect care. In total, 48.2% of time was spent in multitasking and was most often observed in ORNs' and surgeons' work during communication. Interruptions occurred 3.0 per hour, and the largest proportion, 26.7%, was related to equipment. Interruptions were most commonly followed by professional communication. CONCLUSIONS The surgical team constantly dealt with multitasking and interruptions, both with potential impact on workflow and patient safety. Interruptions were commonly followed by professional communication, which may reflect the interactions and constant adaptations in a complex adaptive system. Future research should focus on understanding the complexity within the system, on the design of different work processes and on how teams meet the challenges of a complex adaptive system. TRIAL REGISTRATION NUMBER 2016/264.
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Affiliation(s)
- Camilla Göras
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Anaesthesia and Intensive Care Unit, Falu Hospital, Falun, Sweden
- Centre for Clinical Research, Falun, Dalarna, Sweden
| | - Karolina Olin
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Development Centre, Turku University Hospital, Turku, Finland
| | - Maria Unbeck
- Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Karin Pukk-Härenstam
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Paediatric Emergency Department, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Ehrenberg
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Mesfin Kassaye Tessma
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Ulrica Nilsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Mirjam Ekstedt
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- School of Health and Caring Sciences, Linneuniversitet, Kalmar, Sweden
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Schutijser BCFM, Klopotowska JE, Jongerden IP, Spreeuwenberg PMM, De Bruijne MC, Wagner C. Interruptions during intravenous medication administration: A multicentre observational study. J Adv Nurs 2018; 75:555-562. [PMID: 30334590 DOI: 10.1111/jan.13880] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/25/2018] [Accepted: 10/02/2018] [Indexed: 11/27/2022]
Abstract
AIMS The aim of this study was to determine the frequency and cause of interruptions during intravenous medication administration, which factors are associated with interruptions and to what extent interruptions influence protocol compliance. BACKGROUND Hospital nurses are frequently interrupted during medication administration, which contributes to the occurrence of administration errors. Errors with intravenous medication are especially worrisome, given their immediate therapeutic effects. However, knowledge about the extent and type of interruptions during intravenous medication administration is limited. DESIGN Multicentre observational study. METHODS Data were collected during two national evaluation studies (2011 - 2012 & 2015 - 2016). Nurses were directly observed during intravenous medication administration. An interruption was defined as a situation where a break during the administration was needed or where a nurse was distracted but could process without a break. Interruptions were categorized according to source and cause. Multilevel logistic regression analyses were conducted to assess the associations between explanatory variables and interruptions or complete protocol compliance. RESULTS In total, 2,526 intravenous medication administration processes were observed. During 291 (12%) observations, nurses were interrupted 321 times. Most interruptions were externally initiated by other nurses (19%) or patients (19%). Less interruptions occurred during the evening (odds ratio: 0.23 [95% confidence interval: 0.08-0.62]). Do-not-disturb vests were worn by 61 (2%) nurses. No significant association was found between being interrupted and complete protocol compliance. CONCLUSION An interruption occurred in every eight observed intravenous medication administration, mainly caused by other nurses or patients. One needs to consider critically which strategies effectively improve safety during the high-risk nursing-task of intravenous medication administration.
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Affiliation(s)
- Bernadette C F M Schutijser
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Joanna E Klopotowska
- Department of Medical Informatics, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Irene P Jongerden
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Martine C De Bruijne
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cordula Wagner
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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Toccafondi G, Balboni F, Gallo M, Colao MG, Mazzarelli G, Tanzini M, Dagliana G, Tartaglia R, Lippi G. Interruptions, work environment and work load perceptions in laboratory medicine: patient safety is a "moving target". Diagnosis (Berl) 2018; 5:167-169. [PMID: 29949509 DOI: 10.1515/dx-2018-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 05/30/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Giulio Toccafondi
- GRC - Center for Patient Safety and Risk Management, Florence, Italy
| | - Fiamma Balboni
- Laboratorio Analisi, Istituto Fiorentino di Cura e Assistenza IFCA, Via del Pergolino 4/6, 50139 Florence, Italy, Phone: +390554296368
| | - Marco Gallo
- Nefrologia e Dialisi Istituto Fiorentino di Cura e Assistenza IFCA, Florence, Italy
| | - Maria Grazia Colao
- SOD Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Gianna Mazzarelli
- SOD Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Michela Tanzini
- GRC - Center for Patient Safety and Risk Management, Florence, Italy
| | - Giulia Dagliana
- GRC - Center for Patient Safety and Risk Management, Florence, Italy
| | | | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Hignett S, Albolino S, Catchpole K. Health and social care ergonomics: patient safety in practice. ERGONOMICS 2018; 61:1-4. [PMID: 28960142 DOI: 10.1080/00140139.2017.1386454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Sue Hignett
- a Healthcare Ergonomics & Patient Safety , Loughborough University , UK
| | - Sara Albolino
- b Center for Clinical Risk Management and Patient Safety , Florence , Italy
| | - Ken Catchpole
- c Clinical Practice and Human Factors, Department of Anesthesia and Perioperative Medicine , Medical University of South Carolina , USA
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