1
|
Owen S, Menzies J, Pontefract S. Educational interventions to reduce nurse medication interruptions: A scoping review. NURSE EDUCATION TODAY 2023; 121:105665. [PMID: 36527755 DOI: 10.1016/j.nedt.2022.105665] [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: 12/06/2021] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Preventable harm from medicines is a global problem creating huge economic and social burden. Interruptions occur frequently in clinical environments causing medication episodes to take longer and having a cognitive cost on the nurse. AIM The aim of this scoping review is to identify and evaluate educational interventions that have been employed to reduce medication interruptions and improve medication safety. METHODS Six databases were searched for the scoping review (PubMed, Embase, Cochrane Library, CINAHL, Pishin and Medline) along with reference lists and grey literature searches. Articles were included if they were written in English, published between 2010 and 2020 and employed an education intervention (including bundled interventions). Databases were searched using keywords and Boolean operators. RESULTS Eight studies met the inclusion criteria. Seven of these studies were conducted in hospital (adults n = 6, paediatric n = 1) and one study in a university with undergraduate nurses. Four studies used a combined intervention and four exclusively employed an education intervention. Five studies found a significant decrease in the number of interruptions post intervention, but one of the studies that exclusively employed an education intervention found no significant difference. Changes in the nurses' behaviour post intervention were also cited in two studies. IMPLICATIONS FOR FUTURE RESEARCH There was a lack of exclusive education interventions, making it difficult to determine the effectiveness of education at reducing medication interruptions. This review highlights the necessity of some interruptions when performing tasks, for example, to make a nurse aware of a deteriorating patient. However, as the majority of studies used the number of interruptions to determine the effectiveness of the intervention, there is uncertainty as to whether this is the right outcome measure to use. In the future, a focus on outcome measures reflecting change in nurse behaviour may be more effective in determining the strength of an educational intervention.
Collapse
Affiliation(s)
- Samantha Owen
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Birmingham Children's Hospital, Birmingham, UK.
| | | | - Sarah Pontefract
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| |
Collapse
|
2
|
Abdelhadi N, Drach‐Zahavy A, Srulovici E. Work interruptions and missed nursing care: A necessary evil or an opportunity? The role of nurses' sense of controllability. Nurs Open 2022; 9:309-319. [PMID: 34612602 PMCID: PMC8685781 DOI: 10.1002/nop2.1064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/29/2021] [Accepted: 09/02/2021] [Indexed: 12/30/2022] Open
Abstract
AIM To explore nurses' experiences with work interruptions (WIs) through the lens of missed nursing care (MNC). DESIGN A qualitative descriptive design. METHODS Eleven small focus groups involving 34 nurses (three nurses per group on average) from acute-care hospital wards were conducted. Nurses shared their experiences with WIs (sources, reactions and decisions) from the MNC perspective. Data analysis was conducted via content analysis. RESULTS A preponderant theme emerged-the dynamic of controllability. Nurses who perceived a sense of controllability felt that they could decide whether to accept or reject the WI, regardless of WI type, and emotions of anger emerged. Conversely, nurses who did not perceive sense of controllability attended the secondary task: MNC occurred, and distress emotions emerged. Results emphasized that nurses are active agents prioritizing whether to omit or complete care in the face of WIs. Controllability, accompanied by active negative emotions, perpetuate a prioritization process that makes it less probable that MNC occurs.
Collapse
Affiliation(s)
- Nasra Abdelhadi
- The Cheryl Spencer Department of NursingUniversity of HaifaHaifaIsrael
| | - Anat Drach‐Zahavy
- The Cheryl Spencer Department of NursingUniversity of HaifaHaifaIsrael
| | - Einav Srulovici
- The Cheryl Spencer Department of NursingUniversity of HaifaHaifaIsrael
| |
Collapse
|
3
|
Gao J, Rae AJ, Dekker SWA. Intervening in Interruptions: What Exactly Is the Risk We Are Trying to Manage? J Patient Saf 2021; 17:e684-e688. [PMID: 28953051 DOI: 10.1097/pts.0000000000000429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Interruptions are thought to be significantly associated with medication administration errors. Researchers have tried to reduce medication errors by decreasing or eliminating interruptions. In this article, we argue that interventions are often (perhaps unreflectively) based on one particular model of risk reduction-that of barriers placed between the source of risk and the object-to-be-protected. Well-intentioned interventions can lead to unanticipated effects because the assumptions created by the risk model are not critically examined. In this article, we review the barrier model and the assumptions it makes about risk and risk reduction/prevention, as well as the model's incompatibility with work in healthcare. We consider how these problems lead to interruptions interventions with unintended negative consequences. Then, we examine possible alternatives, viz organizing work for high reliability, preventing safety drift, and engineering resilience into the work activity. These all approach risks in different ways, and as such, propose interruptions interventions that are vastly different from interventions based on the barrier model. The purpose of this article is to encourage a different approach for designing interruptions interventions. Such reflection may help healthcare communities innovate beyond old, ineffective, and often counterproductive interventions to handle interruptions.
Collapse
Affiliation(s)
- Jonathan Gao
- From the Safety Science Innovation Laboratory, Griffith University, Nathan, Queensland, Australia
| | | | | |
Collapse
|
4
|
Johnson M, Langdon R, Levett-Jones T, Weidemann G, Manias E, Everett B. A cluster randomised controlled feasibility study of nurse-initiated behavioural strategies to manage interruptions during medication administration. Int J Qual Health Care 2019; 31:G67-G73. [PMID: 30834932 DOI: 10.1093/intqhc/mzz007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/09/2018] [Accepted: 01/29/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To examine the feasibility of a behavioural e-learning intervention to support nurses to manage interruptions during medication administration. DESIGN A cluster randomised feasibility trial. SETTING The cluster trial included four intervention and four control wards randomly selected across four metropolitan hospitals in Sydney, Australia. PARTICIPANTS We observed 806 (402 pre-intervention and 404 post-intervention) medication events, where nurses prepared and administered medications to patients within the cluster wards. MAIN OUTCOME MEASURES The primary outcome measured was the observed number of interruptions occurring during administration, with secondary outcomes being the number of clinical errors and procedural failures. Changes in the use of behavioural strategies to manage interruptions, targeted by the e-learning intervention, were also assessed. RESULTS No significant differences were found in the number of interruptions (P = 0.82), procedural failures (P = 0.19) or clinical errors per 100 medications (P = 0.32), between the intervention and control wards. Differences in the use of specific behavioural strategies (engagement and multitasking) were found in the intervention wards. CONCLUSION This behavioural e-learning intervention has not been found to significantly reduce interruptions, however, changes in the use of strategies did occur. Careful selection of clinical settings where there is a high number of predictable interruptions is recommended for further research into the impact of the behavioural e-learning intervention. An increase in the intensity of this intervention is recommended with training undertaken away from the clinical setting. Further research on additional consumer-sensitive interventions is urgently needed.
Collapse
Affiliation(s)
- Maree Johnson
- Office of the Executive Dean, Faculty of Health Sciences, Australian Catholic University, PO Box 968, North Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW, Australia
| | - Rachel Langdon
- Centre for Applied Nursing Research (CANR), Ingham Institute for Applied Medical Research, Western Sydney University, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Tracy Levett-Jones
- Nursing Education, University of Technology, 235 Jones St, Ultimo, NSW, Sydney, Australia
| | - Gabrielle Weidemann
- School of Social Sciences and Psychology, Western Sydney University, Locked Bag, Penrith, NSW 2751, Australia
| | - Elizabeth Manias
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Centre for Quality and Patient Safety Research.,221 Burwood Highway, Burwood, Victoria, Australia, Department of Medicine, University of Melbourne, The Royal Melbourne Hospital, Honorary Professor, The University of Melbourne, Melbourne School of Health Sciences, Royal Parade, Parkville, Victoria 3052, Australia
| | - Bronwyn Everett
- Western Sydney University, School of Nursing and Midwifery, Centre for Applied Nursing Research, Ingham Institute for Applied Medical Research
| |
Collapse
|
5
|
Altiner M, Secginli S, Mathiason MA, Monsen KA. Method Development for Describing Content of Multitasked Interventions Using the Omaha System. Res Theory Nurs Pract 2019; 33:147-168. [DOI: 10.1891/1541-6577.33.2.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundUnderstanding multitasking within nursing and midwifery is needed for efficient, effective, and cost-effective health services. Methods are needed to measure and analyze multitasking in alignment with the nursing process. The Omaha System operationalizes the nursing process and may be a valuable resource for multitasking analysis.PurposeThe purpose of this study was to develop and test a method for describing intervention content of nurse/midwife multitasked interventions using the Omaha System and Time Capture Tool (TimeCaT) in a family health center in Turkey.MethodsEight nurses/midwives were observed with TimeCaT in a family health center in 2016. Preidentified 84 nurse/midwife interventions employed in the center were mapped on Omaha System terms and entered in TimeCaT software for data collection. Co-occurring interventions were analyzed using descriptive and inferential statistics and visualization techniques.ResultsOf 1066.8 total minutes observed, 34.0% included more than one intervention that occurred at the same time. Caretaking/parenting and postpartum problems, teaching, guidance, and counseling category, and caretaking/parenting skills target were more often multitasked than others.Implications for PracticeIt was feasible to use the Omaha System and TimeCaT to categorize, describe, and measure multitasking nursing/midwifery interventions. This method may be applied to other time–motion data when more than one co-occurring intervention is recorded.
Collapse
|
6
|
Johnson M, Levett-Jones T, Langdon R, Weidemann G, Manias E, Everett B. A qualitative study of nurses' perceptions of a behavioural strategies e-learning program to reduce interruptions during medication administration. NURSE EDUCATION TODAY 2018; 69:41-47. [PMID: 30007146 DOI: 10.1016/j.nedt.2018.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 05/14/2018] [Accepted: 06/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES We sought to evaluate the perceptions of nurses of an e-learning educational program to encourage the use of behavioural strategies-blocking, engaging, mediating, multitasking, and preventing-to reduce the negative effects of interruptions during medication administration. DESIGN A qualitative design was used to evaluate the impact of this e-learning educational intervention on nurses' behaviour. SETTINGS Two wards (palliative care and aged care) from two different hospitals within a large local health service within Sydney Australia, were included in the study. These wards were also involved in a cluster randomised trial to test the effectiveness of the program. PARTICIPANTS A purposive sample participated comprising nine registered and enrolled nurses certified to conduct medication administration, who had reviewed the educational modules. METHODS Two focus groups were conducted and these sessions were digitally recorded and transcribed verbatim. Thematic analysis identified seven themes. RESULTS The major themes identified included: perceptions of interruptions, accessing the program, content of the program, impact, maintaining good practice and facilitators and barriers to changing behaviour. CONCLUSIONS The use of embedded authentic images of patient interruptions and management strategies increased some nurses' perceived use of strategies to manage interruptions. Nurses varied in their perception as to whether they could change their behaviour with some describing change at the individual and ward team levels, while others described patient caseload and other health professionals as a barrier. The use of this innovative educational intervention is recommended for staff orientation, student nurses, medical officers and allied health staff. Further research is required in how this e-learning program can be used in combination with other effective interventions to reduce interruptions.
Collapse
Affiliation(s)
- Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, PO Box 968, North Sydney, NSW 2059, Australia.
| | - Tracy Levett-Jones
- University of Technology Sydney, 235 Jones St, Ultimo, NSW 2007, Australia.
| | - R Langdon
- Centre for Applied Nursing Research (CANR), Ingham Institute of Applied Medical Research, Western Sydney University, Locked Bag 7103, Liverpool BC, NSW 1871, Australia.
| | - Gabrielle Weidemann
- School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Elizabeth Manias
- Deakin University, Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Australia; The University of Melbourne, The Royal Melbourne Hospital, Australia; The University of Melbourne, Melbourne School of Health Sciences, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
| | - Bronwyn Everett
- Centre for Applied Nursing Research (a joint initiative of the Western Sydney University and South Western Sydney Local Health District), School of Nursing and Midwifery, Ingham Institute of Applied Medical Research, Australia.
| |
Collapse
|
7
|
Hayes C, Power T, Davidson PM, Daly J, Jackson D. Learning to liaise: using medication administration role-play to develop teamwork in undergraduate nurses. Contemp Nurse 2018; 55:278-287. [PMID: 30092706 DOI: 10.1080/10376178.2018.1505435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Aim: To describe undergraduate nursing students' situational awareness and understanding of effective liaison and collaboration within the nursing team during interrupted medication administration.Background: Medication errors related to interruptions are a major problem in health care, impacting on patient morbidity and mortality and increasing the burden of related costs. Effective liaison, teamwork and situation awareness are requisite skills for nurses to facilitate the safe management of interruptions during medication administration.Method: A role-play simulation was offered to 528 second-year undergraduate Bachelor of Nursing students. Qualitative written reflective responses were subsequently collected and subject to thematic analysis to derive themes.Results: Participants (451:528) reported an improved understanding of an unfamiliar and challenging situation that required cooperation and collaboration amongst the nursing team to improve outcomes.Conclusion(s): This simulation exposed undergraduate nurses with limited clinical experience to a situation otherwise unavailable to them. The skills required to engage in effective liaison and teamwork in dynamic situations are vital elements in achieving quality care and must begin to be taught at an undergraduate level.
Collapse
Affiliation(s)
- Carolyn Hayes
- Faculty of Health, University of Technology Sydney, Building 10 level 6, 235 Jones Street, Broadway, NSW, 2007, Australia
| | - Tamara Power
- Faculty of Health, University of Technology Sydney, Building 10 level 7, 235 Jones Street, Broadway, NSW, 2007, Australia
| | - Patricia M Davidson
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205-2110, USA
| | - John Daly
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia
| | - Debra Jackson
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia
| |
Collapse
|
8
|
Predictability of Interruptions During Medication Administration With Related Behavioral Management Strategies. J Nurs Care Qual 2018; 33:E1-E9. [PMID: 28448303 DOI: 10.1097/ncq.0000000000000260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this qualitative study was to examine the nature of interruptions during medication administration. Focus groups were conducted with medical/surgical nurses (n = 15), critical care nurses (n = 13), and nurse managers/educators/specialists (n = 6). Most interruptions (78%) were predictable. Nurse-adopted strategies included blocking, engaging, mediating, multitasking, and preventing. Educational content was developed that relates behavioral strategies to respond to predictable and unpredictable interruptions.
Collapse
|
9
|
Myers RA, Parikh PJ. Nurses’ work with interruptions: an objective model for testing interventions. Health Care Manag Sci 2017; 22:1-15. [DOI: 10.1007/s10729-017-9417-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/22/2017] [Indexed: 01/08/2023]
|
10
|
Hayes C, Jackson D, Davidson PM, Daly J, Power T. Pondering practice: Enhancing the art of reflection. J Clin Nurs 2017; 27:e345-e353. [PMID: 28493618 DOI: 10.1111/jocn.13876] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to describe the effect that immersive simulation experiences and guided reflection can have on the undergraduate nurses' understanding of how stressful environments impact their emotions, performance and ability to implement safe administration of medications. BACKGROUND Patient safety can be jeopardised if nurses are unsure of how to appropriately manage and respond to interruptions. Medication administration errors are a major patient safety issue and often occur as a consequence of ineffective interruption management. The skills associated with medication administration are most often taught to, and performed by, undergraduate nurses in a controlled environment. However, the clinical environment in which nurses are expected to administer medications is often highly stressed and nurses are frequently interrupted. DESIGN/METHODS This study used role-play simulation and written reflections to facilitate deeper levels of student self-awareness. A qualitative approach was taken to explore students' understanding of the effects of interruptions on their ability to undertake safe medication administration. Convenience sampling of second-year undergraduate nursing students enrolled in a medical-surgical subject was used in this study. Data were obtained from 451:528 (85.42%) of those students and analysed using thematic analysis. RESULTS Students reported increasing consciousness and the importance of reflection for evaluating performance and gaining self-awareness. They described self-awareness, effective communication, compassion and empathy as significant factors in facilitating self-efficacy and improved patient care outcomes. CONCLUSIONS Following a role-play simulation experience, student nurses reported new knowledge and skill acquisition related to patient safety, and new awareness of the need for empathetic and compassionate care during medication administration. Practicing medication administration in realistic settings adds to current strategies that aim to reduce medication errors by allowing students to reflect on and in practice and develop strategies to ensure patient safety. RELEVANCE TO CLINICAL PRACTICE Experiencing clinical scenarios within the safety of simulated environments, offers undergraduate student nurses an opportunity to reflect on practice to provide safer, more empathetic and compassionate care for patients in the future.
Collapse
Affiliation(s)
- Carolyn Hayes
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Debra Jackson
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Oxford Brookes University, Oxford, UK.,University of New England, Armidale, NSW, Australia
| | | | - John Daly
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Tamara Power
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| |
Collapse
|
11
|
Hayes C, Jackson D, Davidson PM, Daly J, Power T. Calm to chaos: Engaging undergraduate nursing students with the complex nature of interruptions during medication administration. J Clin Nurs 2017; 26:4839-4847. [PMID: 28445621 DOI: 10.1111/jocn.13866] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To describe undergraduate student nurse responses to a simulated role-play experience focussing on managing interruptions during medication administration. BACKGROUND Improving patient safety requires that we find creative and innovative methods of teaching medication administration to undergraduate nurses in real-world conditions. Nurses are responsible for the majority of medication administrations in health care. Incidents and errors associated with medications are a significant patient safety issue and often occur as a result of interruptions. Undergraduate nursing students are generally taught medication administration skills in a calm and uninterrupted simulated environment. However, in the clinical environment medication administration is challenged by multiple interruptions. DESIGN/METHODS A qualitative study using convenience sampling was used to examine student perceptions of a simulated role-play experience. Data were collected from 451 of a possible 528 student written reflective responses and subject to thematic analysis. RESULTS Students reported an increased understanding of the impacts of interruptions while administering medications and an improved awareness of how to manage disruptions. This study reports on one of three emergent themes: "Calm to chaos: engaging with the complex nature of clinical practice." CONCLUSIONS Interrupting medication administration in realistic and safe settings facilitates awareness, allows for students to begin to develop management strategies in relation to interruption and increases their confidence. Students were given the opportunity to consolidate and integrate prior and new knowledge and skills through this role-play simulation.
Collapse
Affiliation(s)
- Carolyn Hayes
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Debra Jackson
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia.,Faculty of Health & Life Sciences, Oxford Brookes University, Oxford, UK.,Faculty of Health, Head, WHO UTS Collaborating Centre for Nursing, Midwifery & Health Development, University of Technology Sydney, Broadway, NSW, Australia
| | | | - John Daly
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia.,Faculty of Health, Head, WHO UTS Collaborating Centre for Nursing, Midwifery & Health Development, University of Technology Sydney, Broadway, NSW, Australia
| | - Tamara Power
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| |
Collapse
|
12
|
McCurdie T, Sanderson P, Aitken LM. Traditions of research into interruptions in healthcare: A conceptual review. Int J Nurs Stud 2016; 66:23-36. [PMID: 27951432 DOI: 10.1016/j.ijnurstu.2016.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/06/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Researchers from diverse theoretical backgrounds have studied workplace interruptions in healthcare, leading to a complex and conflicting body of literature. Understanding pre-existing viewpoints may advance the field more effectively than attempts to remove bias from investigations. OBJECTIVE To identify research traditions that have motivated and guided interruptions research, and to note research questions posed, gaps in approach, and possible avenues for future research. METHODS A critical review was conducted of research on interruptions in healthcare. Two researchers identified core research communities based on the community's motivations, philosophical outlook, and methods. Among the characteristics used to categorise papers into research communities were the predominant motivation for studying interruptions, the research questions posed, and key contributions to the body of knowledge on interruptions in healthcare. In cases where a paper approached an equal number of characteristics from two traditions, it was placed in a blended research community. RESULTS A total of 141 papers were identified and categorised; all papers identified were published from 1994 onwards. Four principal research communities emerged: epidemiology, quality improvement, cognitive systems engineering (CSE), and applied cognitive psychology. Blends and areas of mutual influence between the research communities were identified that combine the benefits of individual traditions, but there was a notable lack of blends incorporating quality improvement initiatives. The question most commonly posed by researchers across multiple communities was: what is the impact of interruptions? Impact was measured as a function of task time or risk in the epidemiology tradition, situation awareness in the CSE tradition, or resumption lag (time to resume an interrupted task) in the applied cognitive psychology tradition. No single question about interruptions in healthcare was shared by all four of the core communities. CONCLUSIONS Much research on workplace interruptions in healthcare can be described in terms of fundamental values of four distinct research traditions and the communities that bring the values and methods: of those research traditions to their investigations. Blends between communities indicate that mutual influence has occurred as interruptions research has progressed. It is clear from this review that there is no single or privileged perspective to study interruptions. Instead, these findings suggest that researchers investigating interruptions in healthcare would benefit from being more aware of different perspectives from their own, especially when they consider workplace interventions to reduce interruptions.
Collapse
Affiliation(s)
- Tara McCurdie
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane 4072, Australia.
| | - Penelope Sanderson
- Schools of Information Technology and Electrical Engineering, of Psychology, and of Medicine, The University of Queensland, Brisbane, Australia
| | - Leanne M Aitken
- School of Nursing & Midwifery, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Health Sciences, City University London, London, United Kingdom
| |
Collapse
|
13
|
|
14
|
Ledbetter T, Shultz S, Beckham R. Are Technology Interruptions Impacting Your Bottom Line? An Innovative Proposal for Change. Nurs Forum 2015; 52:232-243. [PMID: 26549217 DOI: 10.1111/nuf.12148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Nursing interruptions are a costly and dangerous variable in acute care hospitals. Malfunctioning technology equipment interrupts nursing care and prevents full utilization of computer safety systems to prevent patient care errors. AIMS This paper identifies an innovative approach to nursing interruptions related to computer and computer cart malfunctions. The impact on human resources is defined and outcome measures were proposed. A multifaceted proposal, based on a literature review, aimed at reducing nursing interruptions is presented. This proposal is expected to increase patient safety, as well as patient and nurse satisfaction. SETTING Acute care hospitals utilizing electronic medical records and bar-coded medication administration technology. PARTICIPANTS Nurses, information technology staff, nursing informatics staff, and all leadership teams affected by technology problems and their proposed solutions. METHODS Literature from multiple fields was reviewed to evaluate research related to computer/computer cart failures, and the approaches used to resolve these issues. RESULTS Outcome measured strategic goals related to patient safety, and nurse and patient satisfaction. Specific help desk metrics will demonstrate the effect of interventions. CONCLUSIONS This paper addresses a gap in the literature and proposes practical and innovative solutions. A comprehensive computer and computer cart repair program is essential for patient safety, financial stewardship, and utilization of resources.
Collapse
Affiliation(s)
- Tamera Ledbetter
- Doctor of Nursing Practice Student, College of Nursing and Health Professions, University of Southern Indiana, Evansville, IN
| | - Sarah Shultz
- Doctor of Nursing Practice Student, College of Nursing and Health Professions, University of Southern Indiana, Evansville, IN
| | - Roxanne Beckham
- Assistant Professor of Nursing, College of Nursing and Health Professions, University of Southern Indiana, Evansville, IN
| |
Collapse
|
15
|
Hayes C, Jackson D, Davidson PM, Power T. Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administration. J Clin Nurs 2015; 24:3063-76. [PMID: 26255621 DOI: 10.1111/jocn.12944] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The purpose of this review was to explore what is known about interruptions and distractions on medication administration in the context of undergraduate nurse education. BACKGROUND Incidents and errors during the process of medication administration continue to be a substantial patient safety issue in health care settings internationally. Interruptions to the medication administration process have been identified as a leading cause of medication error. Literature recognises that some interruptions are unavoidable; therefore in an effort to reduce errors, it is essential understand how undergraduate nurses learn to manage interruptions to the medication administration process. DESIGN Systematic, critical literature review. METHODS Utilising the electronic databases, of Medline, Scopus, PubMed and CINAHL, and recognised quality assessment guidelines, 19 articles met the inclusion criteria. Search terms included: nurses, medication incidents or errors, interruptions, disruption, distractions and multitasking. RESULTS Researchers have responded to the impact of interruptions and distractions on the medication administration by attempting to eliminate them. Despite the introduction of quality improvements, little is known about how nurses manage interruptions and distractions during medication administration or how they learn to do so. A significant gap in the literature exists in relation to innovative sustainable strategies that assist undergraduate nurses to learn how to safely and confidently manage interruptions in the clinical environment. CONCLUSIONS Study findings highlight the need for further exploration into the way nurses learn to manage interruptions and distractions during medication administration. This is essential given the critical relationship between interruptions and medication error rates. RELEVANCE TO CLINICAL PRACTICE Better preparing nurses to safely fulfil the task of medication administration in the clinical environment, with increased confidence in the face of interruptions, could lead to a reduction in errors and concomitant improvements to patient safety.
Collapse
Affiliation(s)
- Carolyn Hayes
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Debra Jackson
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | | | - Tamara Power
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| |
Collapse
|