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Hu H, Zhang M, Wu B, Wu X. Effects of different types of interference on nurses' working memory: An ERP study. J Adv Nurs 2023; 79:4326-4338. [PMID: 37431098 DOI: 10.1111/jan.15784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/08/2023] [Accepted: 06/24/2023] [Indexed: 07/12/2023]
Abstract
AIM To explore the effects of different types of interference on nurses' working memory, and the role of attention control. DESIGN A repeated measures design. METHODS A single-factor, four-level within-subjects design was adopted. Thirty-one nurses completed a delay-recognition task with four blocks in September 2020: Interrupting Stimulus (stimuli requiring attention), Distracting Stimulus (stimuli to-be-ignored), No Interference and Passively View. Behavioural responses of the participants and EEG data were recorded. MATLAB 21b and EEGLAB 21b were used for electroencephalogram data preprocessing and data extraction. RESULTS Firstly, when nursing information system was used as task material, the accuracy rate and false alarm rate of primary tasks under interruption condition was statistically significantly different with that of distraction and no interference condition. There is a statistically significant difference in electroencephalogram measurement between correct and wrong response under interruption. Secondly, the role of attention control was different under interruption and distraction. There was a statistically significant positive correlation between the average amplitude distraction attention control index and task accuracy, and statistically significant negative correlation between the latency interruption attention control index and the accuracy of working memory task. CONCLUSIONS There were different effects of interruptions and distractions on nurses' working memory and the role of attention control were also different. Measures can be designed according to these results to reduce the negative impact of interference on nurses, so as to improve work efficiency and reduce patient risk. IMPACT This study has implications for clinical nursing during human-computer interaction. Resumption of the speed of the target information after an interruption affected task performance. Therefore, interventions should be designed to reduce the time needed for nurses to extract task information after an interruption, such as providing key clues in the information system interface. PATIENT OR PUBLIC CONTRIBUTION Registered nurses participated in the study as subjects.
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Affiliation(s)
- Huiling Hu
- School of Nursing, Peking University, Beijing, P.R. China
| | - Mingming Zhang
- School of Nursing, Peking University, Beijing, P.R. China
| | - Bilin Wu
- School of Nursing, Peking University, Beijing, P.R. China
| | - Xue Wu
- School of Nursing, Peking University, Beijing, P.R. China
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Kramer S, Raymond MJ, Hunter P, Saultry B, Gibbs H, Dignam F, Lannin NA, Bucknall T. Understanding the workflow of nurses in acute and subacute medical wards: A time and motion study. J Clin Nurs 2023; 32:7773-7782. [PMID: 37489643 DOI: 10.1111/jocn.16835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/02/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study was to determine how much time nurses spend on direct and indirect patient care in acute and subacute hospital settings. BACKGROUND Quantifying direct and indirect nursing care provided during inpatient stay is vital to optimise the quality of care and manage resources. DESIGN Time and motion cross-sectional observational study and reported the study according to the STROBE guideline. METHODS Nurses working in an acute or subacute medical wards of a single health service participated. Nurses were observed twice for 2 h on the same day with an observer break in between sessions. Real-time task-related data were digitally recorded using the Work Observation Method By Activity Timing (WOMBAT) tool by a single research assistant. Frequency and time spent on pre-determined tasks were recorded and included direct care, indirect care, documentation, medication-related tasks, communication (professional) and other tasks. Task interruptions and multitasking were also recorded. RESULTS Twenty-one nurses (acute n = 12, subacute n = 9) were observed during shifts between 7 AM and 9 PM in May-July 2021. A total of 7240 tasks were recorded. Nurses spent a third of their time on direct patient care (27% direct care and 3% medication administration). A total of 556 task interruptions occurred, mostly during documentation, and medication-related tasks. A further 1385 tasks were performed in parallel with other tasks, that is multitasking. CONCLUSIONS Time spent on tasks was similar regardless of the setting and was consistent with previous research. We found differences in the distribution of tasks throughout the day between settings, which could have implications for workforce planning and needs to be investigated further. Interruptions occurred during documentation, direct care and medication-related tasks. Local-level strategies should be in place and regularly revised to reduce interruptions and prevent errors. Relevance to clinical practice The association between interruption and increased risk of error is well-established and should be an ongoing area of attention including observations and education provided in local settings.
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Affiliation(s)
- Sharon Kramer
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Centre for Quality and Patient Safety, Deakin University, Melbourne, Victoria, Australia
| | | | | | | | - Harry Gibbs
- Alfred Health, Melbourne, Victoria, Australia
| | | | - Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Tracey Bucknall
- Centre for Quality and Patient Safety, Deakin University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
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Knight E, Sanderson P, Neal A, Ballard T. Interruptions in healthcare: Modeling dynamic processes and effects at a team level. APPLIED ERGONOMICS 2023; 112:104051. [PMID: 37269585 DOI: 10.1016/j.apergo.2023.104051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 06/05/2023]
Abstract
Interruptions are associated with increases in medical errors amongst healthcare professionals, yet interventions to reduce interruptions have not been widely successful. While interruptions can be problematic for the interruptee, they may be necessary for the interrupter to maintain patient safety. To understand the emergent effects of interruptions within a dynamic environment, we develop a computational model that describes how nurses make decisions about interruptions and the effects those decisions have at a team level. Simulations reveal the dynamic interplay between urgency, task importance, the cost of being interrupted and team efficiency, depending on the consequences of clinical or procedural error, and shed light on the ways that the risks from interruptions can be better managed.
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Affiliation(s)
- Emma Knight
- School of Psychology, The University of Queensland, Brisbane, Australia.
| | | | - Andrew Neal
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Timothy Ballard
- School of Psychology, The University of Queensland, Brisbane, Australia
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Krishna A, Murali S, Moran AE, Saxena A, Gill SS, Hering D, Kaur P. Understanding the Role of Staff Nurses in Hypertension Management in Primary Care Facilities in India: A Time-Motion Study. Prev Chronic Dis 2023; 20:E39. [PMID: 37200503 DOI: 10.5888/pcd20.220232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION India is facing a shortage of staff nurses; thus, a better understanding of nurses' workloads is essential for improving and implementing noncommunicable disease (NCD) control strategies. We estimated the proportion of time spent by staff nurses on hypertension and other NCD activities in primary care facilities in 2 states in India. METHODS We conducted a cross-sectional study in 6 purposively selected primary care facilities in Punjab and Madhya Pradesh during July through September 2021. We used a standardized stopwatch to collect data for time spent on direct hypertension activities (measuring blood pressure, counseling, recording blood pressure measurement, and other NCD-related activities), indirect hypertension activities (data management, patient follow-up calls), and non-NCD activities. We used the Mann-Whitney U test to compare the median time spent on activities between facilities using paper-based records and the Simple mobile device-based app (open-source software). RESULTS Six staff nurses were observed for 213 person-hours. Nurses spent 111 person-hours (52%; 95% CI, 45%-59%) on direct hypertension activities and 30 person-hours (14%; 95% CI, 10%-19%) on indirect hypertension activities. The time spent on blood pressure measurement (34 minutes) and documentation (35 minutes) was the maximum time on any given day. Facilities that used paper records spent more median time (39 [IQR, 26-62] minutes) for indirect hypertension activities than those using the Simple app (15 [IQR, 11-19] minutes; P < .001). CONCLUSION Our study found that hypertension activities required more than half of nurses' time in India's primary care facilities. Digital systems can help to reduce the time spent on indirect hypertension activities.
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Affiliation(s)
- Ashish Krishna
- Indian Council of Medical Research - National Institute of Epidemiology, Chennai, Tamil Nadu Housing Board, Ayapakkam, Chennai - 600077
- Resolve to Save Lives, New Delhi, India
| | - Sharan Murali
- Indian Council of Medical Research - National Institute of Epidemiology, Chennai, India
| | - Andrew E Moran
- Resolve to Save Lives, New York, New York
- Columbia University Irving Medical Center, New York, New York
| | - Ashish Saxena
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India
| | - Sandeep Singh Gill
- Department of Health and Family Welfare Punjab, Chandigarh, Punjab, India
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Prabhdeep Kaur
- Indian Council of Medical Research - National Institute of Epidemiology, Chennai, India
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Nurse-to-nurse handoff with distractors and interruptions: An integrative review. Nurse Educ Pract 2023; 67:103550. [PMID: 36709660 DOI: 10.1016/j.nepr.2023.103550] [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: 11/01/2022] [Revised: 12/10/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023]
Abstract
AIM An integrative review of the literature was conducted to explore perceptions of distractors and interruptions during nurse-to-nurse handoff. BACKGROUND Handoff distractors and interruptions are recognized as barriers to effective nurse handoff and may lead to preventable and costly medical errors. However, little is known about the perception of these barriers to nurses and strategies to mitigate distractors and interruptions during nurse-to-nurse handoff. METHODS Using the framework of Whittemore and Knafl, four electronic databases were searched for articles written in English and published in the last five years. Inclusion criteria included: qualitative, quantitative, mixed-methods or quality improvement papers focused on distractors/interruptions during nurse handoff. A multi-author independent review of articles was completed with a rigorous process of data extraction and quality assessment. RESULTS A total of 17 articles were reviewed with findings categorized into the following themes: perceptions of handoff, characteristics of handoff, or logistics of handoff. Nurses reported that interruptions and distractions were a limitation in handoff quality and handoff efficiency, occurring during inter-shift and unit-to-unit handoff. The two most common types of interruptions and distractions were people (patient, family) and environmental factors (equipment alarms). An organized and standardized approach to handoff was recommended, but few specific examples were reported. CONCLUSION Despite recent research related to interruptions and distractions in nurse handoff, few evidence-based strategies have been identified that effectively mitigate these patient safety problems. More evidence is needed to determine best practice methods for handoff training for nurses and nursing students.
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Mohammed T, Mahmud S, Gintamo B, Mekuria ZN, Gizaw Z. Medication administration errors and associated factors among nurses in Addis Ababa federal hospitals, Ethiopia: a hospital-based cross-sectional study. BMJ Open 2022; 12:e066531. [PMID: 36600356 PMCID: PMC9730371 DOI: 10.1136/bmjopen-2022-066531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study was conducted to assess the magnitude and contributing factors of medication administration errors among nurses in federal hospitals in Addis Ababa, Ethiopia. DESIGN A hospital-based cross-sectional study design was employed. Data on medication administration and associated factors were collected using a structured self-administered questionnaire. Multivariable binary logistic regression analysis was done to identify factors associated with medication administration errors on the basis of adjusted OR with 95% CI and a p value less than 0.05. SETTING This study was conducted in federal hospitals in Addis Ababa, Ethiopia. PARTICIPANTS Four hundred and twenty-three randomly selected nurses participated. OUTCOME MEASURES The primary outcome variable is medication administration error, which was ascertained using the following errors: wrong medication, wrong dose, wrong time, wrong route, wrong patient, wrong drug preparation, wrong advice, wrong assessment and wrong documentations. RESULTS A total of 59.9% (95% CI: 55.0% to 64.8%) of the nurses in the federal hospitals in Addis Ababa committed one or more medication administration errors in the last 12 months prior to the survey. The most commonly reported medication errors were wrong time (56.8%), wrong documentation (33.3%), wrong advice (27.8%) and wrong dose (20.1%). Medication administration errors among nurses were significantly associated with short work experience (adjusted OR (AOR): 6.48, 95% CI: 1.32 to 31.78), night shift work (AOR: 5.0, 95% CI: 1.82 to 13.78), absence of on-the-job training (AOR: 3.16, 95% CI: 1.67 to 6.00), unavailability of medication administration guidelines in wards (AOR: 2.07, 95% CI: 1.06 to 4.06) and interruptions during medication administration (AOR: 2.42, 95% CI: 1.30 to 4.49). CONCLUSION It was found that a high proportion of nurses in federal hospitals committed medication administration errors. Short work experience, night shift work, absence of on-the-job training, unavailability of medication administration guidelines and interruptions during medication administration explained the high magnitude of medication administration errors.
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Affiliation(s)
| | - Sindew Mahmud
- Department of Nursing, College of Medical and Health Sciences, Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | - Binyam Gintamo
- Addis Ababa Medical and Business College, Addis Ababa, Ethiopia
- Department of Biotechnology, Faculty of Applied Sciences and Biotechnology, Shoolini University, Bajhol, H P, Solan, India
| | - Zelalem Negash Mekuria
- Addis Ababa Medical and Business College, Addis Ababa, Ethiopia
- Yekatit 12 Medical College, Addis Ababa, Ethiopia
| | - Zemichael Gizaw
- Department of Environmental and Occupational Health and Safety, University of Gondar, Gondar, Ethiopia
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Santos CN, Pedrosa BF, Martins M, Gouveia F, Franco F, Vardasca MJ, Pedro B, Nogueira JD. Interruptions during general practice consultations: negative impact on physicians, and patients' indifference. Fam Pract 2022:cmac129. [PMID: 36409278 DOI: 10.1093/fampra/cmac129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Interruptions can impact consultation duration, doctors and patients' satisfaction, and quality of care provided. Although most of them seem to have a negative impact, affecting doctor-patient relationship and interfering with clinical reasoning, which increases the risk of error, there is still no evidence on their global impact on consultations. OBJECTIVES To evaluate the number and duration of interruptions during general practice consultations. To compare physicians and patients' perceptions of their urgency and impact, as well as the overall satisfaction with the consultation. METHODS Cross-sectional study of a representative sample of annual face-to-face general practice consultations at a Health Centre. Between January and March 2022, anonymous questionnaires were given to physicians and patients after consultation. We performed a descriptive and inferential statistical analysis. RESULTS A total of 403 consultations were included. Physicians reported more interruptions than patients (108 vs. 87, P < 0.001). From patients' perspective those interruptions were more urgent (34.5%) compared with physicians' perspective (20.6%; P = 0.029). Patients undervalued their impact on consultations (7.1% of interruptions with a negative impact among patients vs. 24.7% among doctors; P < 0.001). Interruptions did not interfere with patients' satisfaction with consultation (P = 0.135) but were associated with lower physicians' satisfaction with consultation (P = 0.003). CONCLUSION Physicians are more critical regarding consultations interruptions, being more aware of their incidence and reporting more often a negative impact, which translates into lower satisfaction with interrupted consultations. Patients devalue the occurrence of interruptions, showing no concern about their impact on security or privacy, and their satisfaction is not affected by them.
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Affiliation(s)
| | | | | | - Fábio Gouveia
- USF Ramada, ACeS Loures-Odivelas-ARSLVT, Lisboa, Portugal
| | - Fátima Franco
- USF Ramada, ACeS Loures-Odivelas-ARSLVT, Lisboa, Portugal
| | | | - Bernardo Pedro
- USF Ramada, ACeS Loures-Odivelas-ARSLVT, Lisboa, Portugal
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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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Vanbelleghem S, De Regge M, Van Nieuwenhove Y, Gemmel P. Barriers and Enablers of Second-Order Problem-Solving Behavior: How Nurses Can Break Away From the Workaround Culture. Qual Manag Health Care 2022; 31:130-142. [PMID: 35657734 DOI: 10.1097/qmh.0000000000000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Nurses are challenged by numerous day-to-day unexpected problems due to poorly performing work systems that hinder patient care. These operational failures persist in hospitals, partly because nurses tend to prefer quick fixes or workarounds over real improvements that prevent recurrence. The aim of this review is to shed light on the barriers to and enablers of nurses' second-order problem-solving behavior and their consequences, so that hospitals can learn from failure and improve organizational outcomes. METHODS We conducted a systematic review, with quantitative, qualitative, and mixed-method articles, searching 6 databases (PubMed, Embase, Web of Science, CINAHL, and Google Scholar) following the Preferred Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Quality assessment for inclusion was performed by 2 independent authors using the Mixed Methods Appraisal Tool (MMAT). A descriptive synthesis was used for analysis. RESULTS This study reveals the barriers and enablers for second-order problem-solving behavior, and synthesizes improvement proposals within 3 perspectives, namely the "empowerment" perspective, the "process improvement" perspective, and the "time" perspective. Furthermore, we found that limited attention is given to the patient's perspective, and the existence of a no-action behavior. CONCLUSION Although operational failures have several important consequences for hospital staff and organizations, there has been hardly any research into the barriers and enablers that initiate second-order problem-solving behavior; stemming this nursing behavior has thus rarely appeared as a suggestion for improvement.
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Affiliation(s)
- Sem Vanbelleghem
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium (Mr Vanbelleghem); Departments of Marketing, Innovation and Organization (Drs De Regge and Gemmel) and Public Health and Primary Care (Dr Gemmel), Ghent University, Ghent, Belgium; Departments of Strategic Policy Cell (Dr De Regge) and Gastrointestinal Surgery (Dr Van Nieuwenhove), Ghent University Hospital, Ghent, Belgium; and Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium (Dr Van Nieuwenhove)
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Altamimi MH, Abdelraouf Alfuqaha O, Baniissa AS, AL-Maqbeh WT. Visitors and equipment failure as predictors of interruptions among nurses. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2022. [DOI: 10.15452/cejnm.2021.12.0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Wen MH, Bai D, Lin S, Chu CJ, Hsu YL. Implementation and experience of an innovative smart patient care system: a cross-sectional study. BMC Health Serv Res 2022; 22:126. [PMID: 35093036 PMCID: PMC8801128 DOI: 10.1186/s12913-022-07511-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 01/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background Although a patient care system may help nurses handle patients’ requests or provide timely assistance to those in need, there are a number of barriers faced by nurses in handling alarms. Methods The aim of the study was to describe the implementation and experience of an innovative smart patient care system (SPCS). This study applied a cross-sectional descriptive design. We recruited 82 nurses from a medical center in Taiwan, with 25 nurses from a ward that had introduced an SPCS and 57 nurses from wards that used the traditional patient care system (TPCS). The major advantages of the SPCS compared to the TPCS include the specification of alarm purposes, the routing of alarms directly to the mobile phone; the capability of immediate communication via phone; and three-stage bed-exit alerts with low false alarm rate. Results Approximately 56% of nurses in the TPCS wards perceived that the bed-exit alert was easily ignorable, while this rate was reduced to 32% in the SPCS ward. The immediate communication via phone was considered as the most helpful function of the SPCS, with a weighted average score of 3.92/5, and 52% of nurses strongly agreed (5/5) that this function was helpful. The second-highest ranked function was the three-stage bed-exit alert, with an average score of 3.68/5, with approximately 24% of nurses strongly agreeing (5/5) that this function was helpful. The average response time using TPCS was 145.66 s while it was 59.02 s using the SPCS (P < .001). Among the 110 observed alarms in the SPCS ward, none of them were false bed-exit alarms. In comparison, among 120 observed alarms in the TPCS wards, 42 (35%) of them were false bed-exit alarms (P < .001). In this study, we found that 30.91% of alarms using SPCS were processed because nurses received and responded to the alert via mobile phone. Conclusions A smart patient care system is needed to help nurses make more informed prioritization decisions between responding to alarms and ongoing tasks and finally assist them in adjusting their work in various situations to improve work efficiency and care quality.
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Freitas WCJD, Menezes AC, Mata LRFD, Lira ALBDC, Januário LH, Ribeiro HCTC. Interruption in the work of nursing professionals: conceptual analysis. Rev Bras Enferm 2021; 75:e20201392. [PMID: 34705993 DOI: 10.1590/0034-7167-2020-1392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/18/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze the concept of "interruption in the work of nursing professionals". METHODS conceptual study according to the method proposed by Walker and Avant through integrative literature review. The study searched the databases using the descriptors: "Attention", "Attention Bias", "Health Personnel", "Nurses", "Patient Safety" and "Medical Malpractices". The sample consisted of 36 studies. RESULTS the antecedents were alarms, answering phone calls, providing patient care, and lack of material/medicine. The defining attributes were pause, suspension, breakage, and intrusion. In relation to the consequences, the study highlighted the increase in frequency and severity of medication errors and change of focus. FINAL CONSIDERATIONS theconceptual analysis identified the attributes, antecedents, and consequences and allowed to build an operational definition for "interruption in the work of nursing professionals". It will contribute to the improvement of the work process and the creation of strategies that ensure safer care for the patient.
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van den Oetelaar WFJM, Roelen CAM, Grolman W, Stellato RK, van Rhenen W. Exploring the relation between modelled and perceived workload of nurses and related job demands, job resources and personal resources; a longitudinal study. PLoS One 2021; 16:e0246658. [PMID: 33635900 PMCID: PMC7909623 DOI: 10.1371/journal.pone.0246658] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 01/24/2021] [Indexed: 12/21/2022] Open
Abstract
Aim Calculating a modelled workload based on objective measures. Exploring the relation between this modelled workload and workload as perceived by nurses, including the effects of specific job demands, job resources and personal resources on the relation. Design Academic hospital in the Netherlands. Six surgical wards, capacity 15–30 beds. Data collected over 15 consecutive day shifts. Methods Modelled workload is calculated as a ratio of required care time, based on patient characteristics, baseline care time and time for non-patient related activities, and allocated care time, based on the amount of available nurses. Both required and allocated care time are corrected for nurse proficiency. Five dimensions of perceived workload were determined by questionnaires. Both the modelled and the perceived workloads were measured on a daily basis. Linear mixed effects models study the longitudinal relation between this modelled and workload as perceived by nurses and the effects of personal resources, job resources and job demands. ANOVA and post-hoc tests were used to identify differences in modelled workload between wards. Results Modelled workload varies roughly between 70 and 170%. Significant differences in modelled workload between wards were found but confidence intervals were wide. Modelled workload is positively associated with all five perceived workload measures (work pace, amount of work, mental load, emotional load, physical load). In addition to modelled workload, the job resource support of colleagues and job demands time spent on direct patient care and time spent on registration had the biggest significant effects on perceived workload. Conclusions The modelled workload does not exactly predict perceived workload, however there is a correlation between the two. The modelled workload can be used to detect differences in workload between wards, which may be useful in distributing workload more evenly in order prevent issues of over- and understaffing and organizational justice. Extra effort to promote team work is likely to have a positive effect on perceived workload. Nurse management can stimulate team cohesion, especially when workload is high. Registered nurses perceive a higher workload than other nurses. When the proportion of direct patient care in a workday is higher, the perceived workload is also higher. Further research is recommended. The findings of this research can help nursing management in allocating resources and directing their attention to the most relevant factors for balancing workload.
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Affiliation(s)
| | | | - Wilko Grolman
- Division of Surgical Specialties, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Rebecca K. Stellato
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Willem van Rhenen
- ArboUnie Occupational Health Service, Utrecht, the Netherlands
- Center for Human Resource Organization and Management Effectiveness, Business University Nyenrode, Breukelen, the Netherlands
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Valipoor S, Bosch SJ. In the Moment: Fostering Mindfulness and Reducing Stressors in the Healthcare Workplace. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:386-398. [PMID: 33535815 DOI: 10.1177/1937586720988243] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While healthcare design research has primarily focused on patient outcomes, there is a growing recognition that environmental interventions could do more by promoting the overall quality of care, and this requires expanding the focus to the health and well-being of those who deliver care to patients. Healthcare professionals are under high levels of stress, leading to burnout, job dissatisfaction, and poor patient care. Among other tools, mindfulness is recommended as a way of decreasing stress and helping workers function at higher levels. This article aims to identify potential environmental strategies for reducing work-related stressors and facilitating mindfulness in healthcare settings. By examining existing evidence on workplace mindfulness and stress-reducing design strategies, we highlight the power of the physical environment in not only alleviating stressful conditions but intentionally encouraging a mindful perspective. Strategies like minimizing distractions or avoiding overstimulation in the healthcare environment can be more effective if implemented along with the provision of designated spaces for mindfulness-based programs. Future research may explore optimal methods and hospital workers' preferences for environments that support mindfulness and stress management. The long-term goal of all these efforts is to enhance healthcare professionals' well-being, reignite their professional enthusiasm, and help them be resilient in times of stress.
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Affiliation(s)
- Shabboo Valipoor
- Department of Interior Design, College of Design, Construction and Planning, 3463University of Florida, Gainesville, FL, USA
| | - Sheila J Bosch
- Department of Interior Design, College of Design, Construction and Planning, 3463University of Florida, Gainesville, FL, USA
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Interrupções de atividades de enfermeiros: contribuições para a segurança do paciente e do profissional. ACTA PAUL ENFERM 2020. [DOI: 10.37689/acta-ape/2020ao0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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O' Neill SB, Vijayasarathi A, Nicolaou S, Walstra F, Salamon N, Munk PL, Khosa F. Evaluating Radiology Result Communication in the Emergency Department. Can Assoc Radiol J 2020; 72:846-853. [PMID: 32063052 DOI: 10.1177/0846537119899268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess the pattern of result communication that occurs between radiologists and referring physicians in the emergency department setting. METHODS An institutional review board-approved prospective study was performed at a large academic medical center with 24/7 emergency radiology cover. Emergency radiologists logged information regarding all result-reporting communication events that occurred over a 168-hour period. RESULTS A total of 286 independent result communication events occurred during the study period, the vast majority of which occurred via telephone (232/286). Emergency radiologists spent 10% of their working time communicating results. Similar amounts of time were spent discussing negative and positive cross-sectional imaging examinations. In a small minority of communication events, additional information was gathered through communication that resulted in a change of interpretation from a normal to an abnormal study. CONCLUSIONS Effective and efficient result communication is critical to care delivery in the emergency department setting. Discussion regarding abnormal cases, both in person and over the phone, is encouraged. However, in the emergency setting, time spent on routine direct communication of negative examination results in advance of the final report may lead to increased disruptions, longer turnaround times, and negatively impact patient care. In very few instances, does the additional information gained from the communication event result in a change of interpretation?
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Affiliation(s)
- Siobhan B O' Neill
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arvind Vijayasarathi
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Savvas Nicolaou
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frances Walstra
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Noriko Salamon
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Peter L Munk
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Faisal Khosa
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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van den Oetelaar WFJM, van Rhenen W, Stellato RK, Grolman W. Balancing workload of nurses: Linear mixed effects modelling to estimate required nursing time on surgical wards. Nurs Open 2020; 7:235-245. [PMID: 31871707 PMCID: PMC6917947 DOI: 10.1002/nop2.385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/14/2019] [Accepted: 09/02/2019] [Indexed: 11/08/2022] Open
Abstract
Aim Quantifying the relation between patient characteristics and care time and explaining differences in nursing time between wards. Design Academic hospital in the Netherlands. Six surgical wards, capacity 15-30 beds, 2012-2014. Methods Linear mixed effects model to study the relation between patient characteristics and care time. Estimated marginal means to estimate baseline care time and differences between wards. Results Nine patient characteristics significantly related to care time. Most required between 18 and 35 min extra, except "two or more IV/drip/drain" (8) and "one-on-one care" (156). Care time for minimum patient profile: 44-57 min and for average patient profile: 75-88 min. Sources of variation: nurse proficiency, patients, day-to-day variation within patients. The set of characteristics is short, simple and useful for planning and comparing workload. Explained variance up to 36%. Calculating estimated means per ward has not been done before. Nurse proficiency is an important factor.
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Affiliation(s)
| | - Willem van Rhenen
- Center for Human Resource Organization and Management EffectivenessBusiness University NyenrodeBreukelenThe Netherlands
- Arbo UnieUtrechtThe Netherlands
| | - Rebecca K. Stellato
- University Medical Center UtrechtUniversity of UtrechtUtrechtThe Netherlands
| | - Wilko Grolman
- University Medical Center UtrechtUniversity of UtrechtUtrechtThe Netherlands
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Sabat S, Kalapos P, Slonimsky E. Quantifying disruption of workflow by phone calls to the neuroradiology reading room. BMJ Open Qual 2019; 8:e000442. [PMID: 31637315 PMCID: PMC6768390 DOI: 10.1136/bmjoq-2018-000442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/12/2019] [Accepted: 08/18/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction The purpose of this study was to understand the source and the reason for the phone calls to our neuroradiology suit and to quantify the size of the problem in terms of duration of individual and aggregated calls. Materials and methods Observation of the neuroradiology reading room for the entire duration of the working hours over three non-consecutive days was performed, and included telephone calls start time, end time and calls duration for incoming telephone calls. After each phone call the recipients were queried on the details of the phone call; the origin of the call, the reason for the call and the response. Results The average total number of minutes (min) spent on the phone each day was 64 min per working day with a total of 39 phone calls per day and 4.4 per hour on average. The trainees answered 71% of the phone calls with additional intervention by attending in 13% of phone calls. The most common source of phone calls was from either the MRI/CT technicians (48%), followed by providers (20%) and returning pages (18%). Conclusion Cumulative time spent on the phone by neuroradiologists in the reading room ended up in more than an hour per working day, while trainees were taking the majority of phone calls. Most phone calls originated from technicians, hence, requiring specific solutions to mitigate this kind of interruption.
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Affiliation(s)
- Shyam Sabat
- Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Paul Kalapos
- Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Einat Slonimsky
- Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
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Sassaki RL, Cucolo DF, Perroca MG. Interruptions and nursing workload during medication administration process. Rev Bras Enferm 2019; 72:1001-1006. [PMID: 31432958 DOI: 10.1590/0034-7167-2018-0680] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/28/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate the sources and causes of interruptions during the medication administration process performed by a nursing team and measure its frequency, duration and impact on the team's workload. MÉTODOS This is an observational study that timed 121 medication rounds (preparation, administration and documentation) performed by 15 nurses and nine nursing technicians in a Neonatal Intensive Care Unit in the countryside of the state of São Paulo. RESULTADOS 63 (52.1%) interruptions were observed. In each round, the number of interruptions that happened ranged from 1-7, for 127 in total; these occurred mainly during the preparation phase, 97 (76.4%). The main interruption sources were: nursing staff - 48 (37.8%) - and self-interruptions - 29 (22.8%). The main causes were: information exchanges - 54 (42.5%) - and parallel conversations - 28 (22%). The increase in the mean time ranged from 53.7 to 64.3% (preparation) and from 18.3 to 19.2% (administration) - p≤0.05. CONCLUSÃO Interruptions in the medication process are frequent, interfere in the workload of the nursing team and may reflect on the safety of care.
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Affiliation(s)
| | | | - Marcia Galan Perroca
- Faculdade de Medicina de São José do Rio Preto. São José do Rio Preto, São Paulo, Brazil
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Rhudy LM, Johnson MR, Krecke CA, Keigley DS, Schnell SJ, Maxson PM, McGill SM, Warfield KT. Change-of-Shift Nursing Handoff Interruptions: Implications for Evidence-Based Practice. Worldviews Evid Based Nurs 2019; 16:362-370. [PMID: 31328379 DOI: 10.1111/wvn.12390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The importance of change-of-shift handoffs in maintaining patient safety has been well demonstrated. Change-of-shift handoff is an important source of data used in surveillance, a nursing intervention aimed at identifying and preventing complications. Surveillance requires the nurse to acquire, process, and synthesize information (cues) encountered during patient care. Interruptions in handoff have been observed but there is a gap in the evidence concerning how interruptions during nurse-to-nurse handoff impact the change-of-shift handoff process. AIMS To describe registered nurses' perceptions of interruptions experienced during change-of-shift handoff at the bedside in critical care units and analyze the number, type, and source of interruptions during change-of-shift handoff at the bedside. METHODS An exploratory descriptive design was used. One hundred nurse-to-nurse handoffs were observed, and four focus groups were conducted. Observation data were analyzed with descriptive statistics and quantitative content analysis. Focus group data were analyzed with qualitative content analysis. RESULTS AND FINDINGS Of the 1,196 interruptions observed, 800 occurred in the communication between the two nurses involved in the handoff. Over 80% (645) of these interruptions were from the nurse receiving handoff and included questions or clarification of information received. About half of the nurses reported that interruptions occurred during handoff. Focus group findings revealed that whether or not something is an interruption is determined by the individual nurse's appraisal of value added to their knowledge of the patient and/or plan of care at the time of handoff. LINKING EVIDENCE TO ACTION Interruptions during handoff are evaluated as useful or disruptive based on the value to the nurse at the time. Strict structuring or mandating of handoff elements may limit nurses' ability to communicate information deemed most relevant to the care of a specific unique patient.
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Affiliation(s)
- Lori M Rhudy
- Department of Nursing, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | - Sharon M McGill
- University of Minnesota School of Nursing, Minneapolis, MN, USA
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22
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Bell L, James R, Rosa J, Pollentine A, Pettet G, McCoubrie P. Reducing interruptions during duty radiology shifts, assessment of its benefits and review of factors affecting the radiology working environment. Clin Radiol 2018; 73:759.e19-759.e25. [DOI: 10.1016/j.crad.2018.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 04/11/2018] [Indexed: 11/28/2022]
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Alteren J, Hermstad M, White J, Jordan S. Conflicting priorities: Observation of medicine administration. J Clin Nurs 2018; 27:3613-3621. [DOI: 10.1111/jocn.14518] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Johanne Alteren
- Faculty of Nursing and Health Science; Nord University - Mo i Rana; Mo i Rana Norway
| | | | - Jo White
- Department of Public Health, Policy and Social Sciences; Swansea University; Swansea UK
| | - Susan Jordan
- Department of Nursing; Swansea University; Swansea UK
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McCurdie T, Sanderson P, Aitken LM. Applying social network analysis to the examination of interruptions in healthcare. APPLIED ERGONOMICS 2018; 67:50-60. [PMID: 29122200 DOI: 10.1016/j.apergo.2017.08.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/06/2017] [Accepted: 08/28/2017] [Indexed: 06/07/2023]
Abstract
Examinations of interruptions in healthcare often focus on a single clinical discipline, and solutions are targeted accordingly. This approach does not take into account the inter-disciplinary dependencies and other sociotechnical aspects that make up the healthcare work system, and suggested solutions may not meet the needs of all stakeholders. In this article a sociotechnical systems perspective is used to uncover the interdependencies between 16 unique work roles that result in interruptions in an intensive care unit (ICU). By applying social network analysis techniques to data collected using the Dual Perspectives Method, we identified targeted systems-based interventions that may reduce unnecessary interruptions while avoiding unintended consequences that impose additional burden on ICU staff. The rich insights gained into the interruptive communication patterns in the ICU work system stand in contrast to findings that would have otherwise been obtained by focusing only on a single clinical discipline or a single perspective.
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Affiliation(s)
- Tara McCurdie
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.
| | - Penelope Sanderson
- Schools of Information Technology and Electrical Engineering, of Psychology, and of Clinical 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 of London, London, United Kingdom
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Thomson H, Tourangeau A, Jeffs L, Puts M. Factors affecting quality of nurse shift handover in the emergency department. J Adv Nurs 2017; 74:876-886. [DOI: 10.1111/jan.13499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Heather Thomson
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
| | - Ann Tourangeau
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
| | - Lianne Jeffs
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
- St. Michael's Hospital; Toronto ON Canada
- Institute for Health Policy Management and Evaluation; University of Toronto; Toronto ON Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
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Impact of Interruptions, Distractions, and Cognitive Load on Procedure Failures and Medication Administration Errors. J Nurs Care Qual 2017; 32:309-317. [PMID: 28448299 DOI: 10.1097/ncq.0000000000000256] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Medication administration errors are difficult to intercept since they occur at the end of the process. The study describes interruptions, distractions, and cognitive load experienced by registered nurses during medication administration and explores their impact on procedure failures and medication administration errors. The focus of this study was unique as it investigated how known individual and environmental factors interacted and culminated in errors.
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Sassaki RL, Perroca MG. Interruptions and their effects on the dynamics of the nursing work. ACTA ACUST UNITED AC 2017; 38:e67284. [PMID: 28746518 DOI: 10.1590/1983-1447.2017.02.67284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 05/08/2017] [Indexed: 11/21/2022]
Abstract
Objectives To investigate the nurses' perception about interruptions during the workflow and their implications on the professional practice environment. Methods A survey was conducted with 133 nurses in a school hospital in the state of São Paulo from October 2015 to March 2016, through the use of a self-administered questionnaire. For data analysis, Chi-square and Fischer tests have been used. Results Most of the nurses have reported frequent and recurring interruptions during their work activities. The interruptive processes are more frequent during the documentation process (n=118; 91.5%) and guidance to the patient/family (n=58; 45%). They are caused by the ringing of the phone (n=114; 87%), and by problem solving in the unit (n=107; 81.7%). Conclusions According to the nurses' opinion, the interruptive processes have repercussions on the working dynamics, on the caring process and on the patient's safety.
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Affiliation(s)
- Renata Longhi Sassaki
- Faculdade de Medicina de São José do Rio Preto (FAMERP). São José do Rio Preto, São Paulo, Brasil
| | - Márcia Galan Perroca
- Faculdade de Medicina de São José do Rio Preto (FAMERP), Departamento de Enfermagem Especializada. São José do Rio Preto, São Paulo, Brasil
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Implementing a Distraction-Free Practice With the Red Zone Medication Safety Initiative. Dimens Crit Care Nurs 2017; 35:116-24. [PMID: 27043397 DOI: 10.1097/dcc.0000000000000179] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The incidence of medication errors remains a continued concern across the spectrum of health care. Approaches to averting medication errors and implementing a culture of safety are key areas of focus for most institutions. We describe our experience of implementing a distraction-free medication safety practice across a large free-standing children's hospital. METHODS A nurse-led interprofessional group was convened to develop a program-wide quality improvement process for the practice of medication safety. A key driver diagram was developed to guide the Red Zone Medication Safety initiative. Change acceleration process was used to evaluate the implementation and impact of the initiative. RESULTS Since implementation in 2010, there has been a significant reduction in medication events of 79.2% (P = .00184) and 65.3% (P = .035) (in the cardiac intensive care unit and acute care cardiac unit, respectively), including months with unprecedented zero reportable medication events. There also has been a sustained decrease in the number of events reaching the patient (33.3% in the cardiac intensive care unit and 57.1% in the acute care cardiac unit). CONCLUSIONS The implementation of a distraction-free practice was found to be feasible and effective, demonstrating a sustained decrease in the overall number of medication events, event rate, and number of events reaching patients. This interprofessional approach was successful in a large inpatient cardiovascular program and then effectively transferred across all hospital inpatient units. Additional sites of implementation include other high-risk patient care areas such as procedure/operative units.
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Abstract
This study investigated the relationships between seven workload factors and patient and nurse outcomes. (1) Background: Health systems researchers are beginning to address nurses’ workload demands at different unit, job and task levels; and the types of administrative interventions needed for specific workload demands. (2) Methods: This was a cross-sectional correlational study of 472 acute care nurses from British Columbia, Canada. The workload factors included nurse reports of unit-level RN staffing levels and patient acuity and patient dependency; job-level nurse perceptions of heavy workloads, nursing tasks left undone and compromised standards; and task-level interruptions to work flow. Patient outcomes were nurse-reported frequencies of medication errors, patient falls and urinary tract infections; and nurse outcomes were emotional exhaustion and job satisfaction. (3) Results: Job-level perceptions of heavy workloads and task-level interruptions had significant direct effects on patient and nurse outcomes. Tasks left undone mediated the relationships between heavy workloads and nurse and patient outcomes; and between interruptions and nurse and patient outcomes. Compromised professional nursing standards mediated the relationships between heavy workloads and nurse outcomes; and between interruptions and nurse outcomes. (4) Conclusion: Administrators should work collaboratively with nurses to identify work environment strategies that ameliorate workload demands at different levels.
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Understanding Nurses' Strategies to Handle (Un)wanted Nurse Calls: A Resilience Perspective. Comput Inform Nurs 2017; 35:289-299. [PMID: 28195836 DOI: 10.1097/cin.0000000000000331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nurse calls in a hospital can constitute either positive or negative (wanted or unwanted) interruptions depending on various factors. This study aims to understand nurses' strategies in facilitating the reception of wanted nurse calls and the restriction of unwanted nurse calls. Applying a resilience engineering perspective, nurses' performance variability is investigated as a basis to design appropriate computer support to enhance efficiency and patient safety. A qualitative case study was conducted for a period of 4 years with focus on nurses' use of a wireless nurse call system at a Norwegian university hospital. The study involved various data collection methods such as observations, interviews, and workshops. The collected data were then transcribed and analyzed using a combined inductive and deductive approach. Results indicate that nurses use four main strategies involving a large degree of collaboration to allow or avoid interruptions in the form of nurse calls depending on situation and circumstances. However, these strategies are not supported by the wireless nurse call system, which requires nurses to use suboptimal workarounds to enable the necessary performance variability. Interruptions have been largely perceived as a threat to patient safety. However, nurses' handling of calls illustrates that, when aiming to introduce interventions to manage interruptions, a detailed understanding of work as done is important. Nurses continuously make appropriate adjustments to cope with challenges that characterize hospital work to ensure efficient and safe operations. Hence, technology, in terms of a nurse call system, needs to be designed to afford the adjustments made to support a resilient practice and, as such, leverage patient safety.
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Monteiro C, Avelar AFM, Pedreira MDLG. Interruptions of nurses' activities and patient safety: an integrative literature review. Rev Lat Am Enfermagem 2017; 23:169-79. [PMID: 25806646 PMCID: PMC4376046 DOI: 10.1590/0104-1169.0251.2539] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 11/05/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to identify characteristics related to the interruption of nurses in professional practice, as well as to assess the implications of interruptions for patient safety. METHOD integrative literature review. The following databases were searched: Pubmed/Medline, LILACS, SciELO and Cochrane Library, using the descriptors interruptions and patient safety. An initial date was not established, but the final date was December 31, 2013. A total of 29 papers met the inclusion criteria. RESULTS all the papers included describe interruptions as a harmful factor for patient safety. Data analysis revealed three relevant categories: characteristics of interruptions, implications for patient safety, and interventions to minimize interruptions. CONCLUSION interruptions favor the occurrence of errors in the health field. Therefore, there is a need for further studies to understand such a phenomenon and its effects on clinical practice.
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Affiliation(s)
- Cintia Monteiro
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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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.
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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
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Prates DDO, Silva AEBDC. Interruptions of activities experienced by nursing professionals in an intensive care unit. Rev Lat Am Enfermagem 2016; 24:e2802. [PMID: 27627123 PMCID: PMC5048727 DOI: 10.1590/1518-8345.0997.2802] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 04/12/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the interruptions experienced by nursing professionals while undertaking care activities. METHOD an observational study undertaken in two intensive care units. Two nurses observed 33 nursing professionals for three hours. The data were recorded in real time, using a semistructured instrument. RESULTS after 99 hours of observation of 739 activities, it was identified that 46.82% were interrupted, resulting in 7.85 interruptions per hour. On average, the interruptions compromised 9.42% of the nursing professionals' worktime. The activities geared towards indirect care of the patient suffered the highest number of interruptions (56.65%), with the nursing records being the activity interrupted most. The principal source of the interruptions was external, coming from the health professionals (51%), and the main causes were those related to the patients (34.70%) and to interpersonal communication (26.47%). CONCLUSION the activity of nursing suffers a high number of interruptions, mainly caused by the health professionals themselves, indicating that the work environment needs to undergo interventions aiming to reduce the risk of compromising of the professional's performance and to increase the patients' safety. OBJETIVO analisar as interrupções experienciadas por profissionais de enfermagem durante realização de atividades assistenciais. MÉTODO estudo observacional realizado em duas unidades de tratamento intensivo. Dois enfermeiros observaram 33 profissionais de enfermagem, por três horas. Os dados foram registrados em tempo real, usando um instrumento semiestruturado. RESULTADOS após 99 horas de observação de 739 atividades, foi identificado que 46,82% sofreram interrupções, perfazendo 7,85 interrupções por hora. As interrupções comprometeram, em média, 9,42% do tempo de trabalho dos profissionais de enfermagem. As atividades direcionadas ao cuidado indireto do paciente foram as que sofreram maior número de interrupções (56,65%), sendo o registro de enfermagem a atividade mais interrompida. A principal fonte das interrupções foi externa, proveniente dos profissionais de saúde (51%), e as principais causas foram as relacionadas aos pacientes (34,70%) e às comunicações interpessoais (26,47%). CONCLUSÃO A enfermagem sofre um grande número de interrupções, causadas principalmente pelos próprios profissionais de saúde, indicando que o ambiente de trabalho deve sofrer intervenções que objetivem reduzir o risco de comprometimento do desempenho do profissional e aumentar a segurança dos pacientes. OBJETIVO analizar las interrupciones experimentadas por profesionales de enfermería durante la realización de actividades asistenciales. MÉTODO estudio observacional realizado en dos unidades de tratamiento intensivo. Dos enfermeros observaron 33 profesionales de enfermería, durante tres horas. Los datos fueron registrados en tiempo real, usando un instrumento semiestructurado. RESULTADOS después de 99 horas de observación de 739 actividades, fue identificado que 46,82% sufrieron interrupciones, haciendo 7,85 interrupciones por hora. En promedio, las interrupciones comprometieron 9,42% del tiempo de trabajo de los profesionales de enfermería. Las actividades orientadas al cuidado indirecto del paciente fueron las que sufrieron el mayor número de interrupciones (56,65%), siendo el registro de enfermería la actividad más interrumpida. La principal fuente de interrupciones fue externa, proveniente de los profesionales de la salud (51%), y las principales causas fueron las relacionadas a pacientes (34,70%) y a comunicaciones interpersonales (26,47%). CONCLUSIÓN La enfermería sufre un gran número de interrupciones, causadas principalmente por los propios profesionales de la salud, indicando que el ambiente de trabajo debe sufrir intervenciones que objetiven reducir el riesgo de comprometer el desempeño del profesional y aumentar la seguridad de los pacientes.
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Filer HM, Beringuel BL, Frato KM, Anthony MK, Saenyakul P. Interruptions in Preanesthesia Nursing Workflow: A Pilot Study of Pediatric Patient Safety. J Perianesth Nurs 2016; 32:112-120. [PMID: 28343636 DOI: 10.1016/j.jopan.2015.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/27/2015] [Accepted: 01/28/2015] [Indexed: 10/21/2022]
Abstract
PURPOSE Preanesthesia care is a high-risk system where interruptions during the preanesthesia assessment may jeopardize the quality of information obtained. The objective of this study was to (1) identify the number and nature of interruptions occurring during the nursing preanesthesia assessment, (2) evaluate effectiveness of a no interruption zone (NIZ) on the number and nature of interruptions experienced, and (3) determine the frequency with which nurses returned to their original task after interruption. DESIGN A pre-post, quasi-experimental pilot study design was used. METHODS Study included observational methodology to compare the number and nature of interruptions which occurred during the preanesthesia assessment before and after implementation of a NIZ. FINDINGS There was a statistically significant decrease in interruptions per observation after implementation of a NIZ with physical and verbal interruptions being the most common. Nurses returned to the original task more often after the implementation of the NIZ. CONCLUSION Findings suggest use of a NIZ decreased interruptions experienced by nurses and thereby decreases the potential for workflow fragmentation.
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Jahrsdoerfer M. Case Study: Reducing Interruption Fatigue through Improved Alarm Support. Biomed Instrum Technol 2016; 50:109-13. [PMID: 27046685 DOI: 10.2345/0899-8205-50.2.109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Yi L, Seo HB. The effect of hospital unit layout on nurse walking behavior. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2016; 6:66-82. [PMID: 23224843 DOI: 10.1177/193758671200600104] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To confirm a new method for the research question, "How do different hospital unit layouts affect nurses' walking behavior and distance?" BACKGROUND Concern is renewed regarding nurses' long walking distances because of the trend toward larger patient rooms with family areas inside, resulting in a larger overall unit size. Studies have found unit design characteristics that support nurses' efficient walking, but few have done it in units designed for patient- and family-centered care. To examine the effect of unit design on nurses' walking behavior, the authors propose a new method of observing a specific task. METHODS The authors observed nurses during the task of medication administration. RESULTS Contrary to their hypotheses, results showed: (1) Experienced nurses had more unnecessary stops and longer walking distances than new nurses because of interactions; and (2) nurses in the smaller wing of the unit walked more than those in the larger wing of the same unit. The authors posit that the closeness between the nurses' path to the medication supply room and the central nurses' station affected the frequency of interactions and prompted a deviation from the shortest and most efficient path during medication administration. CONCLUSION Observing a specific task to identify the effect of unit layout was effective, determining that overall unit shape or unit layout type might not be a good predictor of nurses' walking behavior; instead the characteristics of the path that connects functional spaces such as patient room and medication area might better predict nurses' walking behavior.
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Affiliation(s)
- Lu Yi
- Corresponding Author: Hyun-Bo Seo, PhD, MArch, Department of Architecture, University of Seoul, Dongdaemoon-gu, Jonnong-dong 90, Seoul, Korea 130-743 a pilot study that was originally conducted as a class exercise at the Georgia Institute of Technology, where the observation of medication administration task was developed (Peponis & Bafna, 2007)
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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.
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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
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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.
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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
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Sasangohar F, Donmez B, Easty AC, Trbovich PL. The relationship between interruption content and interrupted task severity in intensive care nursing: an observational study. Int J Nurs Stud 2015; 52:1573-81. [PMID: 26162227 DOI: 10.1016/j.ijnurstu.2015.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 06/05/2015] [Accepted: 06/09/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND In a previous study, we observed that the majority of interruptions experienced by nurses in a cardiovascular intensive care unit (CVICU) carried information directly related to their patient or other aspects of work affecting other patients or indirectly affecting their patient. Further, the proportion of interruptions with personal content was significantly higher during low-severity (in case of an error as defined by nurses) tasks compared to medium- and high-severity tasks suggesting that other personnel may have evaluated the criticality of the nurses' tasks before interrupting. However, this earlier study only collected data when an interruption happened and thus could not investigate interruption rate as a function of primary task type and severity while controlling for primary task duration as an exposure variable. OBJECTIVES We addressed this methodological limitation in a second observational study that was conducted to further study interruptions and also to evaluate an interruption mitigation tool. The data from the baseline condition (i.e., no tool) is analyzed in this paper to validate the results of our previous study and to report interruption rates observed during tasks of varying severities (low, medium, high), with a particular focus on comparing different interruption contents. DESIGN AND SETTING The study was conducted in a 24-bed closed CVICU at a Canadian hospital, during day shifts. PARTICIPANTS The baseline condition involved thirteen nurses. METHODS Over a 3-week period, three researchers observed these nurses 46-120 min each, with an average of 89 min. Data were collected in real time, using a tablet computer and software designed for this purpose. The rate of interruptions with different content was compared across varying task severity levels as defined by CVICU nurses. RESULTS Nurses spent about 50% of their time conducting medium-severity tasks (e.g., documentation), 35% conducting high-severity tasks (e.g., procedure), and 14% conducting low-severity tasks (e.g., general care). The rate of interruptions with personal content observed during low-severity tasks was 1.97 (95% confidence interval, CI: 1.04, 3.74) and 3.23 (95% CI: 1.51, 6.89) times the rate of interruptions with personal content observed during high- and medium-severity tasks, respectively. CONCLUSIONS Interrupters might have evaluated task severity before interrupting. Increasing the transparency of the nature and severity of the task being performed may help others further modulate when and how they interrupt a nurse. Overall, rather than try to eliminate all interruptions, mitigation strategies should consider the relevance of interruptions to a task or patient as well as their urgency.
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Affiliation(s)
- Farzan Sasangohar
- Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, ON, Canada M5S 3G8; HumanEra, Techna, University Health Network, R. Fraser Elliott Building, 4th Floor, 190 Elizabeth Street, Toronto, ON, Canada M5G 2C4
| | - Birsen Donmez
- Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, ON, Canada M5S 3G8.
| | - Anthony C Easty
- HumanEra, Techna, University Health Network, R. Fraser Elliott Building, 4th Floor, 190 Elizabeth Street, Toronto, ON, Canada M5G 2C4; Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, Canada M5S 3G9
| | - Patricia L Trbovich
- HumanEra, Techna, University Health Network, R. Fraser Elliott Building, 4th Floor, 190 Elizabeth Street, Toronto, ON, Canada M5G 2C4; Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, Canada M5S 3G9
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McBride DL. Distraction of clinicians by smartphones in hospitals: a concept analysis. J Adv Nurs 2015; 71:2020-30. [DOI: 10.1111/jan.12674] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2015] [Indexed: 01/29/2023]
Affiliation(s)
- Deborah L. McBride
- Samuel Merritt University; Oakland California USA
- Kaiser Permanente Oakland Medical Center; California USA
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Gardiner TM, Marshall AP, Gillespie BM. Clinical handover of the critically ill postoperative patient: an integrative review. Aust Crit Care 2015; 28:226-34. [PMID: 25797689 DOI: 10.1016/j.aucc.2015.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/03/2015] [Accepted: 02/04/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES The clinical handover of critically ill postoperative patients from the operating theatre to the intensive care unit is a dynamic and complex process that can lead to communication and technical errors. The objectives of this integrative review were to illustrate how the use of structured handover processes between the operating theatre and intensive care unit impacts information transfer, handover duration, post-handover technical error and high risk events. REVIEW METHOD USED Integrative review methodology was used to allow for the inclusion of broad research designs, summarising current knowledge from existing research and identify gaps in the literature. DATA SOURCES A systematic search of electronic databases including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane library, Embase, ProQuest central and PubMed were performed. Original research articles, in either adults or paediatrics, specific to handover between an operating theatre and intensive care unit were included. REVIEW METHODS Data extracted from studies included country of origin, sample size, number of hospital sites, study design, study aim, measures, key findings and limitations. The quality of the integrative review articles was assessed against the 'Standard Quality Assessment Criteria for Evaluating Primary Research Papers'. RESULTS Ten articles meeting the inclusion criteria were included in the final analysis. Information transfer, post-handover technical errors and high risk events were positively influenced by the use of structured clinical handover tools. Handover duration did not change when using structured handover protocols. CONCLUSIONS The body of literature on clinical handover between operating theatre and the intensive care unit is in its early stages of development. Future research using rigorous study designs, broader populations and varied surgical procedures are needed to further evaluate the effect of clinical handover protocols.
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Affiliation(s)
- Therese M Gardiner
- Gold Coast University Hospital, D.5 090, 1 Hospital Boulevard, Queensland 4215, Australia.
| | - Andrea P Marshall
- Gold Coast University Hospital, D.5 090, 1 Hospital Boulevard, Queensland 4215, Australia; Menzies Health Institute Queensland, Griffith University, Australia; NHMRC Centre of Research Excellence in Nursing, Griffith University, Australia.
| | - Brigid M Gillespie
- Menzies Health Institute Queensland, Griffith University, Australia; NHMRC Centre of Research Excellence in Nursing, Griffith University, Australia.
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The Effect of a Safe Zone on Nurse Interruptions, Distractions, and Medication Administration Errors. JOURNAL OF INFUSION NURSING 2015; 38:140-51. [DOI: 10.1097/nan.0000000000000095] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ead H. Change Fatigue in Health Care Professionals--An Issue of Workload or Human Factors Engineering? J Perianesth Nurs 2014; 30:504-515. [PMID: 26596386 DOI: 10.1016/j.jopan.2014.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 11/24/2013] [Accepted: 02/10/2014] [Indexed: 10/24/2022]
Abstract
In the demanding and fast-paced world of health care, it is not uncommon for nurses and other health care professionals to have days where they are pushed to their limits. Despite these pressures, each year, new initiatives and practice recommendations are shared within organizations that the nurses must learn, embrace, and include in their practice. Each new initiative can be additive to the nurse's workload; most changes are not time neutral but require staff to expend an allotment of time from their day to complete. In our efforts to adopt new recommendations, is it realistic or possible to add on to workload and stretched resources in an ongoing manner? The following article provides an overview of how issues such as change fatigue and increased workload need to be addressed. Through use of workload measurement tools and guidance by the principles of human factors engineering, we can better support the provision of optimal patient care in a demanding environment.
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Balint BJ, Steenburg SD, Lin H, Shen C, Steele JL, Gunderman RB. Do telephone call interruptions have an impact on radiology resident diagnostic accuracy? Acad Radiol 2014; 21:1623-8. [PMID: 25281360 DOI: 10.1016/j.acra.2014.08.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/01/2014] [Accepted: 08/01/2014] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to measure the effect of distractions, in the form of telephone call interruptions, on radiology resident diagnostic accuracy. MATERIALS AND METHODS Radiology resident discrepancy reports and reading room telephone logs at an academic tertiary care pediatric hospital were collected over a 13-month period. Phone call times and durations were recorded. Major discrepancy shifts (defined as a call shift where at least one major discrepancy was discovered the following morning by the attending radiologist between the resident preliminary and attending final reports), and dictation time stamps for each discrepant preliminary dictation were also recorded. Telephone call volume and preliminary report time stamps were compared between "discrepancy shifts" and "no discrepancy shifts." RESULTS Each call shift spanned 14 hours, during which one radiology resident was responsible for the generation of preliminary interpretations. Review of the discrepancy log data revealed 51 major discrepancies in 41 shifts, of which 39 discrepancies had documented error details and resident preliminary report time stamps. The average number of telephone calls for the "discrepancy shifts" was slightly greater than the "no discrepancy shifts" (48.59 vs. 44.02) but was not statistically significant (P = .0575). However, there was a statistically significant increase in the average number of phone calls in the 1 hour preceding the generation of a discrepant preliminary report versus the "no discrepancy shifts" (4.23 vs. 3.24 calls, P = .027). One additional phone call during the hour preceding the generation of a discrepant preliminary report resulted in a 12% increased likelihood of a resident error (P = .017). CONCLUSIONS Distractions in the form of telephone call interruptions may negatively impact on-call radiology resident diagnostic accuracy. Efforts should be made to limit distractions in the reading room.
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Affiliation(s)
- Brad J Balint
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1701 N. Senate Blvd, Rm AG-176, Indianapolis, IN 46202
| | - Scott D Steenburg
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1701 N. Senate Blvd, Rm AG-176, Indianapolis, IN 46202.
| | - Hongbu Lin
- Indiana University School of Medicine, Department of Biostatistics and the Indiana University Fairbanks School of Public Health, Indianapolis, Indiana
| | - Changyu Shen
- Indiana University School of Medicine, Department of Biostatistics and the Indiana University Fairbanks School of Public Health, Indianapolis, Indiana
| | - Jennifer L Steele
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1701 N. Senate Blvd, Rm AG-176, Indianapolis, IN 46202; Division of Radiology Education, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Richard B Gunderman
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1701 N. Senate Blvd, Rm AG-176, Indianapolis, IN 46202; Division of Radiology Education, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
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Foroughi CK, Werner NE, Nelson ET, Boehm-Davis DA. Do interruptions affect quality of work? HUMAN FACTORS 2014; 56:1262-1271. [PMID: 25490806 DOI: 10.1177/0018720814531786] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The aim of this study was to determine if interruptions affect the quality of work. BACKGROUND Interruptions are commonplace at home and in the office. Previous research in this area has traditionally involved time and errors as the primary measures of disruption. Little is known about the effect interruptions have on quality of work. METHOD Fifty-four students outlined and wrote three essays using a within-subjects design. During Condition 1, interruptions occurred while participants were outlining. During Condition 2, interruptions occurred while they were writing. No interruptions occurred in Condition 3. RESULTS Quality of work was significantly reduced in both interruption conditions when compared to the non-interruption condition. The number of words produced was significantly reduced when participants were interrupted while writing the essay but not when outlining the essay. CONCLUSION This research represents a crucial first step in understanding the effect interruptions have on quality of work. Our research suggests that interruptions negatively impact quality of work during a complex, creative writing task. Since interruptions are such a prevalent part of daily life, more research needs to be conducted to determine what other tasks are negatively impacted. Moreover, the underlying mechanism(s) causing these decrements needs to be identified. Finally, strategies and systems need to be designed and put in place to help counteract the decline in quality of work caused by interruptions.
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Klemets J, Evjemo TE. Technology-mediated awareness: Facilitating the handling of (un)wanted interruptions in a hospital setting. Int J Med Inform 2014; 83:670-82. [DOI: 10.1016/j.ijmedinf.2014.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/04/2014] [Accepted: 06/06/2014] [Indexed: 11/16/2022]
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Blay N, Duffield CM, Gallagher R, Roche M. Methodological integrative review of the work sampling technique used in nursing workload research. J Adv Nurs 2014; 70:2434-49. [DOI: 10.1111/jan.12466] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Nicole Blay
- Centre for Health Services Management (CHSM) Faculty of Health University of Technology Sydney New South Wales Australia
| | - Christine M. Duffield
- Centre for Health Services Management (CHSM) Faculty of Health University of Technology Sydney New South Wales Australia
| | - Robyn Gallagher
- Chronic & Complex Care Faculty of Health University of Technology Sydney New South Wales Australia
- Charles Perkins Centre Sydney Nursing School The University of Sydney Sydney New South Wales Australia
| | - Michael Roche
- Centre for Health Services Management (CHSM) Faculty of Health University of Technology Sydney New South Wales Australia
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Yu JPJ, Kansagra AP, Mongan J. The Radiologist's Workflow Environment: Evaluation of Disruptors and Potential Implications. J Am Coll Radiol 2014; 11:589-93. [DOI: 10.1016/j.jacr.2013.12.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 12/26/2013] [Indexed: 11/29/2022]
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Sasangohar F, Donmez B, Easty A, Storey H, Trbovich P. Interruptions experienced by cardiovascular intensive care unit nurses: an observational study. J Crit Care 2014; 29:848-53. [PMID: 24974048 DOI: 10.1016/j.jcrc.2014.05.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 05/13/2014] [Accepted: 05/17/2014] [Indexed: 11/15/2022]
Abstract
PURPOSE Intensive care unit (ICU) nurses get interrupted frequently. Although interruptions take cognitive resources from a primary task and may hinder performance, they may also convey critical information. Effective management of interruptions in ICUs requires the understanding of interruption characteristics, the context in which interruption happens, and interruption content. METHODS An observational study was conducted in a cardiovascular ICU at a Canadian teaching hospital. Four observers (1 PhD and 3 undergraduate students) trained in human factors research observed 40 nurses, approximately 1 hour each, over a 3-week period. Data were recorded by the observers in real time, using touchscreen tablet PCs and special software designed for this purpose. RESULTS Although approximately half of the interruptions (~51%) happened during high-severity tasks, more than half of these interruptions, which happened during high-severity tasks, conveyed either work- or patient-related information. Furthermore, the rate of interruptions with personal content was significantly higher during low-severity tasks compared with medium- and high-severity tasks. CONCLUSIONS Mitigation strategies other than blocking should also be explored. In addition, interrupters might have evaluated primary task severity before interrupting. Therefore, making task severity more transparent may help others modulate when and how they interrupt a nurse.
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Affiliation(s)
- Farzan Sasangohar
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada; HumanEra, Techna, University Health Network, Toronto, ON, Canada
| | - Birsen Donmez
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada.
| | - Anthony Easty
- HumanEra, Techna, University Health Network, Toronto, ON, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | | | - Patricia Trbovich
- HumanEra, Techna, University Health Network, Toronto, ON, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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