Nursing interruptions in emergency room in China: An observational study

Experiences of clinical nurses with medication interruption: A systematic review and qualitative meta-synthesis

BACKGROUND

Managing medication interruptions is considered one of the biggest dilemmas for nurses in clinical settings. To improve medication safety, it was imperative to conduct a systematic review to get a deeper understanding of nurses' experiences with medication interruptions.

AIMS

A systematic review and qualitative meta-synthesis aimed to explore clinical nurses' experiences of interruption during medication in hospitals.

METHODS

Systematic searches were conducted in PubMed, CINAHL, Ovid Medline, Embase, Web of Science, and The Cochrane Library from inception to January 2024. The search strategy included four groups of keywords: (1) qualitative research, (2) nurses, (3) medication interruption, and (4) experience. Critical Appraisal Skills Programme was used to assess the quality of the studies. Meta-ethnography was utilized to synthesize the findings of the included studies.

RESULTS

Nine articles published between 2012 and 2023 were included; the number of participants varied from 5 to 40, aged 20-68 years, and the majority were female. Four synthesized findings were identified as follows: (1) an inevitable part of the routine, (2) a decision-making process, (3) working in a minefield, and (4) coping with interruption.

LINKING EVIDENCE TO ACTION

Nurses embraced interruptions as an inherent component of clinical care. Previous experience and nursing culture, encompassing personal and professional aspects, significantly influence nurses' attitudes toward medication interruptions. It is crucial to incorporate the distinctive work experiences of nurses into techniques aimed at efficiently handling interruptions in future research. The registration number in PROSPERO is CRD42023470276.

Workflow interruptions in an era of instant messaging: A detailed analysis

INTRODUCTION

The complex practice environment and responsibilities incumbent on diagnostic radiologists creates a workflow susceptible to disruption. While interruptions have been shown to contribute to medical errors in the healthcare delivery environment, the exact impact on highly subspecialized services such as diagnostic radiology is less certain. One potential source of workflow disruption is the use of a departmental instant messaging system (Webex), to facilitate communications between radiology faculty, residents, fellows, and technologists. A retrospective review was conducted to quantify the frequency of interruption experienced by our neuroradiology fellows.

MATERIALS AND METHODS

Data logs were gathered comprising all instant messages sent and received within the designated group chats from July 5-December 31, 2021, during weekday shifts staffed by neuroradiology fellows. Interruptions per shift were calculated based on month, week, and day of the week.

RESULTS

14,424 messages were sent across 289 total shifts. The 6 fellows assigned to the main neuroradiology reading room sent 3258 messages and received 10,260 messages from technologists and other staff. There was an average of 50 interruptions per shift when examined by month (range 48-53), and 52 interruptions per shift when examined by day of the week (range 40-60).

CONCLUSION

Neuroradiology fellows experience frequent interruptions from the departmental instant messaging system. These disruptions, when considered in conjunction with other non-interpretative tasks, may have negative implications for workflow efficiency, requiring iterative process improvements when incorporating new technology into the practice environment of diagnostic radiology.

Effects of different types of interference on nurses' working memory: An ERP study

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.

Workflow interruption and nurses' mental workload in electronic health record tasks: An observational study

BACKGROUND

Workflow interruptions are common in modern work systems. Electronic health record (EHR) tasks are typical tasks involving human-machine interactions in nursing care, but few studies have examined interruptions and nurses' mental workload in the tasks. Therefore, this study aims to investigate how frequent interruptions and multilevel factors affect nurses' mental workload and performance in EHR tasks.

METHODS

A prospective observational study was conducted in a tertiary hospital providing specialist and sub-specialist care from June 1^st to October 31^st, 2021. An observer documented nurses' EHR task interruptions, reactions and performance (errors and near errors) during one-shift observation sessions. Questionnaires were administered at the end of the electronic health record task observation to measure nurses' mental workload for the electronic health record tasks, task difficulty, system usability, professional experience, professional competency, and self-efficacy. Path analysis was used to test a hypothetical model.

RESULTS

In 145 shift observations, 2871 interruptions occurred, and the mean task duration was 84.69 (SD 56.68) minutes per shift. The incidence of error or near error was 158, while 68.35% of errors were self-corrected. The total mean mental workload level was 44.57 (SD 14.08). A path analysis model with adequate fit indices is presented. There was a relationship among concurrent multitasking, task switching and task time. Task time, task difficulty and system usability had direct effects on mental workload. Task performance was influenced by mental workload and professional title. Negative affect mediated the path from task performance to mental workload.

CONCLUSIONS

Nursing interruptions occur frequently in EHR tasks, come from different sources and may lead to elevated mental workload and negative outcomes. By exploring the variables related to mental workload and performance, we offer a new perspective on quality improvement strategies. Reducing harmful interruptions to decrease task time can avoid negative outcomes. Training nurses to cope with interruptions and improve competency in EHR implementation and task operation has the potential to decrease nurses' mental workload and improve task performance. Moreover, improving system usability is beneficial to nurses to mitigate mental workload.

Nurse-to-nurse handoff with distractors and interruptions: An integrative review

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.