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Effects of the Interruption Management Strategy "Stay S.A.F.E." During Medication Administration. Rehabil Nurs 2023; 48:65-74. [PMID: 36792960 DOI: 10.1097/rnj.0000000000000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
PURPOSE This study measured the impact of the Stay S.A.F.E. intervention on nursing students' management of and response to interruptions during medication administration. Time to return to the primary task, performance (procedural failures and error rate), and perceived task load were evaluated. DESIGN This experimental study used a randomized prospective trial. METHODS Nursing students were randomized into two groups. Group 1 (the experimental group) received two educational PowerPoints: the Stay S.A.F.E. strategy and medication safety practices. Group 2 (the control group) received educational PowerPoint on medication safety practices. Nursing students participated in three simulations where they were interrupted during a simulated medication administration. Eye tracking of students' eye movements determined focus, time to return to the primary task, performance including procedural failures and errors, and fixation time on the interrupter. The perceived task load was measured using the NASA Task Load Index. RESULTS The intervention group, which was the Stay S.A.F.E. group, demonstrated a significant reduction in time away from task. There was a significant difference in perceived task load across the three simulations, including decreased frustration scores for this group as well. The control group members reported a higher mental demand, increased effort, and frustration. CLINICAL RELEVANCE Rehabilitation units often hire new nursing graduates or individuals with little experience. For new graduates they have typically practiced their skills without interruptions. However, interruptions in performing care, particularly in medication management, occur frequently in real-world situations. Improving the education of nursing students related to interruption management has the potential to improve their transition to practice and patient care. CONCLUSION Students who received the Stay S.A.F.E. training, a strategy to manage interruptions in care, had decreasing frustration over time and spent more time on the task of medication administration.
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Owen S, Menzies J, Pontefract S. Educational interventions to reduce nurse medication interruptions: A scoping review. NURSE EDUCATION TODAY 2023; 121:105665. [PMID: 36527755 DOI: 10.1016/j.nedt.2022.105665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Preventable harm from medicines is a global problem creating huge economic and social burden. Interruptions occur frequently in clinical environments causing medication episodes to take longer and having a cognitive cost on the nurse. AIM The aim of this scoping review is to identify and evaluate educational interventions that have been employed to reduce medication interruptions and improve medication safety. METHODS Six databases were searched for the scoping review (PubMed, Embase, Cochrane Library, CINAHL, Pishin and Medline) along with reference lists and grey literature searches. Articles were included if they were written in English, published between 2010 and 2020 and employed an education intervention (including bundled interventions). Databases were searched using keywords and Boolean operators. RESULTS Eight studies met the inclusion criteria. Seven of these studies were conducted in hospital (adults n = 6, paediatric n = 1) and one study in a university with undergraduate nurses. Four studies used a combined intervention and four exclusively employed an education intervention. Five studies found a significant decrease in the number of interruptions post intervention, but one of the studies that exclusively employed an education intervention found no significant difference. Changes in the nurses' behaviour post intervention were also cited in two studies. IMPLICATIONS FOR FUTURE RESEARCH There was a lack of exclusive education interventions, making it difficult to determine the effectiveness of education at reducing medication interruptions. This review highlights the necessity of some interruptions when performing tasks, for example, to make a nurse aware of a deteriorating patient. However, as the majority of studies used the number of interruptions to determine the effectiveness of the intervention, there is uncertainty as to whether this is the right outcome measure to use. In the future, a focus on outcome measures reflecting change in nurse behaviour may be more effective in determining the strength of an educational intervention.
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Affiliation(s)
- Samantha Owen
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Birmingham Children's Hospital, Birmingham, UK.
| | | | - Sarah Pontefract
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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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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Danesh V, Sasangohar F, Kallberg AS, Kean EB, Brixey JJ, Johnson KD. Systematic review of interruptions in the emergency department work environment. Int Emerg Nurs 2022; 63:101175. [PMID: 35843150 DOI: 10.1016/j.ienj.2022.101175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/05/2022] [Accepted: 05/04/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this systematic review is to describe the operationalization of interruptions measurement and to synthesize the evidence on the causes and consequences of interruptions in the emergency department (ED) work environment. METHODS This systematic review of studies explores the causes and consequences of interruptions in the ED. Of 2836 abstract/titles screened, 137 full-text articles were reviewed, and 44 articles met inclusion criteria of measuring ED interruptions. RESULTS All articles reported primary data collection, and most were cohort studies (n = 30, 68%). Conceptual or operational definitions of interruptions were included in 27 articles. Direct observation was the most common approach. In half of the studies, quantitative measures of interruptions in the ED were descriptive only, without measurements of interruptions' consequences. Twenty-two studies evaluated consequences, including workload, delays, satisfaction, and errors. Overall, relationships between ED interruptions and their causes and consequences are primarily derived from direct observation within large academic hospitals using heterogeneous definitions. Collective strengths of interruptions research in the ED include structured methods of naturalistic observation and definitions of interruptions derived from concept analysis. Limitations are conflicting and complex evaluations of consequences attributed to interruptions, including the predominance of descriptive reports characterizing interruptions without direct measurements of consequences. CONCLUSIONS The use of standardized definitions and measurements in interruptions research could contribute to measuring the impact and influence of interruptions on clinicians' productivity and efficiency as well as patients' outcomes, and thus provide a basis for intervention research.
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Affiliation(s)
- Valerie Danesh
- Center for Applied Health Research, Baylor Scott & White Health, 3500 Gaston Ave, Dallas, TX 75246, United States.
| | - Farzan Sasangohar
- Applied Cognitive Ergonomics Lab Texas, A&M University, Houston, TX, United States; Industrial and Systems Engineering, Texas A&M University, 4079 Emerging Technologies Building, 3131 TAMU, College Station, TX 77843, United States.
| | - Ann-Sofie Kallberg
- School of Health and Welfare, Dalarna University, Falun, Sweden; Department of Emergency Medicine, Falun Hospital, Dalarna University, SE-79188, Sweden.
| | - Emily B Kean
- University of Cincinnati, Health Sciences Library, 231 Albert Sabin Way, Cincinnati, OH 45267, United States.
| | - Juliana J Brixey
- Biomedical Informatics and Nursing, The University of Texas Health Science Center, 6901 Bertner Ave, Rm 629, Houston, TX 77030, United States.
| | - Kimberly D Johnson
- University of Cincinnati, College of Nursing, 234 Proctor Hall 3110 Vine St., Cincinnati, OH 45221, United States.
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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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Spek M, Venekamp R, De Groot E, Geersing GJ, Erkelens DC, van Smeden M, Rutten FH, Zwart DL. Optimising telephone triage of patients calling for acute shortness of breath during out-of-hours primary care: protocol of a multiple methods study (Opticall). BMJ Open 2022; 12:e059549. [PMID: 35450911 PMCID: PMC9024277 DOI: 10.1136/bmjopen-2021-059549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Callers with acute shortness of breath (SOB) are a challenge for telephone triage at out-of-hours primary care (OHS-PC) as SOB could be the sign of a potentially life-threatening disease, yet mostly is a symptom of a broad range of self-limiting disorders. Current telephone triage practice is mainly expert based and clear evidence on accuracy, safety and efficiency of the use of the Netherlands Triage Standard (NTS) by triage nurses based on the eventual clinical outcome is lacking for this domain. METHODS AND DATA ANALYSIS Multiple methods study in five OHS-PC services in the Utrecht region, the Netherlands. Data will be collected from OHS-PC electronic health records (EHR) and backed up tapes of telephone triage conversations, which will be linked to routine primary care EHR data. In cross-sectional studies, we will (1) validate the NTS urgency classification for adults with SOB against final diagnoses and (2) develop diagnostic prediction models for urgent diagnoses (eg, composite endpoint of urgent diagnoses, pulmonary embolism, acute coronary syndrome, acute heart failure and pneumonia). We will develop improvement measures for the use of the NTS by triage nurses through practice observations and semistructured interviews with patients, triage nurses and general practitioners (GPs). In an action research approach, we will, in collaboration with these stakeholders, implement and evaluate our findings in both GP and triage nurse educational programmes as well as in OHS-PC services. ETHICS AND DISSEMINATION The Medical Ethics Review Committee Utrecht, the Netherlands, approved the study protocol (protocol 21/361). We will take into account the 'code of conduct for responsible research' of the WHO, the EU General Data Protection Regulation and the 'Dutch Medical Treatment Contracts Act'. Results will be disseminated in peer-reviewed publications and at (inter)national meetings. TRIAL REGISTRATION NUMBER NL9682.
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Affiliation(s)
- Michelle Spek
- Department of General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Roderick Venekamp
- Department of General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Esther De Groot
- Department of General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Geert-Jan Geersing
- Department of General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Daphne Carmen Erkelens
- Department of General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Maarten van Smeden
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Frans H Rutten
- Department of General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Dorien L Zwart
- Department of General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
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Using Simulation-Based Education to Teach Interruption Management Skills: An Integrative Review. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cabilan CJ, McRae J, Learmont B, Taurima K, Galbraith S, Mason D, Eley R, Snoswell C, Johnston A. Validity and reliability of the novel three‐item occupational violence patient risk assessment tool. J Adv Nurs 2022; 78:1176-1185. [PMID: 35128709 PMCID: PMC9306479 DOI: 10.1111/jan.15166] [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: 06/22/2021] [Revised: 10/27/2021] [Accepted: 01/12/2022] [Indexed: 01/04/2023]
Abstract
Aim To develop and psychometrically test an occupational violence (OV) risk assessment tool in the emergency department (ED). Design Three studies were conducted in phases: content validity, predictive validity and inter‐rater reliability from June 2019 to March 2021. Methods For content validity, ED end users (mainly nurses) were recruited to rate items that would appropriately assess for OV risk. Subsequently, a risk assessment tool was developed and tested for its predictive validity and inter‐rater reliability. For predictive validity, triage notes of ED presentations in a month with the highest OV were assessed for presence of OV risk. Each presentation was then matched with events recorded in the OV incident register. Sensitivity and specificity values were calculated. For inter‐rater reliability, two assessors—trained and untrained—independently assessed the triage notes for presence of OV risk. Cohen's kappa was calculated. Results Two rounds of content validity with a total of N = 81 end users led to the development of a three‐domain tool that assesses for OV risk using aggression history, behavioural concerns (i.e., angry, clenched fist, demanding, threatening language or resisting care) and clinical presentation concerns (i.e., alcohol/drug intoxication and erratic cognition). Recommended risk ratings are low (score = 0 risk domain present), moderate (score = 1 risk domain present) and high (score = 2–3 risk domains present), with an area under the curve of 0.77 (95% confidence interval 0.7–0.81, p < .01). Moderate risk rating had a 61% sensitivity and 91% specificity, whereas high risk rating had 37% sensitivity and 97% specificity. Inter‐rater reliability ranged from 0.67 to 0.75 (p < .01), suggesting moderate agreement. Conclusions The novel three‐domain OV risk assessment tool was shown to be appropriate and relevant for application in EDs. The tool, developed through a rigorous content validity process, demonstrates acceptable predictive validity and inter‐rater reliability. Impact The developed tool is currently piloted in a single hospital ED, with a view to extend to inpatient settings and other hospitals.
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Affiliation(s)
- C. J. Cabilan
- Emergency Department Princess Alexandra Hospital Woolloongabba Queensland Australia
- School of Nursing, Midwifery and Social Work The University of Queensland Brisbane Queensland Australia
| | - Joshua McRae
- Office of the Chief Clinical Information Officer Queensland Health Herston Queensland Australia
| | - Ben Learmont
- Emergency Department Princess Alexandra Hospital Woolloongabba Queensland Australia
| | - Karen Taurima
- Emergency Department Princess Alexandra Hospital Woolloongabba Queensland Australia
| | - Sue Galbraith
- Emergency Department Princess Alexandra Hospital Woolloongabba Queensland Australia
| | - Dale Mason
- Emergency Department Princess Alexandra Hospital Woolloongabba Queensland Australia
| | - Robert Eley
- Emergency Department Princess Alexandra Hospital Woolloongabba Queensland Australia
- Faculty of Medicine The University of Queensland Brisbane Queensland Australia
| | - Centaine Snoswell
- Centre for Online Health, Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
| | - Amy N. B. Johnston
- Emergency Department Princess Alexandra Hospital Woolloongabba Queensland Australia
- School of Nursing, Midwifery and Social Work The University of Queensland Brisbane Queensland Australia
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Abdelhadi N, Drach‐Zahavy A, Srulovici E. Work interruptions and missed nursing care: A necessary evil or an opportunity? The role of nurses' sense of controllability. Nurs Open 2022; 9:309-319. [PMID: 34612602 PMCID: PMC8685781 DOI: 10.1002/nop2.1064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/29/2021] [Accepted: 09/02/2021] [Indexed: 12/30/2022] Open
Abstract
AIM To explore nurses' experiences with work interruptions (WIs) through the lens of missed nursing care (MNC). DESIGN A qualitative descriptive design. METHODS Eleven small focus groups involving 34 nurses (three nurses per group on average) from acute-care hospital wards were conducted. Nurses shared their experiences with WIs (sources, reactions and decisions) from the MNC perspective. Data analysis was conducted via content analysis. RESULTS A preponderant theme emerged-the dynamic of controllability. Nurses who perceived a sense of controllability felt that they could decide whether to accept or reject the WI, regardless of WI type, and emotions of anger emerged. Conversely, nurses who did not perceive sense of controllability attended the secondary task: MNC occurred, and distress emotions emerged. Results emphasized that nurses are active agents prioritizing whether to omit or complete care in the face of WIs. Controllability, accompanied by active negative emotions, perpetuate a prioritization process that makes it less probable that MNC occurs.
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Affiliation(s)
- Nasra Abdelhadi
- The Cheryl Spencer Department of NursingUniversity of HaifaHaifaIsrael
| | - Anat Drach‐Zahavy
- The Cheryl Spencer Department of NursingUniversity of HaifaHaifaIsrael
| | - Einav Srulovici
- The Cheryl Spencer Department of NursingUniversity of HaifaHaifaIsrael
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Santomauro C, Powell M, Davis C, Liu D, Aitken LM, Sanderson P. Interruptions to Intensive Care Nurses and Clinical Errors and Procedural Failures: A Controlled Study of Causal Connection. J Patient Saf 2021; 17:e1433-e1440. [PMID: 30113425 DOI: 10.1097/pts.0000000000000528] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Interruptions occur frequently in the intensive care unit (ICU) and are associated with errors. To date, no causal connection has been established between interruptions and errors in healthcare. It is important to know whether interruptions directly cause errors before implementing interventions designed to reduce interruptions in ICUs. The aim of the study was to investigate whether ICU nurses who receive a higher number of workplace interruptions commit more clinical errors and procedural failures than those who receive a lower number of interruptions. METHODS We conducted a prospective controlled trial in a high-fidelity ICU simulator. A volunteer sample of ICU nurses from a single unit prepared and administered intravenous medications for a patient manikin. Nurses received either 3 (n = 35) or 12 (n = 35) scenario-relevant interruptions and were allocated to either condition in an alternating fashion. Primary outcomes were the number of clinical errors and procedural failures committed by each nurse. RESULTS The rate ratio of clinical errors committed by nurses who received 12 interruptions compared with nurses who received 3 interruptions was 2.0 (95% confidence interval = 1.41-2.83, P < 0.001). The rate ratio of procedural failures committed by nurses who received 12 interruptions compared with nurses who were interrupted 3 times was 1.2 (95% confidence interval = 1.05-1.37, P = 0.006). CONCLUSIONS More workplace interruptions during medication preparation and administration lead to more clinical errors and procedural failures. Reducing the frequency of interruptions may reduce the number of errors committed; however, this should be balanced against important information that interruptions communicate.
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Kwon YE, Kim M, Choi S. Degree of interruptions experienced by emergency department nurses and interruption related factors. Int Emerg Nurs 2021; 58:101036. [PMID: 34332454 DOI: 10.1016/j.ienj.2021.101036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 05/19/2021] [Accepted: 05/28/2021] [Indexed: 10/20/2022]
Abstract
AIMS This study examined the degree of interruptions experienced by emergency department nurses and related factors. METHODS This study is a descriptive survey using standardized observation tools. A total of 23 nurses working in an emergency department participated in this study. Using a stopwatch over 120 h, the degree of interruptions was investigated by measuring start and end times of tasks and interruptions. Factors related to interruptions were classified as communication, telephone calls, medical device alarms, changes in patient condition, and other factors. RESULTS The frequency of interruptions in the emergency department was 6.4 times per hour, and its percentage was 9.1%. The time required for actual nursing tasks of "counseling and education," "safety," and "patient nursing management and information management" were increased significantly due to interruptions. A primary factor in interruptions was communication with patients, families, and nurses. The longest duration and the highest frequency of interruptions occurred during medication tasks. CONCLUSIONS Communication with patients, families, and nurses was the highest factor related to interruptions. Nurses may cause interruptions and be subjected to interruptions simultaneously. Therefore, nurses in the emergency department should work with caution not to cause interruptions.
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Affiliation(s)
- Yong Eun Kwon
- College of Nursing, Ewha Womans University, Seoul, Republic of Korea.
| | - Miyoung Kim
- College of Nursing, Ewha Womans University, Seoul, Republic of Korea.
| | - Sujin Choi
- College of Nursing, Woosuk University, Jeonju, Republic of Korea.
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Zhang WG, Liu JW, Yang SY, Wang QQ, Liu CX, Li Y. A Study on the Improvement of Nursing Interruption Risk by a Closed-Loop Management Model. Risk Manag Healthc Policy 2021; 14:2945-2952. [PMID: 34285608 PMCID: PMC8285302 DOI: 10.2147/rmhp.s301108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/10/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to evaluate the effect of closed-loop management on nursing disruption risk. Methods Using a quasi-experimental research method, convenient sampling was used to extract 20 nurses working at our hospital as the research objects. The control group members were selected from January to March 2018 via the traditional method, and the experimental group members were selected from April to June 2018 via the closed-loop management method. At three months before and after the implementation of the management model, a self-designed quantitative test form and satisfaction questionnaire were used to analyze the frequency of nursing disruption events, the accuracy rate of doctors’ advice, the average drug delivery time of the static distribution center, the implementation rate of personal digital assistant (PDA) code scanning, and the report rate of risk-outcome nursing disruption events. Results After the implementation of the management model, the frequency of nursing disruptions and average drug delivery time of the static distribution center were significantly lower than before, and the differences were statistically significant (p < 0.05). Moreover, the accuracy rate of doctors’ advice, the implementation rate of PDA code scanning, and the reporting rate of risk-outcome nursing disruption events were significantly higher than before, and these differences were statistically significant as well (p < 0.05). Conclusion The application of a closed-loop management model could significantly reduce the occurrence and optimize the outcomes of nursing disruption events and improve the work processes of medical care.
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Affiliation(s)
- Wen-Guang Zhang
- Department of Nursing, The First Hospital of Shanxi Medical University, Taiyuan, 030000, People's Republic of China
| | - Jia-Wei Liu
- School of Nursing, Shanxi Medical University, Taiyuan, 030000, People's Republic of China
| | - Su-Yun Yang
- Department of Nuclear Medicine, The First Hospital of Shanxi Medical University, Taiyuan, 030000, People's Republic of China
| | - Qiao-Qian Wang
- Department of Hypertension, The First Hospital of Shanxi Medical University, Taiyuan, 030000, People's Republic of China
| | - Chen-Xing Liu
- School of Nursing, Shanxi Medical University, Taiyuan, 030000, People's Republic of China
| | - Yao Li
- School of Nursing, Shanxi Medical University, Taiyuan, 030000, People's Republic of China
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Abstract
OBJECTIVE The purpose of this study was to describe factors that influence nurses' time from pain assessment to intervention for acute postsurgical pain. BACKGROUND Nurses' time is a limited resource that must be optimized to manage patients' pain within budget constraints. Little is known about processes and activities nurses negotiate to manage pain. METHODS Human factors engineering and ethnography were used to quantify factors influencing time from pain assessment to intervention. RESULTS On the basis of 175.5 observation hours, nurses spent 11% of shifts (mean, 83 minutes) on pain care activities. Time from alert to intervention with PRN analgesics or biobehavioral strategies for 58 cases ranged from 0 to 48 minutes (mean, <11 minutes). Five factors influenced timeliness. CONCLUSIONS Nurses most efficiently managed postsurgical pain by giving analgesics ordered PRN on a scheduled basis. Nurse leaders can empower prompt responses to patients' pain through delegation, process improvements, real-time monitoring, and prescriber engagement.
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Affiliation(s)
- Renee C B Manworren
- Author Affiliations: Director of Nursing Research and Professional Practice (Dr Manworren), Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Associate Professor of Pediatrics (Dr Manworren), Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and Undergraduate Student (Atabek), Northwestern University, Evanston, Illinois
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Ioannides KLH, Brownstein DJ, Henreid AJ, Torbati SS, Berdahl CT. Quantifying Emergency Physician Interruptions due to Electrocardiogram Review. J Emerg Med 2021; 60:444-450. [PMID: 33414047 DOI: 10.1016/j.jemermed.2020.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/01/2020] [Accepted: 11/22/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Interruptions are recognized as potentially harmful to safety and efficiency, and are especially prevalent in the emergency department (ED) setting. Policies urging immediate review of all electrocardiograms (ECGs) may lead to numerous and frequent interruptions. OBJECTIVE We assessed the role of ECG review as a source of ED interruptions to characterize a potential target for interventions. METHODS We analyzed emergency physician time use during the course of a clinical shift using a time-and-motion design. A research assistant observed a convenience sample of shifts, observing and logging transitions between different tasks using an electronic device. Instances of ECG review were tallied, with start and ending times of ECG review recorded to the nearest second. An ECG review was considered an interruption if the immediate prior and subsequent tasks were the same. RESULTS Twenty shifts were observed for a total of 149 h. There were 211 ECG reviews, (mean rate 1.4 per hour), with more frequent review among physicians staffing a zone with higher-acuity patients (2.8 per hour), where clustering of multiple ECG reviews in succession was more common. Seventy-five percent of ECG reviews required < 30 s. Of all 211 ECG reviews, 102 (48%) were an interruption. The tasks most frequently interrupted were electronic medical record system use (68 of 102, 67%) and communicating with ED staff in person (18 of 102, 18%). CONCLUSIONS Review of ECGs was a substantial driver of interruptions for emergency physicians. Interventions to integrate ECG review more naturally into physician workflow may improve patient safety by reducing these interruptions.
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Affiliation(s)
- Kimon L H Ioannides
- Department of Emergency Medicine, University of California Los Angeles, Los Angeles, California
| | - Daniel James Brownstein
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Andrew J Henreid
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sam S Torbati
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Carl T Berdahl
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, California
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Weigl M, Catchpole K, Wehler M, Schneider A. Workflow disruptions and provider situation awareness in acute care: An observational study with emergency department physicians and nurses. APPLIED ERGONOMICS 2020; 88:103155. [PMID: 32678775 DOI: 10.1016/j.apergo.2020.103155] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/24/2020] [Accepted: 05/10/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The fast-paced and rapidly changing environment of an Emergency Department (ED) requires providers to have a high level of situation awareness (SA). However, acute clinical care also encompasses a multitude of interruption-laden work processes that might degrade SA. It is therefore important to understand how frequent interruptions affect ED provider cognition in general and SA in particular. OBJECTIVE We aimed to examine how sources and contents of provider workflow interruptions influence situation awareness of ED physicians and nurses. METHODS This prospective, multi-method study combined standardized observations, self-reports of ED providers, and ED administrative data of staffing and patient load. Expert observers identified ED providers' workflow interruptions during 90min observation sessions. Afterwards, each provider reported perceived disruptiveness and situation awareness. Controlling for patient load, patient acuity and staffing, we conducted regression analyses to explore prospective associations between interruptions and provider outcomes. RESULTS During 74 observation sessions of overall 110h and 40min, we observed 1205 workflow interruptions (mean rate: 10.9 interruptions/hour). Provider situation awareness was fairly high (M = 7.10; scale 0-10) with no difference between ED physicians and nurses. After controlling for ED workload data, we observed that high rates of interruptions were associated with lower levels of situation awareness (β = -0.27). Further analyses revealed that particularly interruptions by telephone/beeper, technical malfunctions as well as interruptive communication related to completed cases were correlated to low SA. DISCUSSION This study in a naturalistic ED setting shows that ED physicians and nurses continuously cope with disruptions and interruptions. Our findings reveal that highly interruptive workflow environments impede providers' situation awareness. Moreover, it sheds light on specific sources and contents of interruptions that influence providers' SA in acute care. CONCLUSION Frequent workflow interruptions can degrade ED providers' situation awareness. A deeper understanding of how avoidable and unavoidable interruptions affect provider cognitions with particular focus on social and technology-related disruptions is required. Further emphasis should be placed on the effective application of work re-design in this context to foster safe and efficient patient care.
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Affiliation(s)
- Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany.
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, SC, USA
| | - Markus Wehler
- University Hospital Augsburg, Department of Emergency Medicine and Department of Medicine IV, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Anna Schneider
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany; Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Maliszewski B, Whalen M, Lindauer C, Williams K, Gardner H, Baptiste DL. Quality Improvement in the Emergency Department: A Project to Reduce Door-to-Electrocardiography Times for Patients Presenting With Chest Pain. J Emerg Nurs 2020; 46:497-504.e2. [PMID: 32386775 DOI: 10.1016/j.jen.2020.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 02/14/2020] [Accepted: 03/13/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The American Heart Association/American College of Cardiology guidelines recommend obtaining electrocardiography for patients who present to the emergency department with chest pain in less than 10 minutes of arrival. Reducing door-to-electrocardiography time is an important step in adhering to the recommended door-to-balloon times (≤ 90 minutes) for patients who present with ST-segment elevation myocardial infarction. METHODS Based on lean sigma principles, a protocol was implemented in an adult emergency department that included deferring nurse triage for patients with complaints of chest pain, chest tightness, and chest pressure and providing them with a red heart symbol as an indicator for clinical technicians to prioritize their electrocardiography order. Pre- and postintervention data were collected over a 12-month period. RESULTS Before the intervention, the mean door-to-electrocardiography time was 17 minutes for patients with chest pain (n = 893). After the intervention, the mean door-to-electrocardiography time for patients with chest pain significantly decreased to 7 minutes (n = 1,057) (t = 10.47, P ≤ 0.001). Initially, the percentage of compliance with door-to-electrocardiography standard of 10 minutes was 31% and improved to 83% after implementation of the new protocol. DISCUSSION Implementation of the optimized door-to-electrocardiography protocol decreased the time for obtaining diagnostics and improved compliance with the American Heart Association/American College of Cardiology guidelines, potentially decreasing door-to-balloon times for patients who presented with ST-segment elevation myocardial infarction.
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Bertolazzi LG, Perroca MG. Impact of interruptions on the duration of nursing interventions: A study in a chemotherapy unit. Rev Esc Enferm USP 2020; 54:e03551. [DOI: 10.1590/s1980-220x2018047503551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 06/11/2019] [Indexed: 11/21/2022] Open
Abstract
Abstract Objective: To investigate interruptions during nursing interventions in a chemotherapy unit (sources and causes); measure their frequency, duration and the total elapsed time to complete the interventions. Method: This is an observational analytical study performed using a digital stopwatch. It was conducted in a teaching hospital between 2015/2016. The interventions performed and their interruptions were mapped and classified according to the Nursing Interventions Classifications (NIC) taxonomy. Results: There were 492 interruptions recorded in the 107 hours observed, especially in indirect care interventions. They were mainly caused by nursing professionals (n = 289; 57.3%) to supply materials (n = 65; 12.8%) and exchange care information (n = 65; 12.8%). The duration of interruptions ranged from 0:08 to 9:09 (average 1:15; SD 1:03) minutes. On average, interventions took 2:16 (SD 0:27) minutes to complete without interruption; however, the average was 5:59 (SD 3:01) minutes when interrupted. Conclusion: The interruptions were constant during the nursing work in the chemotherapy unit, including during the preparation and administration of medications, and increased the time to complete the interventions by an average of 163.9%.
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Sanderson P, McCurdie T, Grundgeiger T. Interruptions in Health Care: Assessing Their Connection With Error and Patient Harm. HUMAN FACTORS 2019; 61:1025-1036. [PMID: 31469315 DOI: 10.1177/0018720819869115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE We address the problem of how researchers investigate the actual or potential causal connection between interruptions and medical errors, and whether interventions might reduce the potential for harm. BACKGROUND It is widely assumed that interruptions lead to errors and patient harm. However, many reviewers and authors have commented that there is not strong evidence for a causal connection. METHOD We introduce a framework of criteria for assessing how strongly evidence implies causality: the so-called Bradford Hill criteria. We then examine four key "metanarratives" of research into interruptions in health care-applied cognitive psychology, epidemiology, quality improvement, and cognitive systems engineering-and assess how each tradition has addressed the causal connection between interruptions and error. RESULTS Outcomes of applying the Bradford Hill criteria are that the applied cognitive psychology and epidemiology metanarratives address the causal connection relatively directly, whereas the quality improvement metanarrative merely assumes causality, and the cognitive systems engineering metanarrative either implicitly or explicitly questions the feasibility of finding a direct causal connection with harm. CONCLUSION The Bradford Hill criteria are useful for evaluating the existing literature on the relationship between interruptions in health care, clinical errors, and the potential for patient harm. In the future, more attention is needed to the issue of why interruptions usually do not lead to harm, and the implications for how we approach patient safety.
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Affiliation(s)
| | - Tara McCurdie
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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20
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Schneider A, Wehler M, Weigl M. Provider interruptions and patient perceptions of care: an observational study in the emergency department. BMJ Qual Saf 2018; 28:296-304. [PMID: 30337495 DOI: 10.1136/bmjqs-2018-007811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 08/15/2018] [Accepted: 09/07/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Interruptions are endemic in healthcare work environments. Yet, they can have positive effects in some instances and negative in others, with their net effect on quality of care still poorly understood. We aimed to distinguish beneficial and detrimental forms of interruptions of emergency department (ED) providers using patients' perceptions of ED care as a quality measure. METHODS An observational design was established. The study setting was an interdisciplinary ED of an academic tertiary referral hospital. Frequencies of interruption sources and contents were identified in systematic expert observations of ED physicians and nurses. Concurrently, patients rated overall quality of care, ED organisation, patient information and waiting times using a standardised survey. Associations were assessed with hierarchical linear models controlling for daily ED workload. Regression results were adjusted for multiple testing. Additionally, analyses were computed for ED physicians and nurses, separately. RESULTS On 40 days, 160 expert observation sessions were conducted. 1418 patients were surveyed. Frequent interruptions initiated by patients were associated with higher overall quality of care and ED organisation. Interruptions relating to coordination activities were associated with improved ratings of ED waiting times. However, interruptions containing information on previous cases were associated with inferior ratings of ED organisation. Specifically for nurses, overall interruptions were associated with superior patient reports of waiting time. CONCLUSIONS Provider interruptions were differentially associated with patient perceptions of care. Whereas coordination-related and patient-initiated interruptions were beneficial to patient-perceived efficiency of ED operations, interruptions due to case-irrelevant communication were related to inferior patient ratings of ED organisation. The design of resilient healthcare systems requires a thorough consideration of beneficial and harmful effects of interruptions on providers' workflows and patient safety.
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Affiliation(s)
- Anna Schneider
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich
| | - Markus Wehler
- Department of Emergency Medicine and Department of Medicine IV, Klinikum Augsburg, Augsburg, Germany
| | - Matthias Weigl
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich
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Laustsen S, Brahe L. Coping with interruptions in clinical nursing-A qualitative study. J Clin Nurs 2018; 27:1497-1506. [DOI: 10.1111/jocn.14288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Sussie Laustsen
- Department of Cardiothoracic and Vascular Surgery; Aarhus University Hospital; Aarhus N Denmark
- Department of Clinical Medicine; Centre of Research in Rehabilitation (CORIR); Aarhus University; Aarhus N Denmark
| | - Liselotte Brahe
- Department of Cardiothoracic and Vascular Surgery; Aarhus University Hospital; Aarhus N Denmark
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Weigl M, Beck J, Wehler M, Schneider A. Workflow interruptions and stress atwork: a mixed-methods study among physicians and nurses of a multidisciplinary emergency department. BMJ Open 2017; 7:e019074. [PMID: 29275350 PMCID: PMC5770922 DOI: 10.1136/bmjopen-2017-019074] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Dealing with multiple workflow interruptions is a major challenge in emergency department (ED) work. This study aimed to establish a taxonomy of workflow interruptions that takes into account the content and purpose of interruptive communication. It further aimed to identify associations of workflow interruptions with ED professionals' work stress. DESIGN Combined data from expert observation sessions and concomitant self-evaluations of ED providers. SETTING ED of an academic community hospital in Germany. PARTICIPANTS Multidisciplinary sample of ED physicians and nurses. 77 matched observation sessions of interruptions and self-evaluations of work stress were obtained on 20 randomly selected days. OUTCOME MEASURES ED professionals' stress evaluations were based on standardised measures. ED workload data on patient load, patient acuity and staffing were included as control variables in regression analyses. RESULTS Overall mean rate was 7.51 interruptions/hour. Interruptions were most frequently caused by ED colleagues of another profession (27.1%; mean interruptions/hour rate: 2.04), by ED colleagues of the same profession (24.1%; 1.81) and by telephone/beeper (21%; 1.57). Concerning the contents of interruption events, interruptions most frequently occurred referring to a parallel case under care (30.3%, 2.07), concerning the current case (19.1%; 1.28), or related to coordination activities (18.2%, 1.24). Regression analyses revealed that interruptive communication related to parallel cases significantly increased ED providers' stress levels (β=0.24, P=0.03). This association remained significant after controlling for ED workload. DISCUSSION Interruptions that refer to parallel cases under care were associated with increased stress among ED physicians and nurses. Our approach to distinguish between sources and contents of interruptions contributes to an improved understanding of potential benefits and risks of workflow interruptions in ED work environments. Despite some limitations, our findings add to future research on the implications of interruptions for effective and safe patient care and work in complex and dynamic care environments.
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Affiliation(s)
- Matthias Weigl
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Joana Beck
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Markus Wehler
- Department of Emergency Medicine and Medicine IV, Klinikum Augsburg, Augsburg, Germany
| | - Anna Schneider
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
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Johnson KD, Alhaj-Ali A. Using Simulation to Assess the Impact of Triage Interruptions. J Emerg Nurs 2017; 43:435-443. [DOI: 10.1016/j.jen.2017.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/31/2017] [Accepted: 04/19/2017] [Indexed: 11/29/2022]
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Johnson KD, Mueller L, Winkelman C. The nurse response to abnormal vital sign recording in the emergency department. J Clin Nurs 2017; 26:148-156. [PMID: 27272499 DOI: 10.1111/jocn.13425] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To examine what occurs after a recorded observation of at least one abnormal vital sign in the emergency department. The aims were to determine how often abnormal vital signs were recorded, what interventions were documented, and what factors were associated with documented follow-up for abnormal vital signs. BACKGROUND Monitoring quality of care, and preventing or intervening before harm occurs to patients are central to nurses' roles. Abnormal vital signs have been associated with poor patient outcomes and require follow-up after the observation of abnormal readings to prevent patient harm related to a deteriorating status. This documentation is important to quality and safety of care. DESIGN Observational, retrospective chart review. METHODS Modified Early Warning Score was calculated for all recorded vital signs for 195 charts. Comparisons were made between groups: (1) no abnormal vital signs, (2) abnormal vital sign present, but normal Modified Early Warning Score and (3) critically abnormal Modified Early Warning Score. RESULTS About 62·1% of charts had an abnormal vital sign documented. Critically abnormal values were present in 14·9%. No documentation was present in 44·6% of abnormal cases. When interventions were documented, it was usually to notify the physician. The timing within the emergency department visit when the abnormalities were observed and the degree of abnormality had significant relationships to the presence of documentation. CONCLUSIONS It is doubtful that nurses do not recognise abnormalities because more severely abnormal vital signs were more likely to have documented follow-up. Perhaps the interruptive nature of the emergency department or the prioritised actions of the nurse impacted documentation within this study. Further research is required to determine why follow-up is not being documented. RELEVANCE TO CLINICAL PRACTICE To ensure safety and quality of patient care, accurate documentation of responses to abnormal vital signs is required.
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Affiliation(s)
| | | | - Chris Winkelman
- Frances Payne Bolton College of Nursing, Case Western Reserve University, Cleveland, OH, USA
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