Study shows clear link between interruptions, medication errors

Patient safety experts for years have warned about the dangers of interruptions during medication preparation and administration. New research confirms this relationship, showing that interruptions lead to a higher rate of pocedural failures and clinical errors.

"[T]he more interruptions a nurse received while administering a drug to a specific patient, the greater the risk of a serious error occurring," writes the study's lead author, Johanna I. Westbrook, director of the Health Informatics Research and Evaluation Unit at the University of Sydney in Australia. The study appears in this week's Archives of Internal Medicine.

Westbrook's team observed 98 hospital-based nurses during 4,271 medication administrations and found that interruptions occurred in 53 percent of them. Among the interrupted events, 74% had at least one procedural failure and 25 percent had at least one clinical error.

Those rates shot up higher (85 percent and 39 percent, respectively) when nurses were interrupted at least three times. Administrations that were uninterrupted had a procedural failure rate of 70 percent.

Although the authors acknowledged that some nurse interruptions, such as monitor alarms, are necessary, they found that only 11 percent of the studied interruptions were warranted. 

A separate 2005 study conducted at Missouri's Barnes-Jewish Hospital at Washington University School of Medicine in St. Louis found that common distractions include staff inquiries, stopping to search for missing drugs or supplies, and responding to phone calls or pagers. Most of the interruptions were experienced by senior nurses, who serve as a resource for the other nurses on a floor and are asked questions frequently. Notably, RNs did not seek to control interruptions; rather, they accepted them as part of their work, Patient Safety & Quality Healthcare Reports.

Nurse-distraction solutions compiled by the Agency for Healthcare Research and Quality (AHRQ) Health Care Innovations Exchange include the use of "no interruption zones," "do not disturb vests" and a "medication pass time-out," according to the PSQH article.

In an editorial accompanying the AIM study, Julie Kliger, program director of the Integrated Nurse Leadership Program at the University of California, San Francisco, recommended that hospitals provide nurses a "protected hour" during which they can focus on medication administration without having to do such things as take phone calls or answer pages.

To learn more:
- read this Archives of Internal Medicine abstract 
- read this HealthDay report
- check out this Los Angeles Times blog post
- read this Patient Safety & Quality Healthcare article 

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