By Christine Moffa, MS, RN, AJN clinical editor
By NathanF/via Flickr (Creative Commons)
Interruptions are distracting.
I have a hard time focusing when I am repeatedly interrupted. How many times have you walked down the hall to get something, met with an unexpected request or encounter, and then found you couldn’t remember where you were going or why?
A few years ago I was working as float nurse in an outpatient facility. One of the specialties I floated to was the pediatric clinic. There were seven or eight nurses (a mix of RNs and LPNs) working at the same time, with half assigned to administering medication, mostly vaccines, and the others performing telephone triage and monitoring patients in the observation room. I can now admit that I used to pray to get assigned to the triage section—not because giving injections was a problem, but because the setup of their system terrified me. Typically, four nurses would work out of a small room in which they picked up medication orders, checked that the immunization schedule was being followed correctly, drew up the medication, and documented in the patients’ charts.
Keep in mind that many of the patients were infants and toddlers getting up to four injections at one visit. If keeping track of all that wasn’t hard enough, these nurses were also charged with filling out insurance and physical forms. Because of this, patients’ family members frequently interrupted a nurse in the middle of drawing up four vaccines in order to ask about an insurance form.
Reducing distractions during medication administration.
That’s why I was thrilled when I came across this article about a program put in place by the University of California at San Francisco’s Integrated Nurse Leadership Progam to reduce distractions during medication administration. The nurses used simple methods like wearing a sash or a colored vest to alert others that they were not to be interrupted. According to the San Francisco Chronicle, the program has “resulted in a nearly 88 % drop in errors over 36 months at the nine Bay Area hospitals.”
I wish that the public would be brought into the equation as well. After all, they do much of the interrupting. I wonder if, given an option, they would prefer their child to be injected by a nurse in the scenario I described above, or by one in a hospital where nurses can actually concentrate.
What are your strategies for reducing distraction in the workplace?
I would love to see the “medication” nurse implemented again….she would wear a vest, patients would be educated that she solely there to adminster medicatoins. She can then refer others such as family to the patients nurse and explain she is the medication nurse and the patients nurse knows more about the patient in question. There will still be interuptions but this study proves it can work. So can decreased nurse/patient ratios which is already implemented in California. Perhaps that added to the improvements in med errors. That alone decreases distractions. I never leave a task or a patient half finished unless another patient is in trouble. This implies to your patient that you left that they are less important.
As creater and director of this program, the Integrated Nurse Leadership Program, I appreciate the editor writing about this important project. The work done in all these hospitals by all these nurses is remarkable. It takes work and time–it is not just as simple as checking a medicine twice or putting on a colored vest during medication administration. It takes a whole system learning to respond differently. I think that distractions and interruptions are our biggest enemy and all the literature will tell you that taking our focus away from any task at hand increases our chances for error. For more information about how we accomplished this, please read this month the Joint Commission’s Journal on Quality and Patient Safety. Thank you, Julie Kliger
I agree with the issue mentioned above, this system definitely needs to change. Being new nurses, we are easily distracted and often need more time to focus on the task at hand. We often use medication rooms to draw up meds where there are fewer distraction. This is not necessarily feasible in every health care setting, but a “no interruption” zone would definitely be beneficial.
Caroline,
Thanks for your comment. However, I disagree with your approach to nursing. Your statement “I tend to stop tasks halfway-through, start something else, go back and finish the first one, resume the second one, etc, etc.” strikes me as a very unsafe way to practice. I can’t imagine it’s efficient or that your patients appreciate being treated that way either. As far as bar codes are concerned, technological safety nets can help but they fail sometimes too. And technology is only as good as the user.
I have no strategy. I love distractions! Nursing suits the ADD-part of my brain very well. If I’m not distracted by others, I find ways to distract myself. I tend to stop tasks halfway-through, start something else, go back and finish the first one, resume the second one, etc, etc. I think nursing is perfect for that.
Oh, and for safety reasons, I’m a nazi about using the bar code med administration program we have. It’s not foolproof, but it is a GREAT system.
We have to check medications with each other even if its something simple like ampicillin. We also check our TPN and Lipids and verify the rates on the pumps with each other. I like this system. There are also scanners at some hospitals where you scan the medicine and scan the patient but that it basically assuming that the pharmacy is correct.
I saw this article about UC San Francisco. It is a great idea and more is being done around this as it is a problem. I have also heard of a “no interruption area” that is drawn around the med cart or Pyxis. When a nurse is inside this zone, no one can interrupt them. This has also been successful. Any other ideas? If your facility hasn’t implemented something like this, please consider it. Medication errors cost our system many many dollars a year.