Interruptions Increase Errors. Really?


Nurse's Note artist: JParadisi. pencil and ink on paper

     I am writing this post while my husband pumps air into his bicycle tires in our living room (ka-chunka chunka-chunka), muttering about how much work cycling is. Finding uninterrupted time to write or paint is sometimes challenging. In nursing, where the safety of patients depends on accuracy, it is impossible. It is the biggest absurdity of my two careers.    

      This morning I read a Medscape article about interruptions exponentially increasing nursing medication and procedure errors. Researchers collected data for the study by observing nurses at two hospitals. Although the conclusion seems obvious, I appreciate hard numbers applied to a reality all nurses recognize. Collecting data is the first step towards change. Shockingly, according to the study a single interruption during medication administration increases frequency of errors to 25%.    

     In all my years of nursing, I have never completed a single task from start to finish without an interruption. A coworker asks a question, a patient or family member needs something, a phone call from a physician or another department and I am distracted. Once, on pediatric unit, I entered my first patient’s room to find him vomiting violently in the bathroom. While holding his small head out of the toilet, calming him down, and keeping his IV in place, my pager beeped. I had to ignore it, but as soon as the patient was safely in bed, I went to the nurses’ station to see why I was paged. There, a unit secretary lectured me about her expectation for an immediate call back to a page (although doctors have an unwritten, twenty-minute grace period to answer pages for non-urgent matters). Why was I paged? A doctor had a question. I did not need to explain myself to the secretary; when I did, her expectation remained unchanged. Whatever. I called the doctor back, and there wasn’t a problem. My point is interruptions can wait until a patient is safe. The problem is most nursing units have expectations that everything be done now. STAT is the most over-used word in health care. Is there really such a thing as STAT Colace? There is an unrealistic pressure on nurses to do everything at once. It is impossible, and patient safety suffers. It’s a no brainer. How sad studies are necessary to prove the obvious.    

        Creating a safe zone where nurses can draw up medications without interruption is a reasonable idea; however, it does not address the interruptions occurring in the patient’s room, like the pager going off in my pocket.  I am often interrupted while double-checking blood, accessing a port, or hanging chemo by the patient asking for a blanket “when you get a chance” or answering their cell phone. They do not realize how much concentration it takes to give safe care. More than once, I have explained to patients or family members “I need to focus on what I’m doing to keep you safe, and I will be glad to answer your question as soon as I finish.”  I’ve never had a patient or family member complain about it. They appreciate dedication to their safety.   

     Interruptions are a daily part of everyone’s life. Reducing nonessential ones is crucial to safe nursing practice, and adjusting expectations (including staffing ratios) is critical.     

     You can find the article   

Interruptions Linked to Medication Errors by Nurses