Nursing Interruptions: When the Light Gets in Your Eyes

Running through Portland’s Water Front Park for exercise one morning, the sun silhouetted a Coast Guard helicopter flying low over the river. The loud noise of its rotating blades captured the attention of a group of preschoolers playing nearby in the grass.

by jparadisi

by jparadisi

The children stopped to watch the helicopter, but the bright sunlight behind it glared into their eyes so they turned away and resumed their activities — except for one three year-old boy, who held one hand before his eyes, using it as a filter to block the intense light of the sun. This allowed him to stay focused on the helicopter while it glided through clouds and blue sky.

I carry this image in my mind’s eye and pull it out often, like now, while writing this post, distracted by checking Facebook updates, emails, and shopping an online department store sale. I remind myself to focus on the job at hand, like the preternaturally wise three-year old.

For nurses, the need to focus is critical, and the distractions more numerous. In fact, multitasking while performing patient care is encouraged among nurses as a job skill, with mixed results.

According to a 2010 article posted in Medscape Medical News, nurses that are interrupted during medication administration run a risk of making an error:

For each interruption, there was a 12.1% increase in procedural failures and a 12.7% increase in clinical errors, with the association between interruptions and clinical errors independent of hospital and nurse characteristics. More than half (53.1%) of all administrations were interrupted (95% confidence interval [CI], 51.6% – 54.6%), and nearly three quarters of total drug administrations (74.4%; n = 3177) had at least 1 procedural failure (95% CI, 73.1% – 75.7%).

Teamwork requires the flexibility to prioritize the needs of patients against the needs of unit workflow. Nurses need some sort of filter for incoming stimuli so that the essentials — like medication administration — are sorted from interruptions that can wait. Even for nurses with strong prioritization skills, many shifts pass in which no single task is completed from beginning to end without interruption.

Multitasking is as much a team sport as it is a personal responsibility. For instance, when checking medications, particularly chemotherapy, it’s helpful if the team withholds unrelated interruptions from the nurses checking chemo until after the check is completed. Providing a separate space such as a medication room would prevent interruption, but not all clinics or hospitals have the luxury of this much vacant real estate.

To decrease interruptions, some hospitals distribute badges that flash an LED light alerting coworkers when a nurse is in the midst of medication administration. If this works, I’m afraid that the temptation to keep the light flashing my entire shift would overwhelm me.

What are your suggestions for decreasing interruptions during medication administration? Does your institution provide a medication room or use other indicators to prevent interruptions while checking chemotherapy? If so, does it work?