The Impact of Distractions & Interruptions
In the State of California, drivers are prohibited from talking on a hand held device or texting while driving because it is well known that these distractions can and often lead to unsafe driving. Distractions and interruptions pull your attention away from the activity that you are involved in and may lead you to miss a step or make a mistake. In the 1980s, aviation introduced the concept of a “sterile cockpit,” which refers to a distraction-free cockpit; a time when the captain and crew engage only in flight related conversation.It had become apparent that a number of accidents and near misses were related to distracting conversation among the flight deck and cabin personnel.
Unfortunately, clinical staff are faced with constant
distractions while trying to deliver care to their patients.
Imagine a nurse who is preparing medications for his patient
being interrupted by a visitor asking for directions to the
cafeteria. Imagine a physician being interrupted for a phone call
while she is placing an order for a radiology exam. Add to this
the ongoing distractions from alarms by monitors and IV pumps.
Distractions and interruptions are grouped into a category of
human factors that have been identified as contributing or root
causes in several of the adverse events that have been reviewed.
In our CHPSO database, it was identified as a contributing factor
in 81 percent of the events reviewed.
Since many of these distractions are unavoidable, hospitals need to establish a safe work environment that minimizes distractions and interruptions where it is possible and during the most crucial times.
During medication administration
The Agency for Health Care Quality (AHRQ) published a protocol (updated February 2013) that consists of seven relatively simple, inexpensive interventions that are based on safety measures used in the airline industry: (1) a focused protocol and checklist on how to properly administer medications, (2) a quiet zone to retrieve/prepare medications, (3) education of staff to not distract and to “field” interruptions for nurses who are administering medications, (4) the wearing of a special vest or sash designed to signal to others the need to avoid distracting the nurse during medication administration, and (5) use of quiet zone signs on medication room doors and above medication dispensing machines to remind others not to interrupt (6) nurse education about no conversation during medication administration unless it is about medications, and (7) patient education/orientation about the meaning of the vest and the process. A quasi-experimental evaluation showed that both the focused protocol/checklist and the checklist-vest combination significantly reduced the number of distractions experienced by nurses.
The Joint Commission has identified qualities of effective hand-offs, including limited interruptions. However, units are sometimes the busiest during change-of-shift, when clinical staff are transitioning or handing-off care to another clinician. Unless an issue is urgent, the hand-off procedure for all clinicians, including physicians, should be completed without interruption.
Hospital policies should also address limiting or eliminating the use of personal cell phones and protocols for not answering workplace cell phones or other wireless communication systems (Polycom, handheld radio) while performing patient care. Developing a standard approach and communicating that approach and expectation to everyone, including families and visitors, is essential for success in decreasing interruptions and distractions.