Reducing Interruptions and Errors

Healthcare-related mistakes rank among the top 10 leading causes of death. In fact, these medical errors can lead to preventable adverse events that account for an estimated 44,000 to 98,000 American deaths every year.

Now two studies have identified interruptions as a significant factor contributing to errors that threaten patient safety.

Rising Medication Errors

According to a recent observational study, nurses who were interrupted while preparing or administering medications made more medication errors, and the severity of the errors increased with the frequency of interruptions.

The 18-month Australian study took place in two major teaching hospitals and involved 98 nurses who gave 4,271 medications to 720 adult patients. The study divided the results into procedural failures (such as a break in aseptic technique) and clinical errors (such as administration of a wrong dose), and found that interruptions were associated with a 12% increase in both types of errors.

Surprisingly, over half of all observed drug administrations were interrupted, and nearly three-quarters had one or more procedural failures. Consider these findings:

Without Interruption With Interruption
Procedural failure rate 69.6% 84.6% (with three interruptions)
Clincal error (at least one) 25.3% 38.9% (with three interruptions)
Estimated risk of major error 2.3% 4.7% (with four interruptions)

Affecting More Than Medications

In a Canadian study, researchers observed 30 medical-surgical nurses over two weeks for a total of 480 hours of observed work. During this time, they noted 1,687 interruptions, which were divided almost evenly between medical and surgical units. A series of focus groups verified the data analysis.

As summarized in these tables, the study found that healthcare personnel were the most frequent source of interruptions, and other people were the second most frequent source: 

Source of Interruption Overall Frequency
Healthcare team members 31.8%
Other nurses 22.4%
Patients, families and visitors 20.1%
Environment 20.1%
Other 6.7%
Cause of Interruption Overall Frequency
Communication 57.3%
Waiting, finding or both 22%
Patient 16.3%
Environmental noise 4.4%

Of particular significance, the study found that interruptions usually occurred during key patient care activities, such as medication administration. Although 10.8% of all interruptions had the potential to improve patient care, 89.2% could have negatively affected it.

Suggestions and Solutions

These studies suggest that interruptions may negatively affect memory by requiring nurses to shift their attention between tasks. Before returning to the original task, nurses must complete the interrupting task and then reorient themselves to the context of the first task. That helps explain how interruptions can lead to errors.

To aid in preventing unnecessary interruptions—and medical errors—here are some possible solutions:

  • Implement strategies for improving communication practices and reducing unnecessary interruptions on the floor. For example, study the reasons for unnecessary interruptions and then develop strategies for reducing them.
  • Develop large posters that list quiet times for medication administration. Place them throughout the unit.
  • Use the overhead system to announce the start and end of quiet time for medication administration.
  • Conduct medical rounds only during times when medications are not being administered.
  • Create interruption-free zones around medication preparation areas.
  • Develop a one- or two-sentence overview of the key attributes of the protected hour for medication administration. Repeat this overview to staff to stress the importance of this program.
  • Encourage nurses, physicians, pharmacists and all hospital staff to commit to the goal of safe medication administration.

For information about preventing medication errors in your facility, check out the new online course from Mosby’s eLearning, AACN Critical Care Pharmacology, or call 866-416-6697.

Hall, L.M., Pederson, C., and Fairley, L. Losing the moment: Understanding interruptions to nurses’ work. Journal of Nursing Administration. 2010, 14(4): 169-176.

Howie, W.O. Mandatory reporting of medical errors: Crafting policy and integrating it into practice. Journal for Nurse Practitioners. 2009, 5(9): 649-654.

Kliger, J., Blegen, M.A., Gootee, D., and O’Neil, E. Empowering frontline nurses: A structured intervention enables nurses to improve medication administration accuracy. The Joint Commission Journal on Quality and Patient Safety. 2009, 35(12): 604-612.

Westbrook, J.I., Woods, A., Rob, M.I., Dunsmuir, W.T.M., and Day, R.O. Association of interruptions with an increased risk and severity of medication administration errors. Archives of Internal Medicine. 2010, 170(8): 683-690.

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