Ordering Interruptions in a Tertiary Care Center: A Prospective Observational Study

Dadlez, Nina M.; Azzarone, Gabriella; Sinnett, Mark J.; Resnick, Micah; Ushay, H. Michael; Adelman, Jason S.; Broder, Molly; Duh-Leong, Carol; Huang, Joyce Huixin; Kiely, Victoria; Nadler, Ariella; Nelson, Vayola; Simcik, Jared; Rinke, Michael L.

doi:10.1542/hpeds.2016-0127

Cited by 4 publications

(5 citation statements)

References 23 publications

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“…In the prospective observational study conducted by Dadlez et al 27 1-hour-long structured observations on morning rounds and a ernoons and evenings in the resident workroom. The primary outcome was the number of interruptions per 100 orders placed by residents and physician assistants.…”

Section: Resultsmentioning

confidence: 99%

“…Gill et al (Australia, 2011) 26 don't specify the type of factors causing interruptions, asserting that they a ect the application of the protocol of the correct management of the therapy. Dadlez et al (USA, 2017) 27 found that the majority of interruptions were in person or by phone and overall, the individuals initiating the interruption most commonly were nurses, in addition to the fact that the vast majority of these interruptions were non-urgent. They developed various interventions, including marked no-interruption zones in medication preparation areas, having nurses wear a visible symbol to indicate the process of medication administration time, designation of speci c protected medication rounding time, and scripting for nurses to defer interruptions.…”

Section: Discussionmentioning

confidence: 99%

“…Then, assessing the potential error linked to any type of interruption may allow a better management of the therapy process when taking care of children. In fact, in paediatric settings, e orts should be made to reduce interruptions to the minimum permissible during the various critical activities; in order not to create isolated areas such as aircra cockpits, but structured and organised systems that respond to interruptions 27 . Moreover, there is a lack of validated tools for detecting interruptions in paediatric settings, thus further studies and researches are needed.…”

Section: Discussionmentioning

confidence: 99%

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Interruptions during therapy preparation, administration and monitoring while caring for the paediatric population: a scoping review

Parente¹,

Cialdi

Frangioni

et al. 2023

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Background: Nurses perform many actions during the therapy process. However, the time dedicated to the process of drug therapy is very important for the children’s safety; indeed, assessing the factors that can impact on the whole therapy process represent an important objective. Aim. The primary aim of this scoping review is to investigate the factors associated to the interruptions of the therapeutic process (i.e., preparation, administration and, monitoring) for inpatient paediatric population. The secondary aim is to investigate possible implementation strategies to prevent interruptions and, thus, prevent medical administration error (MAE). Materials and method: A scoping review was performed, following the PRISMA guidelines using the keywords ‘paediatric’ AND ‘interruption to therapy administration/preparation/ monitoring’. The search was performed during April 2022. Results: Out of 242 records retrieved, 8 full text studies met the inclusion criteria and therefore, included in the review. the included full texts were grouped according to the stage of the therapy process they addressed. The majority of the studies adopted an observational design and highlighted how interruptions can occur due to environmental reasons and people. All the included studies focused on the “negative” consequences of interruptions, although, they reveal that the nurses constitute a resilient profession, because they can implement adaptive strategies in extremely disruptive environments and organizations. However, development of new strategies to reduce interruptions during the therapy process is highly needed to guarantee the safety of the children. Conclusion: we recognize that prioritization is an ongoing challenge, indeed the first step is a cultural change in order to implement new organizational and clinical models where “positive” disruptions are allowed and the “negative” ones are blocked or prevented.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Interruptions during therapy preparation, administration and monitoring while caring for the paediatric population: a scoping review

Parente¹,

Cialdi

Frangioni

et al. 2023

View full text Add to dashboard Cite

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“…The study explored interruptions in various contexts of health care, mainly in the activity of preparation and administration of medicines (42) . It is one of the most complex and critical activities performed by nursing professionals.…”

Section: Discussionmentioning

confidence: 99%

Interruption in the work of nursing professionals: conceptual analysis

et al. 2022

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Objectives: to analyze the concept of “interruption in the work of nursing professionals”. Methods: conceptual study according to the method proposed by Walker and Avant through integrative literature review. The study searched the databases using the descriptors: “Attention”, “Attention Bias”, “Health Personnel”, “Nurses”, “Patient Safety” and “Medical Malpractices”. The sample consisted of 36 studies. Results: the antecedents were alarms, answering phone calls, providing patient care, and lack of material/medicine. The defining attributes were pause, suspension, breakage, and intrusion. In relation to the consequences, the study highlighted the increase in frequency and severity of medication errors and change of focus. Final Considerations: theconceptual analysis identified the attributes, antecedents, and consequences and allowed to build an operational definition for “interruption in the work of nursing professionals”. It will contribute to the improvement of the work process and the creation of strategies that ensure safer care for the patient.

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“…8 In order to accommodate interruptions, physicians often employ task switching, which occurs when the interrupted person stops their current task, engages with a new task, and then subsequently returns to the initial task. 9,10 It is well known that task switching can degrade performance and increase the rate of errors, [9][10][11][12][13] but it also increases cognitive load and therefore can interfere with learning. [14][15][16] Classroom investigators have shown that text messaging during lectures degrades recall and learning, and that frequent interruptions can disrupt encoding of new material into long-term memory.…”

Section: Introductionmentioning

confidence: 99%

Interruptions to Attending Physician Rounds and Their Effect on Resident Education

Armendariz

Tamayo

Slade³

et al. 2021

Journal of Graduate Medical Education

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Background Daily attending rounds (AR) are a cornerstone of teaching and patient care in academic health centers. Interruptions in health care are common and can cause increased risk of errors, incomplete work, and decreased decision-making accuracy. Interruptions to AR may diminish a trainee's capacity to learn and retain information. Objective We characterized and quantified interruptions that occur during AR. Methods We used a mixed-methods design combining a prospective observational study with a qualitative study. AR were observed January to March 2020 to characterize interruptions, followed by semi-structured interviews with the observed physicians to elucidate the effect of interruptions on workflow and the educational value of rounds. Results There were 378 observed interruptions over the course of 30 AR sessions, averaging 12.6 (range 1–22, median 13) interruptions per rounding session. Bedside nursing staff was the most common source of interruptions (25%) and consultant recommendations was the most common topic of interruption (21%). Most interruptions occurred during patient presentations (76%), and the most common method of interaction was text message (24%). Most team members described negative effects of interruptions, including loss of focus and missing critical clinical information; some also reported that certain interruptions had positive effects on education and clinical care. Interns were more likely to report negative emotional reactions to interruptions. Conclusions AR are frequently interrupted for non-urgent topics by a variety of methods and sources. Negative effects included loss of focus, missed information, and increased stress. Proactive communication, particularly between physicians and nurses, was suggested to reduce interruptions.

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Ordering Interruptions in a Tertiary Care Center: A Prospective Observational Study

Cited by 4 publications

References 23 publications

Interruptions during therapy preparation, administration and monitoring while caring for the paediatric population: a scoping review

Interruptions during therapy preparation, administration and monitoring while caring for the paediatric population: a scoping review

Interruption in the work of nursing professionals: conceptual analysis

Interruptions to Attending Physician Rounds and Their Effect on Resident Education

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