Mar 2020
clinical initiatives, research and current updates in treatment
Interruptions and Distractions Justine Forbes, Epic Pharmacy Hollywood Elke Fischer, Epic Pharmacy Aged Care and Pharmacy Practice Unit Regardless of which healthcare profession, it is nearly impossible to work a single shift without being interrupted or distracted. Most healthcare professionals expect to be either distracted or interrupted and accept it as part of the job. These minor annoyances, however, can have a large impact on professional practice, patient care and safety. 1 Many studies and initiatives are employed in healthcare facilities worldwide to address these disturbances. A distraction is usually defined as ‘a stimulus from an external source where the worker responds to said stimulus, yet continues their task’. 1 A common example is writing patient notes whilst simultaneously answering a colleague’s question. Both tasks are completed, however, instead of completely focussing on one, attention is divided between the two. An interruption, however, is ‘a signal that distracts from the main task’. 1 The initial task is completely stopped in order to address the interruption. In this case, an example is going to see a patient in the middle of writing notes. The United States Institute of Medicine’s 2000 report, To Err is Human, identified interruptions as a likely contributing factor to medical
errors. 2 Some studies suggest healthcare practitioners are distracted and interrupted as often as once every 2 to 5 minutes. 1,3 Each interruption or distraction can increase mental fatigue, potentially leading to slips, lapses, omissions and mistakes. A 2010 Australian hospital study found that each interruption a healthcare worker experienced increased the risk of a medication error by 12.7%. 4 Telephone calls, pagers, face-to-face conversations, and the physical layout of a room are all common examples of external sources of interruptions and distractions which can potentially increase the risk of errors. 1 Another example of an interruption is when supplies and equipment are not available in the workspace, thereby causing a disruption in workflow. One United States hospital study found looking for items needed to complete day to day tasks accounted for 14% of interruptions. 5 Not only do interruptions and distractions increase the risk of medication errors, if a task is interrupted, the mean processing time of said task is greatly increased. 5 Interruptions and distractions are not always from external sources. An interruption can also be internal. There are two main types of internal interruptions, (1) a healthcare
professional may consciously decide to stop their task e.g. pharmacist stops dispensing to check their phone or (2) a thought may enter the working memory of the healthcare professional e.g. did I remember to sign the medication chart? These thoughts can have both positive and negative outcomes, the healthcare professional may remember a task they had forgotten, or the internal interruption may lead to failure to complete the primary task. 6 Identifying the cognitive implication of interruptions is essential in understanding their impact. 6 When an individual is interrupted, attention is switched from their primary task e.g. administering a medication, to the interrupting task e.g. responding to a question. Once this shift has occurred the memory of the primary task begins to fade allowing the brain to “make room” for the processes required to deal with the interrupting task. When the primary task is resumed, it is difficult to remember the current stage. This may result in steps in the process either being repeated or missed, or even failure to return to the original task. The impact of the interruption on the primary task is dependent on the individual characteristics of both the primary task and the interruption. Continued on page 2