In 2/21/2012 edition of the Boston Globe, Correspondent Jan Brogan’s powerful article, “Constant Distractions Can Take a Toll” offers us a compelling opportunity to apply important insights to patient safety, medication errors, and nurse & physician workplace cultures. After two twelve hour shifts on an understaffed Alheimer’s Care unit this week-end, I read the article with extreme interest and fatigue.
In her article, Brogan reports, “…distraction can have disastrous effects when you are behind the wheel of a car, but even multi-tasking at work can take a toll, robbing you of creativity and reflection, and depleting the willpower that might be needed later in the day to force yourself to the gym or avoid overeating”. She also introduces us to Maggie Jackson, author of “Distracted” quoting, “A lot of people today are unhappy, overwhelmed, and feeling like they are knocking themselves out to get things done,’’ Jackson says. “You are not able to use your higher order thinking skills when you are always distracted.’’
In addition, Brogan sites exciting and related work going on at MIT. Dr. Earl K. Miller, professor of neuroscience Power Institute for Learning and Memory states. “Your brain is polling everything around you, noting what needs your attention.’’’
Since we are celebrating National Patient Safety Awareness Week let’s take a moment to consider how this all plays out in our day to day work of high-stress, high-stakes nursing!
Sunday in my tenth hour of work, I was measuring 0.5 cc of ABHR gel from a syringe (about 1 teaspoon of a controlled substance that is a combination of 4 drugs [Ativan, benedryl, reglan, & haldol} often useful in anxiety, nausea & vomitting) to apply on a patient who was being combative with staff and has severe limitations with ability to stand and impaired vision. I was very worried he would fall or hit someone or both and needed to be accurate and fast. A well-meaning family visitor (of another resident) asked me what the code was to leave the unit. I told her I couldn’t talk and to please wait a moment. She said, “I’m sorry, I just want to know the code so I can leave”. I didn’t answer her. Inside, I felt so much pressure. I finished measuring and told her the code. She said, “Thank you”, and i went on to apply the gel. I’m glad I didn’t make a mistake, but I could easily have. And the frustration that I felt trying to focus is still with me as I describe the situation. The family member didn’t really do anything, “wrong”, but there is an huge lack of understanding about the effect of distractions have and nurses’ need to concentrate.
Distractions and interruptions are an almost constant pattern in my own and I believe many nurse practice settings. If we really want to make healthcare safe for patients and workers we absolutely must minimize interruptions/distractions and optimize staffing. This means that healthcare leaders, patient advocates, staff nurses, and physicians must work together to understand how these factors impact the quality and safety of the care we provide and then work collaboratively to make healthcare safe and careers .
- Bed alarms, chair alarms, exit-seeking alarms, bathroom emergency alarms, call bells, phones, pages….
- Continually evolving input from physicians, families, patients, pharmacy, lab, radiology, P.T., O.T, S.T, S.W. and nursing colleagues…
- High degree of precision required for a multitude of tasks…
- Frequent changes in team composition…
- Insidious pressure to work fast…
- Dissonance arising from consumer perspective focused on individual patient vs. nurse/physician perspective focused on ALL patients
The answers to safer healthcare must include minimizing interruptions and I believe requires work to ensure enough skilled staff, teach and support effective limit-setting, apply the principals of group dynamics & teambuilding into staffing decisions, and empower consumers to be active participants in the process. All of which is complex stuff requiring expertise, time and money.
If you haven’t watched 12 min YouTube: “Interruption Awareness: A Nursing Minute for Patient Safety“, I guarantee you will FEEL what I am talking about and be inspired to help!
What do you think about interruptions in nursing?