Description of tasks, interruptions, planted errors, performance metrics and applicable interventions in simulation experiments
| Task | Number and timing of interruptions* | Planted error | Performance metric† | Applicable intervention(s)‡ |
|---|---|---|---|---|
| Medication verification tasks (assessment of error detection) | ||||
| 1. Verifying medication name Participant was required to verify medication name on label against electronic and paper medication orders | During medication verification, participant was interrupted by: 2 requests from nursing colleague; 1 question from patient | Medication name on label did not match name on medication orders. Sound-alike, look-alike medications were chosen (eg, Carboplatin vs Cisplatin) | Task was coded as ‘fail’ if participant did not detect the planted error | Verification booth, standardised workflow |
| 2. Verifying medication dosage Participant was required to verify medication dosage on label against electronic and paper medication orders | During medication verification, participant was interrupted by: 1 question from patient; 1 work-related call; 1 request from physician; 1 background infusion pump alarm | Dosage on the medication label did not match that in the medication order | ‘Fail’ if participant did not detect the planted error | Verification booth, standardised workflow |
| 3. Verifying medication volume in syringe Participant was required to verify medication volume on syringe label against electronic and paper medication orders | During medication verification, participant was interrupted by: 1 request from patient's family | The syringe contained an incorrect volume of medication (underfilled by 5 mL—a clinically significant amount) | ‘Fail’ if participant did not detect the planted error | Verification booth, standardised workflow |
| 4. Verifying medication volume in ambulatory infusion pump (AIP) Participant was required to verify medication volume programmed in AIP against medication order and medication label | During medication verification, participant was interrupted by: 1 question from nursing colleague, 1 question from patient's family | The medication volume programmed in the AIP did not match that on the medication order | ‘Fail’ if participant did not detect the planted error | Verification booth, standardised workflow |
| 5. Verifying patient identification (ID) Participant was required to verify patient name on medication label against the patient's armband | During patient armband verification, participant was interrupted by: 1 question from patient, 1 request from nursing colleague | The name on the medication label did not match that on the patient's armband. Sound-alike, look-alike names were chosen (eg, Pamela Chan vs Patricia Chan) | ‘Fail’ if participant did not detect the planted error | Speaking aloud |
| Medication administration tasks (assessment of error commission) | ||||
| 6. Intravenous push Participant was required to administer a chemotherapeutic agent to a patient via manual intravenous push over the pharmacy-prescribed timeline of 6–10 min | During the intravenous push, the participant was interrupted by: conversations from patient and family, 1 request from nursing colleague, 1 question from patient, repeated background infusion pump alarms | No error was planted in this task | ‘Fail’ if participant did not administer medication within pharmacy-prescribed timeline (eg, 6–10 min for vinorelbine) | Visual timers |
| 7. Pump programming and infusion initiation§ Participant was required to administer medication by correctly hanging the medication bag, closing the clamp of previously hanging medication tubing set, opening the clamp for medication to be delivered, and programming an infusion pump with the prescribed administration rate and volume of medication | During pump programming and infusion initiation, the participant was interrupted by: requests from nursing colleague, requests from patient, conversations with patient's family, and background infusion pump alarms | No error was planted in this task | ‘Fail’ if participant programmed pump with incorrect rate or volume, forgot to open/close appropriate clamps, hung medication bags at incorrect heights such that the wrong medication was being infused, or forgot to start the infusion entirely | No interruption zones with motion-activated indicators, speaking aloud, reminder signage |
*Applicable to Conditions 2 and 3 only. The number and timing of interruptions was kept consistent between the two conditions to permit comparability.
†Participants were instructed to report detected errors to the charge nurse (played by an actor-facilitator).
‡Applicable to postintervention condition (ie, Condition 3) only.
§As described in online supplementary appendix 1, the pump programming task occurred in four of the five scenarios. Therefore, Pass/Fail performance was determined using collective criterion; that is, participants had to correctly program the pump in all four scenarios to receive a ‘Pass’.