ArticlesDistractions and Interruptions: Development of a Healthcare Sterile Cockpit
Section snippets
Background
Distractions are a major cause of error in healthcare. In a 2004 multisite study of voluntary reporting of error in neonatal intensive care units (NICU), 27% of reports were associated with inattention, 22% with a communication problem, and 12% with distractions.1 In another study, distractions were ranked fourth as a major cause of medication errors.2 In an observational study in a medical intensive care unit, one distraction or interruption occurred approximately every 5 minutes and preceded
Phase I: Assessment
To recommend modifications to current clinical practice, it is essential to conduct direct observational assessments to identify potential sources of interruptions and distractions. Observers should be alert for (a) breakdown in communication, (b) a tendency to be “head down” or focused on task-specific activities, and (c) any responses to unexpected or emergency activity. In addition, it is also important to assess for ergonomic barriers (ie, poor lighting), noise level (ie, overhead pages),
Summary
Medication errors are complex, and although causes vary, interruptions and distractions have been identified as risks to safe medication delivery. It is unreasonable to expect that there will be change to such a lengthy history of acceptance of these risks by merely issuing new policies or protocols. Instead, greater success may result from system-wide improvements that decrease inattention, miscommunication, distraction, and other contributory human factors. Although there is need for
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Cited by (28)
Explaining emergency physicians’ capacity to recover from interruptions
2022, Applied ErgonomicsCitation Excerpt :This awareness could enable the implementation of tailored strategies where clinicians have a range of responses that can be initiated, depending on the circumstances and the specific protocols under which they are operating. For emergency physicians with lower cue utilization, a ‘sterile’ communication environment may be invoked during cognitively demanding tasks, whereby interruptions and distractions unrelated to the task are minimized (Hohenhaus and Powell, 2008). While there is an assumption that the differences in performance evident in the present study were due to differences in the capacity to manage cognitive load, reflected in levels of cue utilization, this has yet to be tested directly in the context of emergency medicine.
A Qualitative Analysis of Human Error During the DIBH Procedure
2019, Journal of Medical Imaging and Radiation SciencesCitation Excerpt :Other forms of interruptions or distractions involving extraneous discussions between treating therapists, conversations with external staff, or incoming phone calls were also reportedly preventing therapists from fully focusing on the delivery of treatment, thus leading to missing the step of asking the patient to hold their breath before initiating the beam on. This type of distraction can be paralleled to the nursing profession where distraction during medication delivery is a major cause of human errors [21]. The slip/lapse occurring during the DIBH procedure was associated with a wide variety of causative factors that influence performance as listed previously in Table 2.
Nurse–Technology Interactions and Patient Safety
2018, Critical Care Nursing Clinics of North AmericaPhysician, Interrupted: Workflow Interruptions and Patient Care in the Emergency Department
2017, Journal of Emergency MedicineCitation Excerpt :Although a relatively small number of interruptions actually occurred in the patient room, there is opportunity to reduce those interruptions and their impact at the “sharp end” of care (18). Potential ways to mitigate interruptions at the point of care could include treating the patient room as a “sterile cockpit” or “interruption free zone” (19). It is important to note that these interventions may be more relevant to human-initiated interruptions vs. technology or environmentally induced interruptions; additional work is needed to evaluate the intersection of technology, interruptions, and their management.
Using an integrated information system to reduce interruptions and the number of non-relevant contacts in the inpatient pharmacy at tertiary hospital
2017, Saudi Pharmaceutical JournalCitation Excerpt :In many references, the telephone calls are listed as one source of interruption, as these frequent interruptions can have a significant effect on memory. For example, interruptions may result in loss of concentration leading to medication errors and increased turnaround time (TAT) (Hohenhaus and Powell, 2008; Kistner et al., 1994; Nichols et al., 2008; Sørensen and Brahe, 2014). A common factor that leads to medication errors, in more than 50% of incidents involving pharmacist errors, is distraction.