By Julie Grenuk, RN, Vice President, Clinical Solution
Today’s acute care nurses are carrying a heavy burden, punctuated by an ever-increasing workload, high patient-to-staff ratios, not to mention the significant impact of the COVID-19 pandemic. This burden is compounded by longstanding challenges associated with distractions, stressful shifts, workplace hazards, and the physical demands of the job. It is easy to conclude that nurses need help!
On average, every nurse working within our nation’s hospitals is being interrupted 10 times an hour. These clinical interruptions usually occur while nurses are engaged in patient interactions, monitoring activities, counseling, admitting/discharging, taking orders from MDs, starting IVs, prepping for procedures, rounding, etc. Although interruptions are a part of every caregiver’s job, they are, most definitely, contributing to medical errors.
For RNs, interruptions come from every direction. They come from patients and their families, from fellow staff members, from phones, pagers, and medical devices, overhead paging, etc. Hospitals can be noisy and exhausting places and these distractions can cascade throughout a given shift, leading to cognitive and sensory overload, even for the most seasoned professional.
The NIH estimates that preventable adverse events lead to nearly 100k deaths a year and cost the US healthcare system over $20 billion annually. One of the most common types of adverse events is related to medication administration, a set of related tasks exclusively performed by RNs.
When medication errors occur, there’s a significant cost involved to restabilize the patient. There is also an associated increase in length of stay by nearly two full days. These mistakes and their subsequent interventions – at scale – pose one of the highest ongoing financial liabilities for health systems. And, they are largely preventable.
In a recent study published in the Journal of Patient Safety, a team of researchers surveyed Patient Safety Reporting System (PSRS) data from a hospital enterprise between 2013 and 2016. While the findings were startling, demonstrating just how insidious and rampant clinical interruptions are within our healthcare systems, there were some clear conclusions drawn, perhaps pointing to a way out of this mess.
It is difficult to assess the impacts of clinical interruptions using traditional observational studies. The authors, instead, took a novel approach by reviewing nearly 80k Patient Safety Event (PSE) reports. PSEs are an essential (and required) component of a hospital’s continuous clinical reporting, quality assurance, and governance programs. Tied to CMS, Joint Commission and other regulatory bodies, PSE reporting provides insight into medication errors, adverse events, and other risks to patient outcomes and safety.
The report found that interruptions increased task time, lengthened care delivery, raised stress levels for both caregivers and patients, and created an atmosphere of frequent distraction, often resulting in medical errors. Not surprisingly, nurses were disproportionately affected by interruptions, comprising 50% of all reports. Additionally, for these nurses, over half of the reported incidents occurred while ordering, preparing, and administering meds.
To further put this into context, a quality improvement study published in Medicine in 2017, showed a two-fold increase in the risk of death associated with medication errors. While hospitals can look to fail-safes such as pharmacist interventions or physician overrides, these did not fully mitigate the potential harm to patients or the financial impact to the organizations.
It makes sense that by decreasing interruptions, particularly during medication administration, hospitals can reduce the potential for patient and fiscal harm.
When it comes to limiting the impact of clinical interruptions, health leaders have a number of avenues to provide corrective actions through training, creation and enforcement of new policies and procedures, better documentation, more oversight, etc. Clinical leaders can promote and reinforce strategies such as distraction-free zones, nurse buddies, do not disturb (DND) policies, accept/reject and auto-escalation protocols, among others. These can all lead to better-supported nurse teams with continuous reinforcement from clinical and quality leadership.
While these traditional interventions are necessary for individual staff corrections, they do not, however, address areas for wider, systemic improvements.
This is where your IT teams and technology vendors come in. The clinical software ecosystem (its complexity and scope) partially bears responsibility for the increasing rates of clinical interruptions, particularly among nurses. In an average month, a 300-bed hospital may generate 28k nurse calls, nearly a million alarms from medical devices, and thousands of notifications from EHR, PACs, lab systems, etc. These notifications have to go somewhere. Unfortunately, they are most often sent to the care teams assigned to the patients… a.k.a. the RNs.
As a technology vendor, propagating some of these rings, dings, and buzzes, we can offer some assistance to reduce the volume of notifications through:
Our hope with this blog is to illustrate that the issue of clinical interruption is well documented and that there are practical ways of mitigating the associated risks of preventable medical errors. We also hope to convey that nurses, clinical leaders, IT, and support teams are not facing this challenge alone.
For more information on how TigerConnect can help optimize your clinical communications and care team collaboration, visit us at www.tigerconnect.com.
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Rodziewicz TL, Houseman B, Hipskind JE. Medical Error Reduction and Prevention. [Updated 2021 Jan 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499956/
Kellogg KM, Puthumana JS, Fong A, Adams KT, Ratwani RM. Understanding the Types and Effects of Clinical Interruptions and Distractions Recorded in a Multihospital Patient Safety Reporting System. J Patient Saf. 2018 Jul 7. doi: 10.1097/PTS.0000000000000513. Epub ahead of print. PMID: 29994817.
The Cost-Saving Effect and Prevention of Medication Errors by Clinical Pharmacist Intervention in a Nephrology Unit – Chen, Chia-Chi MSCPa; Hsiao, Fei-Yuan PhDa,b,c; Shen, Li-Jiuan PhDa,b,c; Wu, Chien-Chih MSCPa,c,* Editor(s): Osemene., Inyang Nora Author Information Medicine: August 2017 – Volume 96 – Issue 34 – p e7883 – doi: 10.1097/MD.0000000000007883
Tags: Reducing Unnecessary Clinical Interruptions, Interruptions, Distractions, HIT, Clinical Analytics, RN Burnout, Patient Communications, Preventable Medical Errors, Medication Errors, Alarm Management, clinical workflow, Nurse Call, Patient Experience, Alarm Fatigue, Patient Safety, Clinical Communications, Care Team Collaboration, Patient Satisfaction