Deflect distractions and intercept interruptions

ISMP error alert

As pharmacists, it’s hard to get through a single hour without being distracted or interrupted, even when performing critical tasks. Pharmacists and technicians dispensing medications are distracted and interrupted as often as once every 2 minutes, according to research published in Quality & Safety in Health Care and by the Institute for Safe Medication Practices (ISMP). Health professionals who are interrupted are expected to multitask, and constant distractions and interruptions are generally accepted as the norm in health care.

Effects of distractions and interruptions

Distractions and interruptions include anything that diverts attention from the task at hand, forcing one’s attention on something else, at least temporarily. Attending to a new task increases the risk of error; the stress of distraction causes cognitive fatigue, leading to omissions, mental slips or lapses, and mistakes.

An error reported to ISMP a decade ago remains an excellent example of how easy it is to make an error when distracted. A nurse who had just measured a dose of liquid chloral hydrate into a cup was interrupted by a pharmacist on her way to the patient’s room. The conversation was social, and the nurse—who often had a cup of coffee in her hand—absentmindedly drank the medication, as if taking a sip of coffee! The nurse had to be driven home.

Interruptions early in a task are more likely to lead to errors than those near the end of the task or between subtasks, researchers have found. When interruptions occur at natural transitions between parts of a task, instead of during the busiest moments, errors are less likely.

Sources of interruptions and distractions

Common sources of interruptions include people—staff and patients—or medical devices, such as computers, robotics, and phones. Distractions can be auditory or visual. Interruptions frequently take the form of clinical or procedural clarifications, notifications, requests, systems issues such as missing medications or other supplies, emergencies, and social conversation.

While surveys suggest that health professionals believe telephone calls and patients represent the greatest sources of interruptions and distractions, actual studies published in Quality & Safety in Health Care (see above) and the British Journal of Nursing found that self-induced interruptions such as initiating conversations with others were more common.

With the Internet just a click away, pharmacists may be tempted to conduct personal business while at work. Younger staff may be more susceptible to distraction because they have grown up with text messages, Facebook, and so on.

Do not disturb

To help decrease distractions, consider the following suggestions:

  • No Interruption Zone (NIZ). Using aviation’s concept of a sterile cockpit, an NIZ involves a discreet area for critical medication tasks that is cordoned off with visual markers to signify that talking and interruptions are not permitted. NIZs can be created around drug preparation areas and computer order entry locations.
  • Staff education. All staff should avoid interrupting pharmacists during the final verification process.
  • Timing of necessary interruptions. Necessary interruptions or notifications during final verification should take place between subtasks, such as between patients or orders being prepared. All staff should avoid interruptions during the most complex parts of a task.
  • Checklists. Post a checklist of important points in work areas. Pharmacists can reference these lists when a task is interrupted to aid in remembering where they stopped.
  • System improvements. Identify the sources of common interruptions and remedy any system issues such as out-of-stock medications.
  • Mobile device management strategy. Implement a policy that addresses appropriate use of mobile devices while minimizing the risks associated with distractions. Any inattentive behavior related to personal business should be treated as an at-risk behavior requiring coaching to promote safe behavioral choices.
  • Alerts, alarms, and noises. Reduce the frequency of invalid, insignificant, or overly sensitive computer alerts and device alarms to promote the delivery of critical notifications. Minimize the noise of overhead pages and other unnecessary chatter in preparation areas.