Association Between Mobile Telephone Interruptions and Medication Administration Errors in a Pediatric Intensive Care Unit

Abstract

Incoming text messages and calls on nurses' mobile telephones may interrupt medication administration, but whether such interruptions are associated with errors has not been established.OBJECTIVE To assess whether a temporal association exists between mobile telephone interruptions and subsequent errors by pediatric intensive care unit (PICU) nurses during medication administration. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study was performed using telecommunications and electronic health record data from a PICU in a children's hospital. Data were collected from August 1, 2016, through September 30, 2017. Participants included 257 nurses and the 3308 patients to whom they administered medications.EXPOSURES Primary exposures were incoming telephone calls and text messages received on the institutional mobile telephone assigned to the nurse in the 10 minutes leading up to a medication administration attempt. Secondary exposures were the nurse's PICU experience, work shift (day vs night), nurse to patient ratio, and level of patient care required. MAIN OUTCOMES AND MEASURESPrimary outcome, errors during medication administration, was a composite of reported medication administration errors and bar code medication administration error alerts generated when nurses attempted to give medications without active orders for the patient whose bar code they scanned.RESULTS Participants included 257 nurses, of whom 168 (65.4%) had 6 months or more of PICU experience; and 3308 patients, of whom 1839 (55.6%) were male, 1539 (46.5%) were white, and 2880 (87.1%) were non-Hispanic. The overall rate of errors during 238 540 medication administration attempts was 3.1% (95% CI, 3.0%-3.3%) when nurses were uninterrupted by incoming telephone calls and 3.7% (95% CI, 3.4%-4.0%) when they were interrupted by such calls. During day shift, the odds ratios (ORs) for error when interrupted by calls (compared with uninterrupted) were 1.02 (95% CI, 0.92-1.13; P = .73) among nurses with 6 months or more of PICU experience and 1.22 (95% CI, 1.00-1.47; P = .046) among nurses with less than 6 months of experience. During night shift, the ORs for error when interrupted by calls were 1.35 (95% CI, 1.16-1.57; P < .001) among nurses with 6 months or more of PICU experience and 1.53 (95% CI, 1.16-2.03; P = .003) among nurses with less than 6 months of experience. Nurses administering medications to 1 or more patients receiving mechanical ventilation and arterial catheterization while caring for at least 1 other patient had an increased risk of error (OR, 1.21; 95% CI, 1.03-1.42; P = .02). Incoming text messages were not associated with error (OR, 0.97; 95% CI, 0.92-1.02; P = .22).CONCLUSIONS AND RELEVANCE This study's findings suggest that incoming telephone call interruptions may be temporally associated with medication administration errors among PICU nurses. Risk of error varied by shift, experience, nurse to patient ratio, and level of patient care required.

Physiologic Monitor Alarm Burden and Nurses’ Subjective Workload in a Children’s Hospital

“…Because alarm counts and the number of monitored patients being cared for measured overlapping constructs, we included only alarm counts in our multivariable analysis. Informed by the literature and awareness of the complex relationships between staffing ratios and patient acuity from our previous work 20 and the work of others, 6 we included a 2-way interaction between patient acuity and nurse to patient ratio in our model. We reported scaled, adjusted estimates of workload using predictive margins for each alarm count category.…”

“…For instance, observational work has revealed the association of phone interruptions with medication administration errors. 20 Among the multitude of complex interacting factors that influence workload, alarm counts are modifiable. Reducing nonactionable alarms may be one of the most modifiable pragmatic targets for improving nurse workload.…”

Liver Enzymes After Acetaminophen Error in Critically Ill Children: A Cohort Study

“…Although acetaminophen is considered safe at recommended doses and intervals (15 mg/kg every 4-6 hours to a maximum of 5 doses/day), acute acetaminophen overdose is associated with hepatotoxicity and possible liver failure [1][2][3]. In the intensive care unit, acetaminophen is one of the most frequently administered medications [4,5], and errors are common in the pediatric intensive care unit (PICU) due to the number of medications administered [4]. Indeed, Bona de et al reported that the most common medication alert (7.9%) in a PICU was for acetaminophen [4].…”

“…In the intensive care unit, acetaminophen is one of the most frequently administered medications [4,5], and errors are common in the pediatric intensive care unit (PICU) due to the number of medications administered [4]. Indeed, Bona de et al reported that the most common medication alert (7.9%) in a PICU was for acetaminophen [4]. While acetaminophen dosing errors occur frequently in outpatient, dosing error of acetaminophen has not been evaluated, and the harm associated with these hospital-administered overdoses is not established.…”

Sounds good: the bright future of clinical alarm management initiatives

“…Emphasising outcomes like faster alarm response time without addressing systems factors risks trading one patient safety problem for another. We do not want to engender more frequent interruptions of high-risk activities, like medication administration,18 19 because nurses feel compelled to respond more quickly to alarms.…”