Impact of Frequent Interruption on Nurses’ Patient-Controlled Analgesia Programming Performance

Campoe, Kristi R.; Giuliano, Karen K.

doi:10.1177/0018720817732605

Cited by 31 publications

(52 citation statements)

References 25 publications

(32 reference statements)

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“…10 16 Our results strengthen observational research showing an association only 7 8 and empirical research that uses quasi-experimental methods or small samples only. [12][13][14] Westbrook et al We used an alternately-allocated parallel groups design for pragmatic reasons, but compared to randomized designs, they are more susceptible to selection biases and confounding. The potential for selection biases were minimised by blinded allocation; participants were scheduled by a senior nurse blinded to both study aims and interruption condition without the involvement of the research team.…”

Section: Summary Of Findingsmentioning

confidence: 99%

“…10 A few simulation studies point to a causal connection, but they do not directly test the hypothesis that more interruptions lead to more errors [11][12][13] or they are underpowered pilot studies. 14 Given that a causal dose-response relationship has not been established with a prospective, controlled experimental design, 15 we do not know whether efforts to reduce interruptions will succeed in reducing errors. 16 Recent interventions in clinical contexts have successfully reduced the frequency of workplace interruptions, but their direct impact on errors remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Interruptions to Intensive Care Nurses and Clinical Errors and Procedural Failures: A Controlled Study of Causal Connection

Santomauro

Powell²,

Davis³

et al. 2018

J Patient Saf

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Objectives: Interruptions occur frequently in the intensive care unit (ICU) and are associated with errors. To date, no causal connection has been established between interruptions and errors in healthcare. It is important to know whether interruptions directly cause errors before implementing interventions designed to reduce interruptions in ICUs. The aim of the study was to investigate whether ICU nurses who receive a higher number of workplace interruptions commit more clinical errors and procedural failures than those who receive a lower number of interruptions. Methods:We conducted a prospective controlled trial in a high-fidelity ICU simulator. A volunteer sample of ICU nurses from a single unit prepared and administered intravenous medications for a patient manikin. Nurses received either 3 (n = 35) or 12 (n = 35) scenario-relevant interruptions and were allocated to either condition in an alternating fashion. Primary outcomes were the number of clinical errors and procedural failures committed by each nurse. Results:The rate ratio of clinical errors committed by nurses who received 12 interruptions compared with nurses who received 3 interruptions was 2.0 (95% confidence interval = 1.41-2.83, P < 0.001). The rate ratio of procedural failures committed by nurses who received 12 interruptions compared with nurses who were interrupted 3 times was 1.2 (95% confidence interval = 1.05-1.37, P = 0.006).Conclusions: More workplace interruptions during medication preparation and administration lead to more clinical errors and procedural failures. Reducing the frequency of interruptions may reduce the number of errors committed; however, this should be balanced against important information that interruptions communicate.

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Section: Summary Of Findingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Interruptions to Intensive Care Nurses and Clinical Errors and Procedural Failures: A Controlled Study of Causal Connection

Santomauro

Powell²,

Davis³

et al. 2018

J Patient Saf

View full text Add to dashboard Cite

show abstract

“…Most errors were associated with pump misprogramming which lead to serious unintended consequences such as oversedation, respiratory depression or undertreated pain. Since nurses oversee medication administration tasks and with the frequent distractions and interruptions occurring within the healthcare setting that increase the number of PCA medication errors, Campoe and Giuliano ( 9 ) investigated the impact of frequent interruption (2, 4, or 6 interruptions) on nurses' PCA programming performance. A mean error rate of 4.12% (10 errors) was observed, and although it may seem lower than the 20% of PCA medication errors reported in the United States of America ( 22 ), it reflects 10 patients who would have received incorrect medication dosing ( 9 ).…”

Section: The Silent Dangers Of Pca Use In Children and Adolescentsmentioning

confidence: 99%

Safety of Patient-Controlled Analgesia After Surgery in Children And Adolescents: Concerns And Potential Solutions

et al. 2018

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Patient-controlled analgesia (PCA) is common practice for acute postoperative pain management. Postoperative PCA use decreases pain intensity and improves patient satisfaction when compared to non-PCA routes of medication administration. Although PCA has several advantages regarding efficacy and safety, adverse events remain a concern. Programming errors and protocols, patient monitoring, and PCA by proxy or with continuous infusion are recurring silent dangers of PCA use in children and adolescents. Innovative considerations need to be emphasized for future improvement of PCA devices for elective surgical patients. With technology within the healthcare setting advancing at a fast pace, smart pump technology is something to look forward to.

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“…35,45 Findings from this study also build on previous research that is either observational, quasi-experimental, and underpowered. 3,11,18,37,39 In Westbrook et al's 3 observational study, the estimated rate ratio of clinical errors when comparing nurses who received 1 versus 4 interruptions per medication is 1.41, which is very similar to the rate ratio found for bartenders in the laboratory study (1.44). The rate ratio of clinical errors in the healthcare study is 2.00 when comparing nurses who received 1 versus 4…”

Section: Discussionmentioning

confidence: 62%

“…The preparation and administration of Patient-Controlled Analgesia (PCA) is commonly performed by ICU nurses, but it is more error prone than other IV medications. 37 Therefore, I…”

Section: Scenario Designmentioning

confidence: 98%

Interruptions and errors in healthcare: seeking a causal connection

Santomauro¹

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The purpose of this program of research was to seek robust evidence of a causal relationship between workplace interruptions and medical errors in healthcare. Interruptions are a cause for concern in healthcare because of their association with increased workload and performance decrements. However, interruptions can be crucial to effective work coordination through means of information transfer, relationship development, and improved organizational Publications during candidature Peer-reviewed papers

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Impact of Frequent Interruption on Nurses’ Patient-Controlled Analgesia Programming Performance

Abstract: Complex technology use permeates the acute care nursing practice environment. These results add new knowledge on nurses' clinical performance during PCA pump programming and high-risk medication administration.

Cited by 31 publications

References 25 publications

Interruptions to Intensive Care Nurses and Clinical Errors and Procedural Failures: A Controlled Study of Causal Connection

Interruptions to Intensive Care Nurses and Clinical Errors and Procedural Failures: A Controlled Study of Causal Connection

Safety of Patient-Controlled Analgesia After Surgery in Children And Adolescents: Concerns And Potential Solutions

Interruptions and errors in healthcare: seeking a causal connection

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