Nurses’ responses to interruptions during medication tasks: A time and motion study

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Abstract

Background

The majority of interruption research has focused on the undesirable effects of interruptions, especially related to errors during medication tasks. However, there may be times when interruptions result in positive effects by providing new information to a situation or preventing an error. The study of nurses’ responses to interruptions is limited. Since interruptions cannot (and possibly should not) be avoided, a reasonable method for handling interruptions might be to learn how best to prepare for and manage interruption-prone situations.

Objectives

The purpose of this study was to examine nurses’ responses to interruptions and explore contextual factors that influence interruption management during medication tasks. This is a secondary analysis of an original study aimed at describing interruptions and nurses’ responses to interruptions during routine nursing work on medical-surgical units.

Design and setting

This descriptive study was conducted in 5 medical and/or surgical units at 2 acute care facilities in the southern United States, during weekday shifts.

Participants

Twenty registered nurses participated in the study.

Methods

The researcher observed nurse participants for at least 4.5 h during routine nursing work. Observation data were collected using time and motion software. Questionnaires were used to collect organizational, unit, and nurse level data. Interruptions during medication tasks were isolated and described as a secondary analysis.

Results

Approximately 39% of medication tasks were interrupted. Following an interruption, nurses were more likely to suspend the medication task to attend to the interruption task (51.1%) or multitask (40.3%) than delay responding to the interruption until the medication task was complete (12.6%). Several characteristics of the interruption task, including task type, source, method, and communication intent were associated with nurses’ responses at the level of statistical significance.

Conclusions

The findings of this study reveal that nurses are interrupted frequently during medication tasks. The range of nurses’ responses to interruptions was surprising in relation to the frequency with which nurses accepted the interruption task and the infrequency of delay responses. Additional study of nurses’ responses to interruptions during medication tasks and the effect of different responses on patient safety outcomes is indicated.

Section snippets

What is already known about the topic?

  • Interruptions are pervasive in the nursing work environment and patient care requires a great amount of cognitive resources.

  • Interruption research in healthcare has primarily focused on the undesirable effects of interruptions, especially related to errors during medication tasks.

What this paper adds

  • Nurses were 2.2 times more likely to be interrupted during a medication task than any other observed routine task.

  • Nurses responded to 94.6% of interruptions during medication tasks immediately by either switching tasks (47.9%) or multitasking (46.7%).

  • The characteristics of the interruption were associated with the nurse’s response to the interruption, including the interruption task, source, and method of interruption.

Introduction and review of literature

Interruptions are multidimensional events that occur at varying frequencies and durations in different social contexts and task environments. Given that interruptions are believed to be pervasive in the nursing work environment (Hopkinson and Jennings, 2013; Walter et al., 2014) and patient care requires a great amount of cognitive resources (Potter et al., 2008), it is important to describe nurses’ responses to interruptions in the direct care work environment. Of major concern is the

Theoretical frameworks

Two theoretical frameworks were used to guide the study. The Interruptibility and Interpersonal Interruption Response Management framework by Grandhi and Jones, 2009, Grandhi and Jones, 2010, guided the exploration of registered nurses’ responses to interruptions and the contextual factors and/or cues used to make response decisions. The Cognitive Theory of Persuasive Interruptions (Walji et al., 2004a) was used to illuminate the potential relationships between interruptions, contextual

Materials and methods

The original study employed a descriptive design with multiple data collection methods. Questionnaires were used to collect organizational and unit level data, fatigue and subjective workload levels, as well as nurse characteristics. Data collected from the questionnaires were input to the REDCap electronic data capture tools hosted at Vanderbilt University (Harris et al., 2009). Results from the secondary analysis of medication tasks are presented along with some findings from the original

Setting and sample characteristics

The setting for this study was medical and surgical patient units in acute care facilities. The acute care hospitals (n = 2) included in the study were a 150-bed regional health system and a 500-bed Magnet designated medical center. Facilities and observation units (n = 5) for this study were chosen based on known similarities in the nursing work environment to control for confounding variables at the organizational and unit levels. Observation units were requested that were similar in size

Data analysis

Descriptive statistics (i.e., frequencies, percentages, central tendency, and variability) were generated for all study variables. Tasks performed by the nurses were analyzed by task type, location, and visibility of the nurse to other individuals on the unit. The numbers and percentages of interrupted versus uninterrupted tasks in each category were calculated. Odds ratios were computed to determine the likelihood of being interrupted during certain tasks or in certain locations. Medication

Description of observed tasks

During the original study period, RNs initiated 2128 tasks during approximately 92 h of direct observation. A total of 535 tasks (25.1%) were interrupted. Approximately 39% of medication tasks (n = 357) were interrupted, representing 26% of the total number of interruptions observed during the original study period. These tasks included medication preparation tasks, medication administration tasks, and tasks involving medication clarification or checking dosages. In comparison with all other

Discussion

Nurses acted immediately on approximately 95% of interruptions during medication tasks, by either switching tasks or multitasking, suggesting that nurses feel obligated to act to all interruptions even if acting on the interruption compromises their attention level or requires them to take on a greater cognitive workload. Characteristics of the first interruption were associated with the nurses’ responses. This indicates that presentation of the interruption is important in the nurse’s

Study limitations

Although a primary aim of this study was to describe the situations in which interruptions occur, an examination of the potential positive or negative effects of interruptions would have advanced the program of research related to the value of interruptions during nursing work. A significant barrier to the inclusion of this type of evaluation was the high level of attention required by the researcher to track activity using the WOMBAT tool for an extended period. The developers of the WOMBAT

Conclusion

The findings of this study indicate that nurses are interrupted frequently during medication tasks. The nature of interruptions observed in this study was consistent with what has been described in healthcare literature and the study’s underlying theoretical frameworks. The range of nurses’ responses to interruptions was surprising in relation to the frequency with which nurses accepted the interruption task and the infrequency of delay responses. It is premature to make recommendations for

Study funding & resources

This project was supported by CTSA award No. UL1TR000445 from the National Center for Advancing Translational Sciences to Vanderbilt University, the Vanderbilt University School of Nursing PhD Student Support Fund, and a Sigma Theta Tau Kappa Rho Chapter-at-Large Research Grant. Study data were collected and managed using REDCap electronic data capture tools hosted at Vanderbilt University.

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