Research Article | Open Access
The Effects of Interruptions on Oncologists' Patient Assessment and Medication Ordering Practices
Interruptions are causal factors in medication errors. Although researchers have assessed the nature and frequency of interruptions during medication administration, there has been little focus on understanding their effects during medication ordering. The goal of this research was to examine the nature, frequency, and impact of interruptions on oncologists' ordering practices. Direct observations were conducted at a Canadian cancer treatment facility to (1) document the nature, frequency, and timing of interruptions during medication ordering, and (2) quantify the use of coping mechanisms by oncologists. On average, oncologists were interrupted 17 % of their time, and were frequently interrupted during safety-critical stages of medication ordering. When confronted with interruptions, oncologists engaged/multitasked more often than resorting to deferring/blocking. While some interruptions are necessary forms of communication, efforts must be made to reduce unnecessary interruptions during safety-critical tasks, and to develop interventions that increase oncologists' resiliency to inevitable interruptions.
- L. T. Kohn, J. M. Corrigan, and M. S. Donaldson, Eds., Err is Human: Building a Safer Healthcare System, Institute of Medicine, National Academy Press, Washington, D. C., 2000.
- D. L. B. Schwappach and M. Wernli, “Medication errors in chemotherapy: incidence, types and involvement of patients in prevention. A review of the literature,” European Journal of Cancer Care, vol. 19, pp. 285–292, 2010.
- ISMP Canada, “Fluorouracil incident root cause analysis,” 2007, http://www.ismpcanada.org/download/reports/FluorouracilIncidentMay2007.pdf, Accessed November, 2012.
- R. B. Womer, E. Tracy, W. Soo-Hoo, B. Bickert, S. DiTaranto, and J. H. Barnsteiner, “Multidisciplinary systems approach to chemotherapy safety: Rebuilding processes and holding the gains,” J Clin Oncol, vol. 20, pp. 4705–4712, 2002.
- P. L. Trbovich, V. Prakash, J. Stewart, K. Trip, and P. Savage, “Interruptions during the Delivery of High Risk Medications,” Journal of Nursing Administration, vol. 40, no. 5, pp. 211–218, 2010.
- D. H. Hickam, S. S. Severance, A. Feldstein et al., “The Effect of Health Care Working Conditions on Patient Safety,” Agency For Healthcare Research and Quality, vol. 74, 2003.
- Summary of Information Submitted to MEDMARX in the Year 2001: A Human Factors Approach to Understanding Medication Errors. Rockville, MD: United States Pharmacopeia, December 2002.
- United States Pharmacopeia, “USP Patient Safety CAPSLink September 2003,” USP Patient Safety CAPSLink, http://us.vocuspr.com/Newsroom/ViewAttachment.aspx?SiteName=USPharm&Entity=PRAsset&AttachmentType=F&EntityID=73530&AttachmentID=7e173c5e-8315-4f77-92c0-ce061c17912e. Accessed November, 2012.
- L. L. Leape, D. W. Bates, D. J. Cullen et al., “Systems Analysis of Adverse Drug Events,” JAMA, vol. 274, no. 1, pp. 35–43, 1995.
- American Society of Clinical Oncology: The Oncologist's Field Guide to Selecting and Implementing an Electronic Health Record. Alexandria, VA, ASCO, 2008, http://www.asco.org/ASCOv2/Meetings/Annual+Meeting/Past+Annual+Meetings/2008+Annual+Meeting/2008+ASCO+Daily+News/Monday,+June+2,+2008+Section+B/ASCO+Develops+Practical+Guide+for+Selecting,+Implementing+Electronic+Health+Records.
- L. N. Shulman, R. S. Miller, E. P. Ambinder, P. P. Yu, and J. V. Cox, “Principles of Safe Practice Using an Oncology EHR System for Chemotherapy Ordering, Preparation, and Administration, Part 1 of 2,” J Oncol Pract, vol. 4, no. 4, pp. 203–206, 2008.
- D. Liu, T. Grundgeiger, P. M. Sanderson, S. A. Jenkins, and T. A. Leane, “Interruptions and blood transfusion checks: lessons from the simulated operating room,” Anesthesia and Analgesia, vol. 108, no. 1, pp. 219–222, 2009.
- P. R. Ebright, E. S. Patterson, B. A. Chalko, and M. L. Render, “Understanding the complexity of registered nurse work in acute care settings,” J Nurs Adm, vol. 33, no. 12, pp. 630–638, 2003.
- F. A. Drews, “The frequency and impact of task interruptions in the ICU,” in Proceedings of the 51st Annual Meeting of the Human Factors and Ergonomics Society, pp. 683–686.
- N. Osborne, T. Shin, H. Guo, and S. Gerlain, Remote Analysis of Team Environments (RATE), University of Virginia, 2004, 22.214.171.124, http://www.sys.virginia.edu/hci/Reference/RATE%20Manual.pdf.
- J. I. Westbrook, E. D. Coiera, E. D. W. T. M et al., “The impact of interruptions on clinical task completion,” Qual Saf Health Care, vol. 19, pp. 284–289, 2010.
- G. Alvarez and E. Coiera, “Interruptive communication patterns in the intensive care unit ward round,” Int J Med Inf, vol. 74, no. 10, pp. 791–796, 2005.
- C. D. Chisholm, A. M. Dornfeld, D. R. Nelson, and W. H. Cordell, “Work interrupted: A comparison of workplace interruptions in emergency departments and primary care offices,” Ann Emerg Med, no. 38, pp. 146–151, 2001.
- J. Parker and E. Coiera, “Improving clinical communication: A view from psychology,” JAMIA, vol. 7, no. 5, pp. 453–461, 2000.
- I. Burmistrov and A. Leonova, “Do interrupted users work faster or slower? the micro-analysis of a computerized text editing task,” in Human-computer interaction: theory and practice (Part I), J. Jacko and C. Stephanidis, Eds., pp. 621–625, Lawrence Erlbaum Associates, Mahwah, New Jersey, 2003.
- F. Magrabi, S. Y. W. Li, R. Day, and E. Coiera, “Errors and electronic prescribing: a controlled laboratory study to examine task complexity and interruption effects,” Journal of the American Medical Informatics Association, vol. 17, pp. 575–583, 2010.
- T. M. Pape, D. M. Guerra, and M. Muzquiz, “Innovative Approaches to Reducing Nurses' Distractions During Medication Administration,” The Journal of Continuing Education in Nursing, vol. 36, no. 3, pp. 108–116, 2005.
- E. Relihan, V. O'Brien, S. O'Hara, and B. Silke, “The impact of a set of interventions to reduce interruptions and distractions to nurses during medication administration,” Qual Saf Health Care, vol. 1 9, no. 5:e52, 2010.
- T. Grundgeiger and P. Sanderson, “Interruptions in healthcare: Theoretical views,” Int J Med Inf, vol. 78, no. 5, pp. 293–307, 2009.
- W. Coiera, R. Jayasuriya, J. Hardy, A. Bannan, and M. Thorpe, “Communication loads on clinicians in the Emergency Department,” Medical Journal of Australia, vol. 176, no. 9, pp. 415–418, 2002.
- J. Parker and E. Coiera, “Improving clinical communications: A view from psychology,” Journal of the American Medical Informatics Association, vol. 7, no. 5, pp. 453–461, 2000.
- E. Coiera and V. Tombs, “Communication behaviours in a hospital setting: an observational study,” British Medical Journal, vol. 316, pp. 673–676, 1998.
- H. M. Parsons, “What happened at Hawthorne?” Science, vol. 183, no. 4128, pp. 922–932, 1974.
Copyright © 2013 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.