Call Interruptions Up Medication Error Rate for Pediatric ICU Nurses

By Reuters Staff

December 27, 2019

NEW YORK (Reuters Health) - Incoming calls on nurses' mobile phones in a pediatric intensive care unit were temporally associated with medication errors, according to new findings in JAMA Pediatrics.

Error rates associated with calls were higher for less experienced nurses, during the night shift, and when nurse-to-patient ratio was low and patients required more complex care, Dr. Christopher P. Bonafide, of Children's Hospital of Philadelphia's Buerger Center for Advanced Pediatric Care, and colleagues found.

"The contribution of each of these factors should be considered when designing and prioritizing interventions to reduce the frequency of interruptions and potentially adverse consequences for patient safety," Dr. Bonafide and his team conclude.

The authors looked at the rate of medication administration errors in the 10 minutes after a call or text was received by nurses working at a 55-bed medical-surgical pediatric ICU. From August 2016 through September 2017, there were 238,540 medication administration attempts by 257 nurses treating 3,308 patients. At least one phone call interruption occurred during 8.3% of medication attempts, while 44.7% attempts were interrupted by texts.

The rate of errors was 3.2% overall. When nurses were not interrupted by a call, the rate was 3.1%, while it was 3.7% after a call was received. Incoming text messages were not associated with an increased rate of medication errors.

During the day shift, nurses' error rate when uninterrupted was 3.4%, while it was 2.8% during the night shift. The likelihood of error associated with interruptions was increased for nurses with at least six months of experience (odds ratio 1.02), but the increase was higher for nurses with less experience (OR 1.22).

On the night shift, more experienced nurses were 35% more likely to make medication errors when interrupted by a phone call, while the rate was increased by 53% for nurses with less experience.

Nurses who were administering medications to at least one patient on mechanical ventilation and arterial catheterization, while also caring for at least one other patient, were more likely to make errors (OR 1.21).

"Despite the findings of our study and the work of others, interruptions are not universally bad," Dr. Bonafide and colleagues write. "They are a necessary aspect of clinical care, as they often stem from the need to communicate important information between clinical staff.

However, they add, "there may be opportunities to reduce the frequency of interruptions or to alter the context in which they occur. In an analysis of more than 5000 interruptions measured using direct observation, only 11% were found to result in a positive outcome, suggesting that many interruptions could be eliminated."

SOURCE: JAMA Pediatrics, online December 20, 2019.


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