Nurses who are interrupted are more likely to make procedural and clinical errors, according to a new study published in Archives of Internal Medicine (2010;170:683-690).
The study examined drug administration by nurses in two major teaching hospitals in Australia. Researchers looked at procedural errors, such as failure to read medication labels or patient charts, and clinical errors, such as the wrong drug, dose, or formulation. Procedural errors were also classified as to their potential severity on a five-point assessment scale. The study results indicated that each interruption was associated with a 12.1% increase in procedural errors and a 12.7% increase in clinical errors. Interruptions occurred in 53.1% of medication administrations. In addition, 74.1% of total drug administrations had one procedural error. Administrations with no interruptions had a procedural failure rate of 69.6%; with three interruptions, the rate increased to 84.6%. One quarter of drug administrations had at least one clinical error. Those with no interruptions had a rate of 25.3%, whereas those with three interruptions had a rate of 38.9%. Error severity increased with interruption frequency. Nurse experience provided no protection against making a clinical error and was actually associated with higher procedural failure rates.
“Part-time and less experienced nurses had lower rates of procedural failures,” the authors observed. “We found the most frequent procedural failure was not checking the patient’s identification prior to drug administration. Full-time, experienced nurses may believe that they can easily visibly identify patients and thus a formal identification process is not necessary. However, recognizing a patient does not ensure that you have the correct medication chart.”