Interruptions During Senior Nurse Handover in the Intensive Care Unit: A Quality Improvement Study

BACKGROUND: Interruptions during handover may compromise continuity of care and patient safety. LOCAL PROBLEM: Interruptions occur frequently during handovers in the intensive care unit. METHODS: A quality improvement study was undertaken to improve nursing team leader handover processes. The frequency, source, and reason interruptions occurred were recorded before and after a handover intervention. INTERVENTIONS: The intervention involved relocating handover from the desk to bedside and using a printed version of an evidence-based electronic minimum data set. These strategies were supported by education, champions, reminders, and audit and feedback. RESULTS: Forty handovers were audiotaped before, and 49 were observed 3 months following the intervention. Sixty-four interruptions occurred before and 52 after the intervention, but this difference was not statistically significant. Team leaders were frequently interrupted by nurses discussing personal or work-specific matters before and after the intervention. CONCLUSIONS: Further work is required to reduce interruptions that do not benefit patient care

Factors influencing the work of registered nurses and practical nurses in acute inpatient units

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesSkipulag, upplýsingaflæði, samskipti, forgangsröðun og verkaskipting skipta sköpum fyrir árangur meðferðar og afdrif sjúklinga á sjúkrahúsum. Vinna í hjúkrun er margslungin og mótast af þörfum sjúklinga á hverri stund. Öryggi þjónustunnar byggist á faglegri þekkingu og færni, góðum samskiptum og árangursríkri samvinnu. Áríðandi er að tryggja bestu nýtingu tiltækra úrræða og að þekking og færni hvers og eins nýtist sem best fyrir meðferð sjúklinga. Rannsóknir sýna að hjúkrunarfræðingar og sjúkraliðar verða oft fyrir truflunum og töfum í vinnu sinni og standa gjarnan frammi fyrir kerfisvillum, svo sem skorti á upplýsingum, birgðum og nauðsynlegum búnaði. Enn skortir þó nánari þekkingu á umfangi truflana af þessum toga og eðli þeirra. Tilgangur rannsóknarinnar var að varpa ljósi á vinnu hjúkrunarfræðinga og sjúkraliða og hvaða þættir hafa áhrif á vinnunna á bráðalegudeildum. Gagna var aflað með blandaðri aðferð þar sem megindlegum gögnum var safnað í gagnagrunn handtölvu og eigindlegum gögnum safnað hjá athugendum og þátttakendum. Gögnum var safnað um vinnuna, áhrifaþætti hennar, hreyfingar og tíma. Hjúkrunarfræðingarnir vörðu mestum hluta vinnutíma síns í óbeina umönnun sjúklinga á deildinni og sjúkraliðar í beina umönnun. Vinna þátttakenda einkenndist af fjölverkavinnslu, tíðum truflunum og rofum og hreyfingu á milli staða á deildinni. Þátttakendur sinntu gjarnan vinnu sem þeir telja almennt að krefjist ekki fagkunnáttu þeirra, svo sem að svara í síma, búa upp rúm og þrífa. Sé litið til niðurstaðna þessarar rannsóknar í ljósi fyrri rannsókna um tengsl álags, rofa og öryggis þjónustunnar er mikilvægt fyrir starfsfólk heilbrigðisþjónustunnar að rýna vel í skipulag, verkferla, verkaskiptingu, samskipti og allt efnislegt umhverfi. Mikilvægt er að finna leiðir til úrbóta í skipulagi og stjórnun hjúkrunar en jafnframt er mikilvægt að styðja starfsfólk til að skoða viðhorf og verklag til að tryggja sem besta nýtingu á þekkingu og hæfni hvers og eins, sjúklingum og starfsfólki til hagsbóta.Organization, information, communication, prioritization and task delegation are important factors for successful health care services and the wellbeing of hospital patients. Nursing is complex and based on patients´ needs. The safety of the services builds on professional knowledge, expertise, skilled communication and effective decision making. It is important to ensure optimal use of resources, knowledge and skills of each member of the nursing team in order to provide the best possible patient care. Former studies show that during their work registered nurses (RNs) and practical nurses (PNs) frequently encounter interruptions and systems failures such as lack of information, equipment and material resources. There is still a gap in the literature about the scope and nature of the problem. The aim of this study was to increase knowledge about influencing factors on nursing work in acute inpatient units. Mixed methods were used for data collection where quantitative data were collected by structured computerized measures on hand held computers and qualitative field notes and interviews with participants were recorded on digital recorders. Data were collected on work, influencing factors, movements and time. RNs time was mostly spent on indirect patient care and PNs time was mostly spent on direct patient care. The work of RNs and PNs was characterized by multitasking, frequent interruptions and disruptions, and moves from one location to another within the unit. Participants frequently undertook work which they have identified as not requiring their professional knowledge such as answering the telephone, bed making, and cleaning. In light of these and previous findings on the link between interruptions and patient safety it is important for clinicians and leaders in nursing to re-evaluate organization of work in nursing, workflow, delegation, collaboration and the whole physical environment. It is important to improve organization and management of work in nursing and furthermore it is important to support nursing staff to reflect on attitudes and self-management to optimize use of professional skills and resources for the good of staff and patientsVísindasjóður Landspítala, B-hluti vísindasjóðs Félags íslenskra hjúkrunarfræðinga, rannsóknasjóður Háskóla Íslands, starfsþróunarsjóður Sjúkraliðafélags Íslands og Rannsóknastofnun í hjúkrunarfræði við Háskóla Íslands og Landspítala

Combatiendo la cultura de la interrupción en la práctica enfermera = Fighting culture of interruption in nursing practice

Resumen: Introducción: En el entorno sanitario las interrupciones son contempladas como algo normal, aceptado y esperado, es lo que se ha venido en denominar “Cultura de la Interrupción”. Un número creciente de investigaciones señalan que un alto volumen de interrupciones no sólo impacta negativamente en la eficiencia del desempeño de una enfermera, sino que además aumenta las probabilidades de omisiones, lapsus y errores. Objetivo: Encontrar en la literatura científica publicada estrategias e intervenciones específicas destinadas a reducir las interrupciones en el trabajo de enfermería, como forma de mejorar la seguridad y la calidad del cuidado. Metodología. Búsqueda bibliográfica en las principales bases de datos a través de GERIÓN, metabuscador de la Biblioteca Pública Virtual del Servicio Andaluz de Salud. Resultados: Se describen las siguientes intervenciones: Zonas tranquilas o zonas de no interrupción, uniformidad no interrupción, la hora protegida y educación del personal en el uso del no positivo. Conclusiones: Con los datos encontrados en la revisión bibliográfica, concluimos que gestionar, desalentar y combatir esta “Cultura de la Interrupción” puede conllevar a una gran mejora en la seguridad del paciente respecto de aquellas organizaciones que las toleran, las alientan o simplemente aún no hayan advertido la trascendencia de su alcance.Palabras clave: Buenas prácticas, Enfermería, Interrupción, Seguridad del pacienteAbstract: Introduction: In the health care setting, interruptions are referred to as normal, accepted, and expected, is what has come to be called "Culture of Interruption". A growing body of research suggests that a high volume of interruptions not only negatively impacts the performance efficiency of a nurse, but also increases the chances of failure, lapses and errors. Objective: Find in the scientific literature published strategies, specific interventions, best practices to reduce interruptions in nursing work as a way to improve safety and quality watch out. Methodology. Literature search in major databases through GERION, metasearch Virtual Public Library Andalusian Health Service. Results: The following procedures are described: No interruption zones, Do not disturb vest, Medication passtime out, and staff education on the use of the positive no. Conclusions: With the data found in the literature review, we have concluded that manage, discourage and combat this "Culture of Interruption" can lead to a great improvement in patient safety regarding organizations that tolerate, encourage them or simply have not yet noticed the importance of reach.Keywords: Good practice, Nursing, Interruption, Patient safety doi: http://dx.doi.org/10.20318/recs.2016.316

Validation of the Work Observation Method By Activity Timing (WOMBAT) method of conducting time-motion observations in critical care settings: an observational study

<p>Abstract</p> <p>Background</p> <p>Electronic documentation handling may facilitate information flows in health care settings to support better coordination of care among Health Care Providers (HCPs), but evidence is limited. Methods that accurately depict changes to the workflows of HCPs are needed to assess whether the introduction of a Critical Care clinical Information System (CCIS) to two Intensive Care Units (ICUs) represents a positive step for patient care. To evaluate a previously described method of quantifying amounts of time spent and interruptions encountered by HCPs working in two ICUs.</p> <p>Methods</p> <p>Observers used PDAs running the Work Observation Method By Activity Timing (WOMBAT) software to record the tasks performed by HCPs in advance of the introduction of a Critical Care clinical Information System (CCIS) to quantify amounts of time spent on tasks and interruptions encountered by HCPs in ICUs.</p> <p>Results</p> <p>We report the percentages of time spent on each task category, and the rates of interruptions observed for physicians, nurses, respiratory therapists, and unit clerks. Compared with previously published data from Australian hospital wards, interdisciplinary information sharing and communication in ICUs explain higher proportions of time spent on professional communication and documentation by nurses and physicians, as well as more frequent interruptions which are often followed by professional communication tasks.</p> <p>Conclusions</p> <p>Critical care workloads include requirements for timely information sharing and communication and explain the differences we observed between the two datasets. The data presented here further validate the WOMBAT method, and support plans to compare workflows before and after the introduction of electronic documentation methods in ICUs.</p

Patient safety in the emergency department : errors, interruptions and staff experience

International studies have reported that injuries and complications during hospital admissions affect nearly 1 in 10 patients and that up to 50 % are the direct result of errors and therefore preventable. In Sweden, the figures are similar. The often cited report, To err is human – building a safer health system by the Institute of Medicine (IOM) emphasises the system approach in preventing future errors by designing safety into systems and not to blame individuals for past errors. This approach has also been implemented into the Swedish healthcare system through the Patient Safety Act and through the formation of a new agency in 2013, the Health and Social Care Inspectorate (IVO). Emergency departments (EDs) have a front position in Swedish healthcare in that a high percentage of patients have their first contact with hospital care in EDs. The ED environment has been described as complex and dynamic and one in which errors often occur. Research on patient safety in the ED has increasingly grown, with recent findings indicating that crowding, interruptions and multitasking all contribute to errors. However, there remains little knowledge on patient safety in Swedish EDs. The overall aim of this thesis was therefore to increase our knowledge about errors, interruptions and staff experience of patient safety risks in the ED. The specific aims in paper I and II were to describe the incidence and types of reported errors and complaints in ED care and their contributing factors. In paper III the aims were to explore interruptions occurring during common activities of clinicians and their perceptions of interruptions. The final paper was designed to describe physicians and registered nurses’ (RNs) perceptions and management of patient safety risks in the ED. In this descriptive project qualitative and quantitative data were collected from national registries and through observations of and interviews with ED clinicians. Data were analysed using qualitative content analysis and non-parametric statistics. The results represent the frequencies and characteristics of reported errors and complaints in Swedish ED care. The overall result shows that the most common errors that care providers, healthcare staff and patients reported were those concerned with diagnostic procedures, treatments and organisational matters. The contributing factors to errors in cases reported to the National Board of Health and Welfare were multifactorial: the most common contributing factor was human error that occurred most often during diagnostic procedures, followed by factors in the local environment. Interruptions took place most often on a face-to-face basis and during information exchange. Preparation of medication was the most interrupted activity in relative terms. Interruptions were not always perceived as negative, and negative feelings of interruptions were related to a disturbed work process. The physicians and RNs perceived high workload as the main patient safety concern in the ED. The most common strategy to prevent errors was to check and double check. Because the RNs felt responsible for managing patient safety risks, they reported using a strategy of taking command and control if they felt that patient safety was in jeopardy. The level of information detail varied and was sometimes missing in the different national and local registries. Further, we found that internal investigations and root cause analysis were sometimes missing entirely. These shortcomings constitute a risk of missing important patient safety risks and limit the development of solutions that can improve such safety. Latent conditions, such as high workload, were rarely identified and interruptions were ever identified as a contributing factor in cases reported to the National Board of Health and Welfare. The clinicians perceived high workload as the main patient safety concern in the emergency department. Interruptions during high workload were seen as increasing the risk for communication and medication errors. Some RNs taking command and control when patient safety was threatened indicating that RNs may play an important role in patient safety

TURF for Teams: Considering Both the Team and I in the Work-Centered Design of Systems

Teams are an inherent part of many work domains, especially in the healthcare environment. Yet, most systems are often built with only the individual user in mind. How can we better incorporate the team, as a user, into the design of a system? By better understanding the team, through their user, task, representational, and functional needs, we can create more useful and helpful systems that match their work domain. For this research project, we utilize the TURF framework and expanded it further by also considering teams as a user, thus, creating the TURF for Teams framework. In addition, we chose to examine teams in the emergency department environment. We believe that designing a system with the team also fully incorporated and acknowledged in the work domain will be beneficial for supporting necessary team activities. Using TURF for Teams, we first conducted an observational field study in the emergency department to get a better understanding of the users, teams, tasks, workload, and interactions. We then identified the need for team communications to be better supported, especially in the management of interruptions, and further categorized the interruptions by their function in order to design a team tool that could help team members better manage their interruptions by focusing on the necessary, or domain, types of interruptions and more easily disregarding the unnecessary, or overhead, types of interruptions. We then administered some surveys and conducted a card sort and cognitive walkthrough with emergency clinician participants to help us better identify how to design interfaces for the team tool and simulation that would better match the needs of team communication behaviors observed and reported by emergency clinicians. After designing and developing the team tool and simulation, we conducted an evaluation of this system by having emergency medicine, medicine, and informatics graduate student teams go through the system and utilize the team tool and simulation as a team. Though we had a small sample size, we found that emergency medicine teams found the team tool and simulation to be very usable and they reacted favorably to its potential in helping them better understand and manage their team communications. In summary, we were able to utilize the TURF framework for incorporating teams into the design of systems, in this case a team communication tool and microworld simulation for the emergency department. Our findings suggest that TURF for Teams is a viable framework for designing useful and helpful team based systems for all work domains

Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement

‘Teach Me Chemistry Like a Ladder and Make it Real’ – Barriers and Motivations Students Face in Learning Chemistry for Bioscience

Students enrolled in the Bachelor of Nursing program come with diverse academic abilities, age, language skills and experience. Many enrol without any prior knowledge of the supporting sciences including chemistry. Moreover, whilst some do possess such prior knowledge, they may have had a substantial break since they last studied chemistry. This paper draws from surveys and interviews conducted to investigate students’ prior knowledge of chemistry and experiences around learning. These were first year students enrolled in a core unit of anatomy and physiology for which, albeit implicitly some prior knowledge of chemistry is assumed. It explores barriers and motivations to learning chemistry and offers insights into what students need in order to gain a mastery of the foundational chemical principles that underlie anatomy and physiology. This research is of considerable importance given that the teaching of anatomy and physiology relies heavily on foundation-level chemistry knowledge. It is of great significance if students can be better supported in the successful learning, retention and completion of their nursing studies. Insights reveal that problems stem from various factors including length of time since their last chemistry studies, language difficulties, students’ interests and motivations in the subject, pace and structure of sessions, relevance of information and the students’ ability to manage the amount of content. This informs future practice suggesting that it is important to scaffold the learning for all students in a structured and relevant manner. Additionally, it supports the development and provision of resources to support students transitioning into higher education from diverse backgrounds