Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors

Background: Interruptions have been implicated as a cause of clinical errors, yet, to our knowledge, no empirical studies of this relationship exist. We tested the hypothesis that interruptions during medication administration increase errors. Methods: We performed an observational study of nurses preparing and administering medications in 6 wards at 2 major teaching hospitals in Sydney, Australia. Procedural failures and interruptions were recorded during direct observation. Clinical errors were identified by comparing observational data with patients’ medication charts. A volunteer sample of 98 nurses (representing a participation rate of 82%) were observed preparing and administering 4271 medications to 720 patients over 505 hours from September 2006 through March 2008. Associations between procedural failures (10 indicators; eg, aseptic technique) and clinical errors (12 indicators; eg, wrong dose) and interruptions, and between interruptions and potential severity of failures and errors, were the main outcome measures. Results: Each interruption was associated with a 12.1% increase in procedural failures and a 12.7% increase in clinical errors. The association between interruptions and clinical errors was independent of hospital and nurse characteristics. Interruptions occurred in 53.1% of administrations (95% confidence interval [CI], 51.6%-54.6%). Of total drug administrations, 74.4% (n=3177) had at least 1 procedural failure (95% CI, 73.1%-75.7%). Administrations with no interruptions (n=2005) had a procedural failure rate of 69.6% (n =1 395; 95% CI, 67.6%-71.6%), which increased to 84.6% (n=148; 95% CI, 79.2%-89.9%) with 3 interruptions. Overall, 25.0% (n=1067; 95% CI, 23.7%26.3%) of administrations had at least 1 clinical error. Those with no interruptions had a rate of 25.3% (n=507; 95% CI, 23.4%-27.2%), whereas those with 3 interruptions had a rate of 38.9% (n=68; 95% CI, 31.6%-46.1%). Nurse experience provided no protection against making a clinical error and was associated with higher procedural failure rates. Error severity increased with interruption frequency. Without interruption, the estimated risk of a major error was 2.3%; with 4 interruptions this risk doubled to 4.7% (95% CI, 2.9%-7.4%; P.001). Conclusion: Among nurses at 2 hospitals, the occurrence and frequency of interruptions were significantly associated with the incidence of procedural failures and clinical errors.

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Association of Interruptions With an Increased Risk and Severity of Medication Administration Errors

This article takes a critical look at three pervasive urban legends in education about the nature of learners, learning, and teaching and looks at what educational and psychological research has to say about them. The three legends can be seen as variations on one central theme, namely, that it is the learner who knows best and that she or he should be the controlling force in her or his learning. The first legend is one of learners as digital natives who form a generation of students knowing by nature how to learn from new media, and for whom “old” media and methods used in teaching/learning no longer work. The second legend is the widespread belief that learners have specific learning styles and that education should be individualized to the extent that the pedagogy of teaching/learning is matched to the preferred style of the learner. The final legend is that learners ought to be seen as self-educators who should be given maximum control over what they are learning and their learning trajectory. It con...

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Do Learners Really Know Best? Urban Legends in Education

https://interruptions.net/literature/Laxmisan-IntJMedInform07.pdf

The multitasking clinician: Decision-making and cognitive demand during and after team handoffs in emergency care

The myths of the digital native and the multitasker

SEVERAL STUDIES quantifying the impact of poor communication on clinical work suggest that communication is a likely cause of systematic error in the health system. In Australia, inadequate communication has been associated with 17% of system problems, and, of these, 84% were deemed potentially preventable. 1 About 50% of all adverse events detected by general practitioners were associated with communication difficulties. 2 Within intensive care units, 2% of the activity consists of verbal communication between nurses and doctors, but accounts for 37% of error reports. 3 Thus, the evidence strongly suggests that poor communication wastes time, threatens patient care and may be one of the chief culprits behind preventable adverse events in clinical practice. 4 The research reported here extends work begun in the United Kingdom in the mid-1990s, 5,6 in which it was found that physician teams in hospital were subject to high levels of interruption. Clinical staff also appeared to bear a higher communication load than necessary, considering the many tasks that could be accomplished by accessing information sources rather than asking questions of people. It has since been hypothesised that such interruptions impose cognitive loads on clinical staff and have a negative impact on memory, leading to clinical error. 7 As a continuation of this research, we measured communication load more precisely and studied communication patterns in a high-workload clinical setting. METHODS 1.Methods

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Communication loads on clinical staff in the emergency department.

porotrichosis is a dermatomycosis caused by the dimorphic fungus Sporothrix schenckii This environmental saprophyte inhabits decaying vegetation, hay, wood, sphagnum moss and soil, and has a ubiquitous global distribution Infection occurs sporadically in endemic settings or as outbreaks Although sporotrichosis is rarely associated with dissemination and mortality, 1 it can cause considerable morbidity owing to delayed diagnosis and inappropriate administration of antibacterial agents Prompt diagnosis and treatment with antifungal therapy is aided by awareness of classical clues to infection: acquisition in an endemic area; an at-risk occupation or activity

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Sporotrichosis (Sporothrix schenckii infection) in the New South Wales mid-north coast, 2000-2010

A 20-year-old man was admitted to a regional hospital with fevers, rigors, anorexia and left upper quadrant pain. It was his fourth presentation to the emergency department in the preceding 10 days. On the first two presentations, he had been sent home with a provisional diagnosis of renal colic. After review by his general practitioner, he had undergone outpatient imaging that identified filling defects in the pulmonary arteries of his left lower lobe, which were reported as being consistent with pulmonary emboli. In addition, two hypodense splenic lesions were identified, as well as collapse and possible consolidation of the left lower lobe. His GP had referred him to the emergency department for further review (his third presentation), after which he had commenced therapeutic anticoagulation for a presumed diagnosis of pulmonary emboli.

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Aiveen M Bannan

Papers

Communication loads on clinical staff in the emergency department.

Sporotrichosis (Sporothrix schenckii infection) in the New South Wales mid-north coast, 2000-2010

Splenic abscess complicating gastroenteritis due to Salmonella Virchow in an immunocompetent host.