PURPOSE:Actual or potential adverse medical device events are a recognized, incompletely understood problem in the intensive care unit (ICU). Error-producing conditions (i.e., task interruptions) in the ICU can impact task performance and contribute to adverse medical device events. We developed a tablet computer-based tool to capture nursing task interruptions, other error producing conditions, and actual or potential medical device related harm via direct observation. The measurement tool was developed with a long-term research objective to develop strategies for reducing adverse medical device events in the ICU.
METHODS:Observers obtained informed consent from staff nurses in two separate medical ICUs in different health systems. Observers utilized a mobile touch screen computer that time stamped all nursing activities categorized as direct care (e.g. patient assessment, hygiene), indirect care (e.g. charting) or medical device use (e.g. administering medications, interacting with ventilators). Additional information recorded included the occurrence, cause, length and impact of task interruptions or other error producing conditions, and actual or potential medical device-related harm.
RESULTS:59 observation sessions totaling over 140 hours have been performed to date. Direct care, indirect care, and medical devices constituted 15.3%, 70.3%, and 14.4% of task hours, respectively. 7382 nursing tasks have been observed, 886 (12%) of which were interrupted. The two most frequent causes of interruption were device alarms (35%) and other nurses (17%); physicians caused 10% of interruptions. In 263 (30%) and 278 (31%) of the 886 instances of interruptions respectively, the nurse switched focus to the interrupting task or multi-tasked, most commonly in response to a device alarm. The majority of device alarms were not immediately attended to. The impact of task interruptions and other error producing conditions is being reviewed.
CONCLUSION:Interruptions of nursing tasks in the ICU are common and frequently due to device alarms and other nurses. In general, the interrupting task changes task focus or results in multi-tasking.
CLINICAL IMPLICATIONS:Interruptions of nursing tasks may be a cause of adverse events in the ICU.
DISCLOSURE:Boaz Markewitz, None.