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H ow disruptive are interruptions to dispensary personnel ?. Prof. Anthony Sinclair. September 11, 1974 Eastern Air Lines Flight 212 carrying 78 passengers and 4 crew crashed just short of the runway whilst attempting to land at Douglas airport North Carolina.
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How disruptive are interruptions to dispensary personnel ? Prof. Anthony Sinclair
September 11, 1974 Eastern Air Lines Flight 212 carrying 78 passengers and 4 crew crashed just short of the runway whilst attempting to land at Douglas airport North Carolina • Probable cause……..The Pilots were chatting about politics and cars • Silent cockpit rule *….no distractions no unnecessary conversation • FAA FAR 121.542/135.100
“High levels of noise causes employees to lose concentration….leading to low productivity and stress”* • A 200 multisite study of voluntary reporting of error in neonatal intensive care units (NICU), 27% of reports were associated with inattention, 22% with a communication problem, and 12% with distractions. Hohenhaus (2008) • Medmarx, a registry of adverse drug events in the U.S, with over 400 healthcare facilities, lists distractions as the number one contributing factor in error causation in each of its data reports published between 2002 and 2006 https://www.medmarx.com/
Interruptions are not good for office workers, they’re bad for healthcare workers and they’re not great for airline pilots but how disruptive are they for paediatric dispensary accuracy checkers?
The Study-1 • The study instrument was non-participant, direct observation of a discrete, clearly identifiable step within the dispensing process- The accuracy-checking phase of the dispensing process • A prescription requiring two bottles of liquid medicines to be dispensed was created. • The medicines were labeled and placed in a tray together with the required paperwork, additional spoons or oral syringes and a dispensing bag. • Pharmacists and Pharmacy technicians volunteered to participate.
The Study-2 • Participants were told that they would be timed accuracy checking the prescription. • The observations were to measure the impact of the environment on them. • They themselves were not being assessed. • The prescriptions were non-complex, had been clinically screened, and didn’t contain any errors by design
The Study - 3 • Observations were carried out in the dispensary (noisy) and in an Office (quiet), with and without a standardised interruption • The interruption consisted of a task that required the participants complete attention i.e. to check a dose calculation • 12 possible variants each with 2 arms • Dispensary with an interruption • Dispensary without an interruption • The Office with an interruption • The Office without an interruption • Each variant was repeated 3 times giving 36 observations- (21 participants) the sequence was determined by a Latin Square
Results -1 • Minitab was used to analyse the results • Analysis of Variance for time using Adjusted Sum of Squares for Tests and Least Squares Means for time • Variance for time was tested against length of interruption, the individuals, the location, the order in which the events happened and location+interruption
Results -2 • It took longer to accuracy check the prescription in the dispensary (noisy) than in the office (quiet) • It also took longer to accuracy check when interrupted than when not interrupted
Results - 3 • Overall paticipants were 22% less efficient in the dispensary when interrupted than when not distracted or interrupted. • One third of participants took 30-78% longer when distracted and interrupted
Conclusion Most dispensaries are designed around linear workflow and space constraints- a square or rectangle The two tasks requiring most cognitive activity are usually sited at the start and at the end of the dispensing process in areas particularly prone to noise and interruptions Distractions and noise reduce efficiency increase stress and arguably by inference might well make tasks less safe.
What next -1 • To recover well from an interruption requires pre-planning and preparation. • One strategy is to reduce the information required to be remembered (break at an obvious boundary) • Another approach would be to Increase the probability of recalling the task (prospective memory) by using strategies to increase internal memory- i.e. rehearsal , alternatively • Through the creation of external memory …leave notes Boehm-Davis, D.A., Remington, R., Reducing the disruptive effects of interruption: A cognitive framework for analysing the costs and benefits of intervention strategies. Accid. Anal. Prev. (2009
What next -2 • The next step will be to observe the impact on individual’s error rates by creating external memory as an aide using a checking protocol.
