Association of External Interruptions with Increased Medication Administration Duration and Self-Interruptions: A Direct Observational Study

Purpose

The purpose of this study was to examine task duration and frequency of self-interruptions among study participants during externally interrupted compared with externally uninterrupted simulated medication administration.

Background and significance

Interruptions are prevalent during nursing medication administration and can lead to inefficient, delayed, omitted, and unsafe patient care. Interrupted nursing tasks take longer to complete compared to uninterrupted tasks; however, few studies indicate if the time spent in the interruption was included or excluded in the reported task duration. It is unknown if the interruption duration leads to longer task completion times or if other factors are involved. Additionally, little is known about associations between external and self-interruptions during nursing tasks. Self-interruptions are caused by an individual's own decision to stop an activity to attend to something else. Therefore, the purpose of this study was to explore mediators of interruptions that lead to longer task completion times. Findings can be used to guide efforts aimed at improving task efficiency and the quality of patient care.

Theoretical/Conceptual framework

The Memory for Goals cognitive science model explains that time is needed to re-engage with an interrupted primary task, offering one possible explanation for longer interrupted task durations. The model also provides a clear description of the structure of an interruption which guided data collection on the external interruption duration.

Method

This two-site study utilized a cross-sectional within-subjects design to investigate externally interrupted and uninterrupted simulated medication administration among 35 senior nursing student participants. Data on medication administration duration, external interruption duration, and self-interruptions were collected via direct observation. The external interruption duration was deducted from the medication administration duration.

Results

The externally interrupted task had a significantly longer (p<0.001) duration and significantly more frequent (p=0.004) self-interruptions within-subjects compared to the uninterrupted task. Self-interruptions were most often due to forgotten supplies.

Conclusions

The findings suggest that the time needed to re-engage with an interrupted task and/or self-interruptions may lead to longer task completion times. Interruptions are ubiquitous in healthcare settings; thus, researchers are encouraged to investigate mediators of interruptions that lead to longer task completion times to guide strategies aimed to improve the quality of healthcare.

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Association of External Interruptions with Increased Medication Administration Duration and Self-Interruptions: A Direct Observational Study