Nurses in the pediatric intensive care unit (PICU) are susceptible to making medical errors when interrupted by incoming cell phone calls, according to a study published in JAMA Pediatrics.
In this retrospective cohort study, researchers evaluated the telecommunication and electronic health record data of 3,308 patients (55.6% male, 46.5% white) from a children’s hospital’s PICU. They investigated incoming calls and text messages received on the institutional cell phones assigned to 257 nurses in the 10 minutes leading up to a medication administration attempt, which was defined as the study’s primary exposure. The study’s secondary exposures were the nurse’s PICU experience (of which 65.4% had six months or more experience), work shift (day vs night), nurse to patient ratio, and level of patient care required.
The study’s primary endpoint was specified as medical errors during medication administration, which was determined by a composite of reported medication administration errors and bar code medication administration error alerts. The researchers collated data between August 2016 and September 2017.
Interventions Needed to Mitigate these Medical Errors
According to the results of the study, the overall rate of medical errors during 238,540 medication administration attempts was 3.1% (95% CI, 3.0% to 3.3%) when nurses were uninterrupted by incoming telephone calls and 3.7% (95% CI, 3.4% to 4.0%) interrupted by such calls. During the day shift, the odds ratios (ORs) for medical errors when interrupted by cell phone calls (compared with uninterrupted) were 1.02 (95% CI, 0.92 to 1.13; P = .73) among nurses with six months or more of PICU experience juxtaposed to 1.22 (95% CI, 1.00 to 1.47; P = .046) among nurses with less than six months of experience.
During night shift, the results showed that the ORs for medical errors when interrupted by cell phone calls were 1.35 (95% CI, 1.16 to 1.57; P < .001) among nurses with six months or more of PICU experience and 1.53 (95% CI, 1.16 to 2.03; P = .003) among nurses with less than six months of experience. Moreover, nurses administering medications to one or more patients receiving mechanical ventilation and arterial catheterization while caring for at least one other patient were shown to have an increased risk of making medical errors (OR, 1.21; 95% CI, 1.03-1.42; P = .02). Despite the results showing that incoming calls create errors, the study found no correlation between incoming text messages and medical errors (OR=0.97; 95% CI, 0.92 to 1.02; P = .22).
Fascinating study from @chris_bonafide @adziorny @markmaiwords and others showing interruptive telephone calls associated with nursing med errors. Worse at night and for less experienced nurses. Text messages not temporally associated with errors. https://t.co/lKMws7rt3M
— Evan Orenstein (@evan_orenstein) December 21, 2019
The researchers wrote in their conclusion that: “This study’s findings suggest that, although communication-related interruptions cannot be eliminated, interventions to reduce the frequency and adverse consequences of interruptions should include consideration of time of day, nurse experience, nurse to patient ratio, and level of patient care required.”
https://twitter.com/clin_owl/status/1208114321374502912?s=20
Check this out @sgdambrauskas
"…findings suggest that incoming telephone call interruptions may be temporally associated with medication administration errors among PICU nurses"
via @JAMAPediatricsMobile phone Interruptions & Medication Adm Errors…https://t.co/QJjIcSlqGX
— Ivan D. Florez, MD, MSc, PhD (@IvanD_Florez) December 21, 2019
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