Taming work interruptions: Rice Hospital departments take steps to reduce interruptions and distractions, increase patient safety
WILLMAR — When someone on the pharmacy staff at Rice Memorial Hospital is verifying a physician order, making up an IV or engaged in some other critical task, a red stop sign taped to the counter sends a can’t-miss message to everyone: This person is involved in a no-talk task and shouldn’t be interrupted.
It’s one of many steps the hospital pharmacy has taken to increase patient safety and reduce the possibility of error.
“It’s reminding each other that there are lives at st ake. It’s why we come to work each day and why we need to be focused,” said Carnie Allex, pharmacy director.
Similar strategies are being adopted in the hospital laboratory, which has a no-interruption zone in the histology section and plans to add more distraction-free areas.Whether it’s a construction site, an office or a hospital, interruptions and distractions are the bane of the 21st-century workplace. Most workers can attest to how interruptions slow them down, hinder their concentration, increase their stress and ultimately allow mistakes to creep into their work, and research has backed this up.But the issue is especially critical in busy health care settings, where a moment of distraction can lead to a disastrous outcome for a patient.In many of the most serious patient safety errors, interruptions or distractions usually play at least some role — for example, a 2008 surgery at a Twin Cities hospital during which a patient had a healthy kidney mistakenly removed. An analysis afterwards of what went wrong concluded that one of the contributing factors was a distracted surgeon.“It’s one thing we ask when we investigate an incident. Was there a distraction when this happened?” Allex said. “It’s rarely a knowledge deficit. They know what the right thing was, but something interrupted them.”Recognizing the potential for errors due to distractions and interruptions, many health care organizations are taking steps to reduce the risk. Although this is a relatively new focus in patient safety and the jury is still out on which interventions are most effective, studies are confirming there’s a benefit to minimizing interruptions.More than a year into the implementation of the Rice Hospital pharmacy’s no-talk initiative, it seems to be successful in helping reduce workplace distractions, Allex said.Even more important, she believes it has led to fewer errors.The pharmacy had an opportunity two years ago to work on safety initiatives with Voluntary Hospitals of America, a national organization that provides hospitals with networking and expertise in areas ranging from purchasing to care innovations.Allex put together a focus group with her staff to talk about potential projects they could undertake.“Through that process, it came out that distractions are a big deal,” she said. “We weren’t always conscious of what a person was doing before we talked to them.”Together the staff developed a list of critical tasks that shouldn’t be interrupted. They looked at processes that held potential for errors that would be especially difficult to catch downstream. They looked at who answered the phone and how messages were conveyed.The result has been a more systematic approach to reducing interruptions during priority tasks.It doesn’t mean there are no interruptions at all, Allex said. “This is a hospital. It’s very difficult to not have distractions in a hospital. This is a place where things are happening urgently.”But it has helped raise the staff’s awareness of when their colleagues shouldn’t be distracted and when a message can be delivered later or handled by someone else, she said. “It’s the simple fact of stopping and thinking about what you’re doing and who you’re interrupting. Even though we’re in a hospital, not everything is urgent.”The laboratory adopted similar measures this year in its histology section, where tissue samples are analyzed. It has been so helpful that no-distraction zones will be implemented in two other sections of the lab as well, said Jason Mayer, laboratory director.The lab is concentrating its efforts in an especially critical area: maintaining specimen identification.“If a sample gets misidentified, it’s a really bad thing,” Mayer said. “You can’t have one error. You need to have 100 percent accuracy.”One of the challenges for the lab was its open design, he said. “Noise can be a problem. Between phone calls and people talking, it’s easy to get distracted.”Staff came up with some inexpensive visual cues — a red sign, a taped area on the floor — to signal that when someone is working in the no-interruption zone, “you can’t talk to them until they talk to you,” Mayer said. “It’s putting the person who’s there in control of the situation.”It has helped the staff recognize the need to work without interruptions and to allow a colleague to work free of interruptions, he said. “Honestly, it’s even helped me.”Efforts to reduce distractions aren’t always easy.It’s a fast-paced world and technology has upped the ante with emails, texting and the expectation of an immediate response, Mayer noted. “I need it now. I need it faster and I don’t want to wait. That plays into the distraction as well.”Allex’s department is small and collegial, and not talking to coworkers “feels unfriendly at times,” she said. “But we’ve become much better at giving each other the OK to say, ‘I can’t answer your question right now’ or ‘Give me a minute to finish this.’ It’s not personal.”The human element remains one of the most difficult and elusive areas to address in patient safety, Allex said. “As long as you have human factors in the process, you have potential for error.”When distractions and interruptions are minimized, however, it can help create an environment that allows people to perform more effectively, she said. “We’re here to not make an error, but if it happens, we want to be able to catch it. This is one piece. It didn’t require any money or equipment to do but it has a great impact.”