Interruptions to intensive care nurses and clinical errors and procedural failures: A controlled study of causal connection

Objectives. Interruptions occur frequently in the Intensive Care Unit (ICU) and are associated with errors. To date, no causal connection has been established between interruptions and errors in healthcare. It is important to know if interruptions directly cause errors before implementing interventions designed to reduce interruptions in ICUs. Our objective was to investigate whether ICU nurses who receive a higher number of workplace interruptions commit more clinical errors and procedural failures than those who receive a lower number of interruptions. Methods. We conducted a prospective controlled trial in a high -fidelity ICU simulator. A volunteer sample of ICU nurses from a single unit prepare d and administered intravenous medications for a patient manikin. Nurses received either 3 (n=35) or 12 (n=35) scenario - relevant interruptions and were allocated to either condition in an alternating fashion. Primary outcomes were the number of clinica l errors and procedural failures committed by each nurse. Results . The rate ratio of clinical errors committed by nurses who received 12 interruptions compared to nurses who received 3 interruptions was 2.0 (95% CI [1.41, 2.83]), p < .001. The rate ratio of procedural failures committed by nurses who received 12 interruptions compared to nurses who were interrupted 3 times was 1.2 (95% CI [1.05, 1.37]), p = .006. Conclusions. More workplace interruptions during medication preparation and administration le ad to more clinical errors and procedural failures. Reducing the frequency of interruptions may reduce the number of errors committed; however, this should be balanced against important information that interruptions communicat