Interruption handling strategies during paediatric medication administration.
BACKGROUND
Interruptions are a part of many hospital settings. During medication administration, interruptions have been shown to lead to medication errors. Understanding interruption management strategies during medical management could lead to the design of interventions to reduce and mitigate related errors.


METHODS
Semi-structured interviews with paediatric nurses in an in-patient setting were used to identify types of interruptions, strategies for safe medication administration and interruption management, as well as factors influencing the interruption management strategy choice. Nurses also worked through use cases and provided verbal protocols about their strategies. To confirm and refine a framework for interruption handling, on-the-job observations were also conducted.


RESULTS
Four case studies of medication administration highlight four interruption handling strategies. Three allow the interruption: 1) the primary task is suspended so that the higher priority secondary task may be engaged immediately; 2) multi-task by dividing attention between the primary and secondary tasks; and 3) mediating the interruption with an action that supports resumption of the primary task. The fourth blocks the interruption, keeping attention on the primary task (blocking). Interviews and on-the-job observation suggest that nurses dynamically assess the primary and (interrupting) secondary tasks. They prioritise task execution based on both risk and workflow efficiency assessments. Specific interruption handling depends on both task and experience related factors.


CONCLUSIONS
Paediatric nurses have developed sophisticated strategies to manage interruptions and maintain patient safety and work efficiency during medication administration. To support a more resilient healthcare system, interruption management strategies should be supported through process, task support tools and education.
Division of Neonatology, University of Virginia, Charlottesville, VA 22908, USA. rlc7z@virginia.edu
Lacey
L
Colligan
Ellen J
EJ
Bass
D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000592:standards*; D017598:Efficiency, Organizational; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control*; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D061214:Patient Safety; D010372:Pediatrics / Q000379:methods / Q000458:organization & administration; D010934:Planning Techniques; D013647:Task Performance and Analysis