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Resumption lag: the time taken to re-orient and resume a primary task at the end of an interruption (adapted from 31 ).
Source publication
To examine the effect of interruptions and task complexity on error rates when prescribing with computerized provider order entry (CPOE) systems, and to categorize the types of prescribing errors.
Two within-subject factors: task complexity (complex vs simple) and interruption (interruption vs no interruption). Thirty-two hospital doctors used a CP...
Citations
... Several attempts have been made to conduct observational studies that focus on a speci c department [15,16] or care provider and explore the frequency and effect of interruptions [3,17,18]. Moreover, some studies have just discussed a speci c source of interruption, such as a paging device [14,19], a communication device [20] or electronic medical record [21]. Furthermore, many studies have examined whether there is a relationship between interruptions and multitasking [2,22,23], workloads [1,[24][25][26][27], work quality and e ciency [12,28], work outcomes [29,30] and patient satisfaction [11]. ...
Background: Workflow interruptions are frequent in hospital outpatient clinics. Eventually, not only reducing the work efficiency and quality, but also further threatening patient safety. Over the last 10–15 years, research on workflow interruptions in inpatient care has increased, but there is a lack of research on the interruptions in outpatient clinics. The present study aimed to study the differences in physicians' workflow interruptions among outpatient departments in the tertiary hospital in China.
Methods: In a tertiary hospital, a standardized observational study of 32 doctors' workflow in outpatient department of four typical clinical specialties was conducted. The record of workflow interruptions was based on a self-made observation instrument after verifying its reliability and validity. Linear regression methods were used to assess outpatient characteristics as predictors of the number of interruptions. The Kruskal-Wallis test was used to analyze the difference about the duration of interruptions among specialties, and the Chi-Square Test was used to examine the sources of interruptions among different specialties, to determine whether interruption source is associated with specialty.
Results: The number of patients was the significant independent predictor of the number of interruptions(p<0.001). In terms of work tasks being interrupted, the highest interruption rate occurred when physicians were asking health history: 19.95 interruptions per hour. The distribution of interruption sources among the four clinical specialties were statistically different (Χ² =16.988, p = 0.049).
Conclusion: The findings indicate that physicians' workflow interruptions are connected with many contents in the work system. Further emphasis should be placed on the effective application of hospital management measures in an interrupted environment to promote a safe and efficiency outpatient care.
... MIs are not only the product of inadequate knowledge and misapplication of rules but also of slips, lapses and violations inherently associated with reduced task performance [69][70][71]. Since medication use problems often occur in recurrent error traps [72], introducing human factor interventions and safety measures that aim to re-design workflow, reduce interruptions and multitasking and promote doublechecking and implementation of checklists, protocols or poster prompts may play a role in prevention [73][74][75][76]. Despite the shortcomings of some of these strategies like checklists and double-checking and the sparse empirical evidence to support their use [77][78][79], they are widely accepted and recommended practices in the field of safety science because they are designed to compensate for cognitive deficiencies [80]. ...
Purpose
To identify factors in community pharmacy that facilitate error recovery from medication incidents (MIs) and explore medication safety prevention strategies from the pharmacist perspective.
Methods
Thirty community pharmacies in Sydney, Australia, participated in a 30-month prospective incident reporting program of MIs classified in the Advanced Incident Management System (AIMS) and the analysis triangulated with case studies. The main outcome measures were the relative frequencies and patterns in MI detection, minimisation, restorative actions and prevention recommendations of community pharmacists.
Results
Participants reported 1013 incidents with 831 recovered near misses and 165 purported patient harm. MIs were mainly initiated at the prescribing (68.2%) and dispensing (22.6%) stages, and most were resolved at the pharmacy (76.9%). Detection was efficient within the first 24 h in 54.6% of MIs, but 26.1% required one month or longer; 37.2% occurred after the patient consumed the medicine. The combination of specific actions/attributes (85.5%), appropriate interventions (81.6%) and effective communication (77.7%) minimised MIs. An array of remedial actions were conducted by participants including notification, referral, advice, modification of medication regimen, risk management and documentation corrections. Recommended prevention strategies involved espousal of medication safety culture (97.8%), better application of policies/procedures (84.6%) and improvements in healthcare providers’ education (79.9%).
Conclusion
Incident reporting provided insights on the human and organisational factors involved in the recovery of MIs in community pharmacy. Optimising existing safeguards and redesigning certain structures and processes may enhance the resilience of the medication use system in primary care.
... Enabling prescribers to use free-text instructions to enter orders may lead to inconsistencies between narrative text and structured order information. 78,80,81 For instance, Zhou et al. 82 found that around 17 percent of free-text medication order entries contained misspellings and led to additional errors. ...
The Institute of Medicine estimates that 7,000 lives are lost yearly as a result of medication errors. Computerized physician and/or provider order entry was one of the proposed solutions to overcome this tragic issue. Despite some promising data about its effectiveness, it has been found that computerized provider order entry may facilitate medication errors.
The purpose of this review is to summarize current evidence of computerized provider order entry -related medication errors and address the sociotechnical factors impacting the safe use of computerized provider order entry. By using PubMed and Google Scholar databases, a systematic search was conducted for articles published in English between 2007 and 2019 regarding the unintended consequences of computerized provider order entry and its related medication errors. A total of 288 articles were screened and categorized based on their use within the review. One hundred six articles met our pre-defined inclusion criteria and were read in full, in addition to another 27 articles obtained from references. All included articles were classified into the following categories: rates and statistics on computerized provider order entry -related medication errors, types of computerized provider order entry -related unintended consequences, factors contributing to computerized provider order entry failure, and recommendations based on addressing sociotechnical factors. Identifying major types of computerized provider order entry -related unintended consequences and addressing their causes can help in developing appropriate strategies for safe and effective computerized provider order entry. The interplay between social and technical factors can largely affect its safe implementation and use. This review discusses several factors associated with the unintended consequences of this technology in healthcare settings and presents recommendations for enhancing its effectiveness and safety within the context of sociotechnical factors.
... The potential errors are then reviewed by an independent adjudication committee that uses chart review, expert consultation, and discussion with the clinicians involved, to determine whether an error occurred [1••]. The resulting error rates are similar to those found in inpatient hospital settings (5 to 15%) [26][27][28], critical care settings (9 to 20%) [29,30], and outpatient settings (7 to 12%) [31,32]. ...
Purpose of Review
To describe the incidence and types of perioperative medication errors and adverse medication events, and to provide a summary of strategies to reduce their incidence.
Recent Findings
Between 4 and 11% of perioperative medications administered may involve a medication error. Methods for detecting medication errors include incident reporting, chart review, direct observation (which is the most sensitive) and engineering modeling techniques. While a paucity of evidence exists to support recommendations to prevent medication errors, consensus recommendations involve process standardization, technology solutions, pharmacy solutions, and fostering an institutional culture of safety.
Summary
While medication errors in the operating room are common, they are difficult to identify and measure. Most recommendations to prevent them are based on expert consensus. Future research should focus on randomized controlled trials to test whether the recommended strategies prevent medication errors.
... Currently, many physicians use CPOE systems in their daily routine health care, and the acceptance of this system, as well as the EHR, is increasing worldwide. In general, using CPOE has reduced the prescription errors (12,13), increased the safety of data processing, ensured availability of meaningful data in all sections, and provided clinical support decisions to poor patients, while receiving complex medical and pharmaceutical services (12). But the positive effect of these systems on the disease process and the results of the patient's treatment is not well known, and unfortunately, this efficiency does not always occur (14). ...
... Currently, many physicians use CPOE systems in their daily routine health care, and the acceptance of this system, as well as the EHR, is increasing worldwide. In general, using CPOE has reduced the prescription errors (12,13), increased the safety of data processing, ensured availability of meaningful data in all sections, and provided clinical support decisions to poor patients, while receiving complex medical and pharmaceutical services (12). But the positive effect of these systems on the disease process and the results of the patient's treatment is not well known, and unfortunately, this efficiency does not always occur (14). ...
... The organization's policy in implementing technology should provide users with the conditions of execution and readiness to assure them that the newly employed technology will increase the productivity of the organization. In some cases, after the use of CPOE, medical errors have increased, or despite the elimination of paper errors, new forms of errors have observed (12). If the necessary training is provided to learn technology, the acceptance of technology is measured and then stepped up to increase its acceptance, the level of errors will decrease, and thus the productivity of the technology will increase. ...
Background: Currently, many physicians use the computerized physician order entry (CPOE) system, and the adoption of this system is increasing worldwide. The technology acceptance model has been implemented and evaluated. It has become one of the most recognized empirical models. Besides, recent studies showed that this model well anticipates users’ behavioral tendencies in accepting technology in healthcare centers. The use of the technology acceptance model in the implementation of health care systems such as CPOE, which is effective in reducing medical errors, is necessary. Objectives: This applied research has used a descriptive-analytical approach. In the current study the technology acceptance model in Iranian health care centers, which was proposed by Safdari and colleagues aimed to investigate the attitudes of clinical staff toward the computerized physician orders entry system, was used in the Cardiac Care Unit of Alzahra’s Heart Hospital in Shiraz to determine the importance and effectiveness of each dimension on attitudes toward using CPOE by 140 of physicians and nurses. Methods: Three main dimensions, including human, monitoring-management, and organizational strategies factors, were evaluated using a researcher-made questionnaire. Data were analyzed by SPSS version 25 using the descriptive and analytical statistics (i.e., Pearson correlation test and t-test). Results: The results showed that organizational strategies dimension with an average of 3.85 (out of 5) had the highest users’ attention, followed by monitoring-management and human dimensions. The overall average of all dimensions was 3.78. All dimensions had a positive and direct effect on the attitudes toward using the CPOE. Demographic characteristics did not have a meaningful relationship with any dimensions. Conclusions: Finally, the average above 3 in the mean of the total dimensions, as well as each dimension, shows views of the users are appropriate to using the CPOE., the views of the users are appropriated toward using CPOE. It should be noted that the difference in the dimension means is a small amount. The centered focus on organizational strategies with the highest average should not cause to neglect other dimensions.
... Fourth, Hodgetts and Jones (2006b) revealed that more complex interrupting tasks increased the time taken to retrieve initial goals. Fifth, Magrabi, Li, Day, and Coiera (2010) found that complex primary tasks are more difficult to resume when interrupted compared to simple primary tasks. Sixth, Grundgeiger et al. (2013) found that a lack of visual cues resulted in worse prospective memory performance following an interruption. ...
... d (Hodgetts & Jones, 2006b). e (Magrabi et al., 2010). ...
... d (Hodgetts & Jones, 2006b). e (Magrabi et al., 2010). f (Grundgeiger et al., 2013). ...
In this paper we describe the risks of complex applied research, especially in work domains where professional practitioners are scarce. For such research, careful preparation and piloting is needed, especially when estimating sample size is required for a full study. However, such pilot work may reduce the potential sample size for the full study. We describe how the these issues have been addressed in applied psychology contexts. We then present a case study illustrating how we determined sample size for a study investigating the impact of workplace interruptions on errors that intensive care unit nurses might make during medication preparation and administration. The pilot work was performed in a functionally related domain to nursing-bartending-and bartender participants filled cocktail orders. Pilot 1 investigated performance with 0 interruptions and applied a model from a field observation to estimate probable effect sizes and sample sizes with 1 or 4 interruptions per medication scenario. Pilot 2 collected empirical data on the effect of 1 or 4 interruptions per cocktail scenario on cocktail errors and estimated sample size for the medication study, which was subsequently successfully run. The applied community could benefit from further discussions about these issues and the means for addressing them. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... Fewer studies examined how characteristics of the primary task affected RL (see also Iqbal & Bailey, 2005). In one study, healthcare providers were interrupted while they entered patient and medication information into a computerized provider order entry (CPOE) system (Magrabi, Li, Day, & Coiera, 2010). A complex CPOE primary task led to longer RLs than a simple CPOE task, indicating that complex primary tasks require more time to resume after an interruption than simple primary tasks. ...
We compared time-to-collision (TTC) judgments between automated and manual driving to determine whether automation affected only responses (i.e., braking) or also affected visual perception (i.e., TTC estimation). Automation presumably frees cognitive resources because drivers do not have to control the vehicle. Those resources may be reallocated to processing visual information (e.g., optic flow) relevant for judgments of TTC. With a driving simulator, participants completed drives using manual or automated driving and responded to a rapidly decelerating vehicle using either the brake pedal or a button on the steering wheel (TTC judgment). They also completed a cognitive secondary task during half of the drives. Results suggest that automation can affect perceptual judgments (e.g., TTC estimation) in addition to driving responses (e.g., braking). TTC judgments were more accurate, and brake reaction times were faster, during automated driving than manual driving. This occurred even while performing a cognitively demanding secondary task, suggesting that participants used resources freed by automation to process visual information relevant to TTC judgments rather than complete non-driving tasks. TTC judgments were more accurate during automated driving than manual driving, presumably because automation freed up cognitive resources, allowing participants to assign those resources to processing of visual information (e.g., optic flow) relevant to judgments about collisions. To realize the safety benefit suggested by the results, automated systems should be designed so that cognitive resources freed by automation are assigned to information relevant to the driving task and not to non-driving tasks.
... This is consistent with another controlled experiment, where interruptions did not affect electronic prescribing tasks. 13 A previous observational study on the impact of interruptions on ED physicians' task time showed a reduction in task time following interruptions, possibly because physicians hurry to complete tasks after being interrupted when they are under time pressure. 14 Our results suggest that documentation tasks might not be easily time compressed, and that interruption penalties might therefore be incurred with other tasks associated with patient care. ...
Objective:
To compare the efficiency and safety of using speech recognition (SR) assisted clinical documentation within an electronic health record (EHR) system with use of keyboard and mouse (KBM).
Methods:
Thirty-five emergency department clinicians undertook randomly allocated clinical documentation tasks using KBM or SR on a commercial EHR system. Tasks were simple or complex, and with or without interruption. Outcome measures included task completion times and observed errors. Errors were classed by their potential for patient harm. Error causes were classified as due to IT system/system integration, user interaction, comprehension, or as typographical. User-related errors could be by either omission or commission.
Results:
Mean task completion times were 18.11% slower overall when using SR compared to KBM (P = .001), 16.95% slower for simple tasks (P = .050), and 18.40% slower for complex tasks (P = .009). Increased errors were observed with use of SR (KBM 32, SR 138) for both simple (KBM 9, SR 75; P < 0.001) and complex (KBM 23, SR 63; P < 0.001) tasks. Interruptions did not significantly affect task completion times or error rates for either modality.
Discussion:
For clinical documentation, SR was slower and increased the risk of documentation errors, including errors with the potential to cause clinical harm compared to KBM. Some of the observed increase in errors may be due to suboptimal SR to EHR integration and workflow.
Conclusion:
Use of SR to drive interactive clinical documentation in the EHR requires careful evaluation. Current generation implementations may require significant development before they are safe and effective. Improving system integration and workflow, as well as SR accuracy and user-focused error correction strategies, may improve SR performance.
... Medication errors have been highlighted as an important contributor to patient harm, and error rates range from 5% to 20%, depending on the patient care area. [1][2][3][4][5][6][7][8][9][10][11] When harm is caused by a medication, it is called an adverse drug event (ADE), regardless of whether the harm is preventable. ADEs associated with errors are considered preventable ADEs. ...
Objective:
To define the types and numbers of inpatient clinical decision support alerts, measure the frequency with which they are overridden, and describe providers' reasons for overriding them and the appropriateness of those reasons.
Materials and methods:
We conducted a cross-sectional study of medication-related clinical decision support alerts over a 3-year period at a 793-bed tertiary-care teaching institution. We measured the rate of alert overrides, the rate of overrides by alert type, the reasons cited for overrides, and the appropriateness of those reasons.
Results:
Overall, 73.3% of patient allergy, drug-drug interaction, and duplicate drug alerts were overridden, though the rate of overrides varied by alert type (P < .0001). About 60% of overrides were appropriate, and that proportion also varied by alert type (P < .0001). Few overrides of renal- (2.2%) or age-based (26.4%) medication substitutions were appropriate, while most duplicate drug (98%), patient allergy (96.5%), and formulary substitution (82.5%) alerts were appropriate.
Discussion:
Despite warnings of potential significant harm, certain categories of alert overrides were inappropriate >75% of the time. The vast majority of duplicate drug, patient allergy, and formulary substitution alerts were appropriate, suggesting that these categories of alerts might be good targets for refinement to reduce alert fatigue.
Conclusion:
Almost three-quarters of alerts were overridden, and 40% of the overrides were not appropriate. Future research should optimize alert types and frequencies to increase their clinical relevance, reducing alert fatigue so that important alerts are not inappropriately overridden.
... The literature on human factors in healthcare has explored the potential relationships between cognitive job demands and safety, in terms of workers', patients' and organizational outcomes (Gaba et al. 2002, Landrigan et al. 2004, Rogers et al. 2004, Needleman et al. 2011, Stone et al. 2008, Gurses et al. 2009, Carayon et al. 2005, 2008, Costa 2003, Magrabi et al. 2010, Li et al. 2012, Shouded et al. 2012. More recently, this literature has focused on specific risks related to interruptions and multitasking, reporting their pervasive extent and potentially disruptive effects in the clinical environments (Coiera, 2012). ...
The aim of this study was to obtain baseline data on doctors’ and nurses’ work activities and rates of interruptions and multi-tasking to improve work organization and processes. Data were collected in six surgical units with the WOMBAT (Work Observation Method by Activity Timing) tool. Results show that doctors and nurses received approximately 13 interruptions per hour, or one interruption every 4.5 minutes. Compared to doctors, nurses were more prone to interruptions in most activities, while doctors performed multitasking (33.47% of their time, 95% CI 31.84%-35.17%) more than nurses (15.23%, 95% CI 14.24%-16.25%). Overall, the time dedicated to patient care is relatively limited for both professions (37.21%, 95%CI 34.95%-39.60% for doctors, 27.22%, 95% CI 25.18%-29.60% for nurses) compared to the time spent for registration of data and professional communication, that accounts for two thirds of doctors’ time and nearly half of nurses’ time. Further investigation is needed on strategies to manage job demands and professional communications.
Practitioner summary
This study offers further findings on the characteristics and frequency of multitasking and interruptions in surgery, with a comparison of how they affect doctors and nurses. Further investigation is needed to improve the management of job demands and communications according to the results.